Journal of Cancer Survivorship最新文献

Purpose: Perceived cancer-related cognitive impairment (CRCI) has been reported in prostate cancer survivors. Little is known about how CRCI impacts occupational functioning in working-aged prostate cancer survivors (PCS). This study aimed to investigate the association between CRCI and occupational functioning in PCS.

Methods: Data from 51 PCS, who were employed at the time of diagnosis, undergoing hormonal treatments (e.g., androgen deprivation therapy) or 'watchful waiting'/ 'active surveillance', were analysed. An online survey assessed CRCI using the FACT-Cog Perceived Cognitive Impairments (PCI20) subscale, the EORTC-QLQ-30 two-item cognitive functioning scale, and a single 'Yes/No' CRCI item (i.e., were 'changes in thinking (e.g., memory, attention)' experienced as a treatment side effect). PCS also indicated 'Yes/No' to changes to their ability to work, performance of work duties, and decreased work hours. Logistic regression analyses examined the relationship between CRCI measures and occupational outcomes.

Results: Of the 51 PCS, 19 (37%) endorsed experiencing cognitive side effects from treatment. The single 'Yes/No' CRCI question was significantly associated with perceived changes in work ability and ability to perform work duties at the same level. PCI20 and the EORTC-QLQ-30 cognitive functioning scale were not significantly associated with any occupational outcomes.

Conclusion: Perceived CRCI is associated with adverse changes to occupational functioning and is important to consider when PCS are making plans to return-to-work following treatment.

Implications for cancer survivors: Prostate cancer survivors may experience cognitive changes, which may impact their work ability.

Purpose: This feasibility study estimated accrual, retention, adherence, and summarized preliminary efficacy data from a stepped-care telehealth intervention for cancer survivors with moderate or severe levels of anxiety and/or depressive symptoms.

Methods: Participants were randomized to intervention or enhanced usual care (stratified by symptom severity). In the intervention group, those with moderate symptoms received a cognitive-behavioral therapy (CBT) workbook/6 bi-weekly check-in calls (low intensity) and severe symptoms received the workbook/12 weekly therapy sessions (high intensity). Depression, anxiety, insomnia, fatigue, quality of life (QOL), fear of recurrence, and cancer-related distress were assessed pre- and post-intervention.

Results: Participants (N = 68; ages 36-82; 88% White) were randomized to telehealth (n = 34) or enhanced usual care (EUC, n = 34), stratified by symptoms (moderate, n = 38; severe, n = 30). Accrual was 1.8/month with 88% retention and > 75% adherence. For those with moderate symptoms, the low-intensity intervention was associated with better cancer-related distress post-intervention but worse fatigue, insomnia, and physical QOL and and minimal differences for anxiety, depression, fear of recurrence, and mental QOL compared with EUC using clinically meaningful values to assess differences. For those with severe symptoms, the high-intensity intervention was associated with better fatigue, fear of recurrence, cancer-related distress, and physical/mental QOL.

Conclusions: Accrual to a stepped-care telehealth intervention for distressed cancer survivors was lower than expected, but retention and adherence were strong. Data suggest potential impact of the high-intensity intervention.

Implications for cancer survivors: A telephone-based CBT intervention where cancer survivors worked with a therapist yielded improvements in fatigue, fear of recurrence, distress, and quality of life.

Purpose: Patients with rare cancer often experience diagnostic delays and limited treatment options, potentially negatively impacting their working lives. We explored whether those with rare vs. common cancer have an increased risk of loss of contractual employment (1) up to 2 years pre-diagnosis, (2) up to 5 years post-diagnosis, and (3) which characteristics of rare cancer survivors are associated with loss of contractual employment 5 years post-diagnosis.

Methods: Data from the Netherlands Cancer Registry and Statistics Netherlands were linked. Demographic, work-related, and cancer-related characteristics were obtained of 16,203 patients with rare cancer and 23,295 unmatched patients with common breast or colorectal cancer. Transitions in primary source of income were explored from contractual employment to work disability, unemployment, social welfare, (early) retirement, or self-employment. Logistic regression and competing risk survival analyses were applied.

Results: Employees with rare vs. common cancer had increased odds of becoming work-disabled pre-diagnosis (OR = 1.83, 95%CI 1.30-2.58) and of becoming self-employed post-diagnosis (HR = 1.32, 95%CI 1.03-1.68). Younger age and having a temporary employment contract were associated with becoming self-employed among those with rare cancers.

