Journal of Cancer Survivorship最新文献

Purpose: Few studies assess how well the Theory of Planned Behavior (TPB) predicts physical activity over time after a breast cancer diagnosis. This study evaluated TPB's prediction, measured at diagnosis, on women's physical activity 1 year later.

Methods: The Alberta Moving Beyond Breast Cancer (AMBER) study follows women recently diagnosed with breast cancer (n = 1528; average age 55.4). Participants completed questionnaires on TPB variables about recreational activity shortly after diagnosis. At 1 year, actiGraph GT3X+® devices measured light and moderate-vigorous activity, and self-reported activity over the past year was assessed with the Past Year Total Physical Activity Questionnaire. Structural equation models evaluated TPB variables' ability to predict physical activity after 1 year.

Results: At diagnosis, positive attitudes (β = 0.51; p < 0.001) and greater perceived behavioral control (β = 0.16; p < 0.001) were associated with greater intentions for physical activity derived from device-measured (R² = 0.51, p < 0.001) and self-reported questionnaire (R² = 0.54, p < 0.001). The TPB at diagnosis was associated with greater device-measured MVPA at 1 year (β = 0.13; p < 0.01). The TPB was not associated with device-measured light-intensity physical activity (β = 0.07; p = 0.08) or self-reported recreational physical activity (β = 0.08; p = 0.07).

Conclusion: The variance explained by the TPB for physical activity at 1 year after breast cancer diagnosis was minimal. These findings highlight the need to identify additional factors influencing intentions and long-term activity.

Implications for cancer survivors: Incorporating behavior change strategies that influence attitudes toward physical activity may positively impact intentions at diagnosis. To ensure long-term activity among breast cancer survivors, supportive care should include interventions addressing factors beyond initial intentions.

Background: Survivorship Care Plans (SCPs) support the transition from active cancer treatment to long-term survivorship. The POSTHOC mobile application (app) was developed to digitize the SCP, improving accessibility, modifiability, longevity, and usefulness, while promoting adherence to diet and physical activity recommendations. This study tested the feasibility, acceptability, and usability of the POSTHOC app and its effect on global symptom burden compared to a traditional SCP among recent cancer survivors.

Methods: In a phase I/II randomized controlled trial, cancer survivors within 12 weeks of curative treatment were recruited. Participants were randomized 2:1 POSTHOC:usual care. The POSTHOC arm had full use of the app for 12 weeks, while the usual care arm received a static SCP. Outcomes were assessed at baseline, 6 weeks, and 12 weeks, which included symptom burden (MD Anderson Symptom Inventory), diet (ASA24, 24-h recall), and physical activity (Fitbit). Acceptability (custom usefulness scale) and usability (System Usability Scale, range 0-100) were assessed within the POSTHOC arm at weeks 6 and 12. Mixed models tested SCP effects on outcomes. At week 12, participants also reflected on patient-provider communication regarding healthy lifestyle behaviors.

Results: Fifty-one participants consented, 41 participants (80%) successfully downloaded the app, and 34 were randomized. In the POSTHOC group, 48% (95% CI: 28-68%) and 52% (95% CI: 32-72%) recorded symptoms and/or diet in the app at weeks 6 and 12, respectively, which was below the a priori 75% usage hypothesis. POSTHOC participants reported moderate usefulness of the app at week 6 (mean ± SD = 3.5 ± 2.2) and week 12 (4.3 ± 2.4). In regard to usability, POSTHOC participants rated the app 62.7 ± 21.1 at week 6 and 65.7 ± 18.1 at week 12, which is slightly below "average" in industry standards. In regard to exploratory symptom outcomes, the POSTHOC group showed a greater reduction in symptom burden than controls at week 12 [b = 3.40 (95% CI: 0.51‒6.28), p = 0.022, ES = 0.36]. Improvements were also observed at week 12 for memory problems [b = 0.42 (95% CI: 0.03‒0.82), p = 0.034; ES = 0.30] and symptom interference with walking [b = 0.47 (95% CI: 0.05‒0.90), p = 0.030; ES = 0.45]. On average, participants desired more communication about healthy behaviors, reporting dissatisfaction with these conversations on average [2.6 (95% CI 1.5‒3.8), range 1-5].

Conclusions: POSTHOC is a partially feasible digital SCP with moderate usability and potential to reduce symptom burden in cancer survivors, supporting mobile health approaches to survivorship care. Future studies should explore the effects of a mobile SCP on symptom outcomes as a primary outcome.

Trial registration: ClinicalTrials.gov: NCT05499663.