Conclusions: Employees with rare vs. common cancer have an increased risk of loss of contractual employment pre- and post-diagnosis.

Implications for cancer survivors: To reduce the risk of adverse work outcomes pre- and post-diagnosis, awareness and knowledge of rare cancers need to be increased to shorten time to diagnosis and accelerate access to adequate care.

Purpose: The aim of this study was to develop and refine Cardiovascular Health Equity through Food (CHEF), an intervention to address food insecurity (FI) in early childhood cancer survivors (CCS).

Methods: Single-center mixed-methods pilot study of a novel "food is medicine" intervention evaluating acceptability, satisfaction, and opportunities for refinement. CHEF participants were provided: (1) meal-kit delivery for 3 household meals/week for 3 months and (2) application assistance for federal nutrition benefits. Eligible participants were CCS < 1 year from cancer therapy completion, with self-reported FI or household income < 200% federal poverty level. Acceptability was defined as > 75% consent to participation, < 25% attrition, and > 75% program-component utilization. Surveys were completed at baseline and end-intervention, and semi-structured interviews were completed at months 1, 2, and 4.

Results: Ten families (100%) consented to participation, with 0% attrition. Ninety-seven percent of meal kits were successfully received and > 90% cooked. Four families utilized study-team assistance in navigating benefits participation. One hundred percent of families would participate again, and 80% would recommend to others. Qualitative feedback supported CHEF's timing following treatment and positive impact on family cooking engagement. Broader non-English language accessibility, formalized benefits counseling, and extended duration were identified as refinement opportunities.

Conclusion: CHEF was highly acceptable among CCS in early survivorship. The next steps include proof-of-concept evaluation of the refined intervention's impact on cardiovascular-relevant outcomes among CCS with FI.

Implications for cancer survivors: Interventions directly addressing food insecurity, a known cardiovascular risk factor, have the potential to support well-being and address health disparities among childhood cancer survivors.

Purpose: This study aimed to evaluate the prevalence and predictors of frailty and the association between frailty and neurocognitive impairments among Chinese survivors of childhood cancer.

Methods: A total of 185 survivors of childhood cancer were recruited from a long-term follow-up clinic in Hong Kong (response rate: 94.4%; 48.1% female; mean age 28.9 years, standard deviation = 6.7 years). Frailty was assessed using the Fried frailty criteria. Neurocognitive outcomes were evaluated using a performance-based test. Multivariable logistic regression was used to identify the predictors of frailty. Multivariable generalized linear models were used to explore the associations between frailty and cognitive outcomes.

Results: The proportions of survivors with frailty and pre-frailty were 22.7% and 27.0%, respectively. "Frail" survivors were more likely to be diagnosed with cancer at a younger age (odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.87-0.99, P = 0.041) and to have coexisting chronic health conditions (OR = 4.63, 95% CI: 1.68-12.80, P = 0.003) than "non-frail" and "pre-frail" survivors. Survivors with frailty exhibited worse attention detectability (unstandardized point estimate [Est] = 4.57, standard error [SE] = 1.69, P = 0.007), omissions (Est = 3.68, SE = 1.15, P = 0.001), and cognitive flexibility (Est = 8.08, SE = 3.08, P = 0.009) than "non-frail" and "pre-frail" survivors.

Conclusions: More than one fifth of the participating Chinese survivors of childhood cancer were identified as phenotypically frail. Frailty was associated with worse performance in attention and executive function.

Implications for cancer survivors: The findings highlight the needs for regular monitoring and early interventions that can modify the aging pathway in the cancer continuum, to mitigate frailty and improve psychosocial outcomes during long-term cancer survivorship.

Purpose: Up to 74% of breast cancer survivors (BCS) treated with aromatase inhibitor (AI) experience AI-induced musculoskeletal symptoms (AIMSS). AIMSS is the predominant cause of poor adherence to AI therapy, yet no definitive treatment exists. The primary research objectives of this study were (1) to develop a novel BCS-specific complex intervention to alleviate AIMSS, and to assess its feasibility. The secondary research objective was (2) to assess the preliminary efficacy of this intervention.