Purpose: Virtual Reality (VR)-based interventions emerge as promising tools for symptom management among cancer survivors receiving active treatments. Evidence from previous systematic reviews and meta-analyses is limited by small numbers of studies and lack of sub-group analyses. The purpose of this review was to evaluate the effectiveness of VR/AR/MR interventions on symptom management for cancer survivors receiving active treatments.

Methods: Five electronic databases were searched up to March 2025. A meta-analysis was conducted. Sub-group analyses for age, treatment type, cancer type, VR type (immersive or non-immersive), lengths of interventions, scene type, and interaction methods were evaluated.

Results: Twenty-seven unique randomized controlled trials (RCTs) were included. In total, 62 effect sizes for eight symptom outcomes, including fatigue, pain, anxiety, depression, nausea, distress, confusion, and dyspnea, were computed. Meta-analyses showed that the effects of VR interventions were significant on fatigue (n = 12, SMD-0.9494 [- 1.5083, -0.3904]), pain (n = 13, SMD-0.7426 [-1.2694, -0.2158]), and anxiety (n = 16, SMD-1.8063 [-3.0549, -0.5576]). In our sensitivity test, the effect of VR on depression was also significant (n = 8, SMD-0.3682 [-0.5774, -0.1589]). No significant effect was found for outcomes of nausea, distress, confusion, and dyspnea.

Conclusions: VR interventions showed efficacy in decreasing fatigue, pain, and anxiety among individuals with cancer receiving active treatment.

Implications for cancer survivors: As the VR interventions demonstrated differential effects across subgroups defined by age, cancer type, treatment type, and their unique VR features, tailored intervention designs are needed to address the specific needs of each patient group.

Purpose: A minority of childhood cancer survivors (CCS) receive post-therapy survivorship surveillance at their oncology center (OC) within 5 years of diagnosis. Primary care providers (PCPs) could be a promising alternative. We determined CCS' preferences for the site of surveillance, associated factors, and rationale.

Methods: CCS diagnosed with cancer at < 21 years at one of four participating hospitals, 2-4 years post-therapy, and English- or Spanish-speaking (or their caregivers if CCS < 18 years) indicated their preference and reasons for site of survivorship surveillance (OC vs. PCP vs. no preference) at baseline prior to randomization into the BRIDGES trial (NCT05448560). Multivariable logistic regression models estimated prevalence ratios for site preference and examined associations with patient characteristics. Qualitative methods examined reasons for preference.

Results: Of 235 participants, 92% (n = 214; 48% female, 36% Hispanic, 46% public insurance, median age 12 years at enrollment) indicated their preference. The majority (63%) were amenable to PCP-based surveillance (21% preferred PCP, 42% no preference). Preference for OC was associated with identifying as non-Hispanic "other" (Black, Asian, multi-racial) vs. non-Hispanic White (PR 4.7, p = 0.005, 95% CI 1.68, 13.84) and older age (PR 1.1/year, p = 0.02, 95% CI 1.01, 1.15), but not insurance or area-level social determinants of health (SDoH) indices. Reasons for preference comprised two themes: practical (facts, logistics) and psychological (emotions, beliefs). OCs were preferred for psychological reasons (46/60; 77%); PCPs were preferred for practical reasons (25/35; 74%).

Conclusions: Among diverse CCS, most were amenable to PCP-based survivorship surveillance, independent of SDoH factors.

Implications for cancer survivors: Survivorship surveillance by PCPs may be a useful alternative for CCS.

Purpose: This systematic review aims to synthesize randomized controlled trials (RCTs) evaluating the effectiveness and safety of virtual reality-based exercise rehabilitation (VRER) in adult cancer survivors.

Methods: Following PRISMA 2020, PubMed, Scopus, Web of Science, and Cochrane Library were searched up to November 2024. Only RCTs of VR-based exercise in adult patients with cancer were included. Risk of bias was assessed using the Cochrane ROB2 tool. Outcomes were narratively synthesized across strength/range of motion, functional status, quality of life, physical performance, and adverse events.

Results: Eight RCTs involving 359 participants with breast, prostate, brain, or combined cancer types were included. VRER increased shoulder mobility and reduced fear of movement compared with usual care. Functional status, specifically activities of daily living, showed consistent improvement. Physical performance including better balance, endurance, and activity level improved. Three trials reported quality-of-life advantages, mainly in physical and vitality domains, though heterogeneity of measures limited comparison. Safety was good with only mild, transient symptoms and no serious adverse events.

Conclusions: VRER has promising effects on mobility, daily function, physical performance, and quality of life in cancer survivors, with strong adherence and safety.