Methods: A single-arm, longitudinal pilot study was conducted involving 15 BCS with AIMSS. The complex intervention, which included pain science education, patient-led goal setting, and self-management strategies, was administered over 3 months. Feasibility was assessed by measuring overall participation, treatment completion rates, and satisfaction after 3 months of intervention. Additionally, the preliminary efficacy of the intervention was evaluated using a mixed model repeated measures analysis, with the change in pain intensity (brief pain inventory [BPI] worst pain/stiffness intensity) at 3 months as the primary endpoint.

Results: The feasibility assessment showed promising results, with a 70.7% participation rate, an 83.3% intervention completion rate, and a satisfaction score of 8.2 ± 1.5. The intervention significantly reduced BPI worst pain/stiffness intensity by 2.78 points after 3 months (95% CI, - 4.5 to - 0.87, p < 0.01). Secondary outcomes demonstrated significant improvements in disability, quality of life, and pain catastrophizing (p < 0.05).

Conclusion: The novel complex intervention appears valuable for management AIMSS in BCS. Future large-scale studies, including randomized controlled trials, are warranted.

Trial registration: The study was registered in the Clinical Trials Registry of the University Hospital Medical Information Network (UMIN-CTR: UMIN 000049035) in October 2022.

Implications for cancer survivors: The novel BCS-specific complex intervention program holds the potential to aid in managing AIMSS, improving adherence to AI therapy, and enhancing their quality of life.

Purpose: This register-based study investigates the probability of a livebirth after cancer during the female reproductive age.

Methods: The study population, derived from the DANAC II cohort, included women aged 18-39 diagnosed with cancer between 1978 and 2016, matched with 60 undiagnosed women each from the general population. Primary outcome was a livebirth after cancer with follow-up until death, emigration, or end of follow-up. Hazard ratios (HR) were calculated using multivariable Cox regression analyses.

Results: The population included 21,596 women with cancer and 1,295,760 without. The 20-year cumulative incidence of livebirth after cancer/study entry was lower among women with cancer (0.22 [95% CI 0.22-0.22]) compared to those without (0.34 [95% CI 0.34-0.34]). The HR of a livebirth after cancer was 0.61 [95% CI 0.59-0.63]; highest at age 18-25 (HR = 0.72 [95% CI 0.68-0.76]); and lowest at age 33-39 (HR = 0.50 [95% CI 0.47-0.54]). Nullipara women had higher HR of a livebirth than those with children (HR = 0.72 [95% CI 0.69-0.75] vs. HR = 0.48 [95% CI 0.46-0.51]). HR was lowest for women with breast, gynecological, central-nerve-system cancer, and leukemia. Women with/without cancer were comparable in assisted reproductive technology initiation after cancer/study entry, but HR was higher among nullipara than in those with prior children.

Conclusions: Cancer during reproductive years significantly and negatively impacts HR of a livebirth after cancer, particularly as age at diagnosis increases. Low HR of livebirth is observed in specific cancer groups.

Implications for cancer survivors: Results underscore the importance of oncofertility counseling at diagnosis, referral to fertility specialist before treatment, and follow-up after cancer, focusing on cancer type, parity status, and age at diagnosis.

Purpose: Survival for childhood Acute Lymphoblastic Leukaemia (ALL) has surpassed 90%, making quality of survival an important endpoint in treatment outcomes. This study examined health-related quality of life (HRQoL) trajectories in early survivorship for patients post-ALL treatment compared with a matched group of healthy peers, and explored the association of individual factors (age, sex) and treatment intensity with HRQoL outcomes.

Methods: Eighty-three paediatric patients aged 4-16 years who recently completed treatment for ALL were recruited to the study, alongside 53 age- and sex-matched healthy children. All participants completed the self-report Pediatric Quality of Life Inventory (PedsQL) generic score scale at 3-, 15- and 27-months post-study enrolment.

Results: Trajectory of overall HRQoL for the patient group declined over time, falling below clinical cutoffs at 27 months. Subscale trajectories differed between groups, with patients' emotional and social functioning negatively diverging relative to healthy peers, while school functioning remained consistently reduced. Children treated for ALL experienced significantly poorer HRQoL compared to healthy peers at 27 months post-treatment (p = 0.027, ES = - 0.47) with moderate effect sizes, reflecting lower social functioning (p = 0.044, ES = - 0.42) and school functioning (p = 0.011, ES = - 0.52). Age and sex were not associated with overall HRQoL at 27 months; however, younger age was associated with reduced emotional functioning in the standard treatment-intensity group.

Conclusion and implications: HRQoL is impaired in children treated for ALL in early survivorship, particularly across social and school functioning domains. Screening using patient-reported outcomes is reliable at identifying young people at risk and has potential to guide psychosocial interventions in this early off-treatment period.

Purpose: The Healthy Hearts pilot study evaluated the effect of an eHealth motivational interviewing-framed intervention on cardiomyopathy screening-related knowledge, health beliefs, intrinsic motivation, and behavioral action steps among adult survivors of childhood cancer.

Methods: We consented N = 73 survivors to participate in a single-arm pilot study. Participants completed an online baseline survey (n = 68) assessing knowledge, health beliefs, and intrinsic motivation related to cancer therapy-induced cardiomyopathy and screening echocardiograms. Then, they engaged in two sessions with a fully automated web-based health intervention platform based on motivational interviewing techniques to build motivation. Participants completed an online post-intervention survey (n = 61) re-assessing knowledge, health beliefs, and intrinsic motivation and a 1-month follow-up survey (n = 59) assessing actions taken toward obtaining an echocardiogram and intervention satisfaction.

Results: Participant age averaged 40.5 years (SD = 7.2). Most self-identified as women (n = 42) and non-Hispanic white (n = 62). Paired t-tests revealed statistically significant pre-post changes in several health beliefs and elements of intrinsic motivation. Specifically, we observed decreases in perceived barriers (p < .001) and increases in knowledge (p < .001), perceived benefits (p < .001), self-efficacy (p < .001), perceived importance (p = .001), confidence (p = .02), and intentions (p < .001). By 1-month follow-up, 38.6% of participants had engaged in behavioral action steps (e.g., set echocardiogram appointment). Intervention satisfaction was moderately high (M = 3.9, SD = 0.9, median = 4, min = 2, max = 5).

Conclusions: Results provide preliminary indications of efficacy of the eHealth motivational interviewing-framed intervention on uptake of screening echocardiograms among adult survivors of childhood cancer.

Implications for cancer survivors: An eHealth motivational interviewing-framed intervention could increase childhood cancer survivors' ability to receive high-quality support for engaging in cardiomyopathy screening.

Purpose: This paper estimated overall, by sex, and by race and ethnicity walking behaviors in the cancer survivor population, where prevalence is not known, compared to those without cancer.

Methods: Data from the 2015 and 2020 National Health Interview Survey (n = 54,542) were used to estimate walking behaviors. Multivariable logistic regression models estimated walking behavior prevalence with predictive margins and volume of weekly minutes overall and stratified by sex and race/ethnicity. Walking behaviors for breast and prostate cancer survivors were also examined.

Results: There were no significant differences in adjusted prevalence for walking behaviors overall or by race/ethnicity for women. However, there were significant differences for men, with cancer survivors' any reported walking at 62.6% (95% CI: 60.1, 65.4) compared to men without cancer, 65.9% (95% CI: 65.1%, 66.8%) (p = 0.02). There was also a difference in transportation only walking for men, with cancer survivors reporting 6.8% (95% CI: 5.5%, 8.2%), compared to men without cancer, 9.1% (8.5%, 9.6%) (p = 0.008); a similar pattern was observed for transportation walking for non-Hispanic white men. There were no differences in walking prevalence among breast cancer survivors, but overall prostate cancer survivors reported less walking for both purposes as did non-Hispanic white survivors. Leisure walking volume for cancer survivors, both women and men, was higher than for those without cancer. Median leisure walking minutes for non-Hispanic white women, 120 min (95% CI: 120, 140) was higher than those without cancer, 105 min (95% CI: 105, 120) (p = 0.002). Median leisure walking minutes for non-Hispanic white men, 120 min (95% CI: 120, 140), was higher than those without cancer, 100 min (95% CI: 100, 105) (p = 0.001).

Conclusions: Overall, there are no significant differences in walking prevalence for women, but men cancer survivors reported less overall walking, walking for transportation, or walking for both purposes. However, volume of leisure walking was higher for cancer survivors compared to those without cancer.

Implications for cancer survivors: For cancer survivors, this suggests that even though prevalence of leisure walking was similar, volume of weekly minutes was higher compared to those without cancer. This suggests that for cancer survivors, leisure walking is an accessible and important source of physical activity.