Implications for cancer survivors: VR-based exercise is an effective, safe adjunct to conventional rehabilitation. By improving mobility, adherence, and well-being, it offers benefits and can be integrated into survivorship care.

Purpose: The aims of this study were to (1) understand the interactions between system-level factors and key leverage points impacting the implementation of shared care models in Australia and (2) develop strategies and actions targeting these leverage points.

Methods: A systems thinking approach was applied through two facilitated workshops (online and face-to-face) using group model building and the nominal group technique to guide discussions.

Results: Twenty-four stakeholders participated in either one or both workshops (18 in workshop one and 15 in workshop two), including patient advocates (n = 4), oncology specialists (n = 3), primary care providers (i.e., general practitioners (GPs) and practice nurses) (n = 5), oncology nursing professionals (n = 6), cancer care researchers (n = 3), and policymakers (n = 3). A causal loop diagram was developed following workshop one, informed by stakeholder discussions and existing literature. In workshop two, stakeholders prioritised 10 key leverage points in terms of importance, with the top three being (i) funding and resource allocation; (ii) healthcare interoperability, health information exchange, and information technology; and (iii) collaborative relationships. In response to these prioritised leverage points, stakeholders identified 12 potential strategies and 55 corresponding actions to address the challenges.

Conclusions: A systems thinking lens enabled stakeholders to prioritise key leverage points and develop targeted strategies to enhance shared care implementation. These strategies can be used to address key areas for change in policy planning and practice in Australia.

Implications for cancer survivors: This study highlights key areas in the health system where targeted changes can improve follow-up and survivorship care for cancer survivors.

Purpose: Colorectal cancer (CRC) survivors are at risk for experiencing healthcare-related financial burden, which can be exacerbated by low health insurance literacy (HIL). This pilot RCT assessed the feasibility, acceptability, and preliminary efficacy of a virtual health insurance navigation intervention adapted for CRC survivors (Health Insurance Navigation Tools; HINT-C).

Methods: Insured adult CRC survivors at the MGH Cancer Center with access to a wireless device were eligible. Participants were randomized to HINT-C, a five-session Zoom-based intervention, or enhanced usual care (EUC). Feasibility was assessed by proportion of enrolled individuals and sessions completed. Measures of patient satisfaction and program helpfulness assessed acceptability. Program efficacy was measured as changes in HIL, ACA knowledge, familiarity with health care legislation, and financial burden between baseline and five-month post-intervention.

Results: From 01/2022 to 02/2023, 36 participants enrolled (22.6% enrollment rate; 47.2% female; 88.9% White, M_age = 52.1). Most (82.4%) completed all sessions and rated the program positively, highlighting the program's flexibility and helpful interaction with the navigator. HINT-C improved participants' HIL (p = 0.01) and ACA knowledge (p = 0.002), whereas such improvements were not observed in the EUC.

Conclusion: The HINT-C intervention demonstrated feasibility, acceptability, and preliminary efficacy for improving CRC survivors' HIL and ACA knowledge. Future research will assess this intervention more broadly among CRC survivors.

Implications for cancer survivors: Interventions are needed for enhancing CRC survivors' ability to understand, choose, and utilize the best health insurance option for their unique healthcare needs. To our knowledge, the present intervention tailored to CRC survivors is the first of its kind.

Purpose: To examine labor force participation and employment income during early adulthood among childhood cancer survivors and matched cancer-free individuals in Canada.

Methods: Children aged 0-14 diagnosed with cancer from 2000 to 2017 in Canada were identified from the Canadian Cancer Registry and matched to cancer-free individuals by birth year, sex, and region of Canada at age 18. Matched cohorts were generated for all cancers combined, by cancer type (hematologic/central nervous system [CNS]/solid), and age at cancer diagnosis (0-4, 5-9, 10-14 years). Using linked national tax records, we examined labor force participation (declared employment income of > $0) and employment income (2017 CAD) annually during adulthood (≥ 18 years) until 2017. Absolute and relative differences in outcomes between groups were investigated using generalized estimating equations.

Results: Overall, 3635 childhood cancer survivors and 1,032,090 cancer-free individuals were included (median age by maximum follow-up: 22 years). During follow-up, survivors were 5% less likely to be employed (risk ratio [RR], 0.95; 95% CI 0.94, 0.96) and earned 6% lower income annually (ratio of income, 0.94; 95% CI 0.89, 0.98), after adjusting for age and period effects. The largest effect sizes were observed among CNS survivors (RR for, 0.89; 95% CI 0.87, 0.92; ratio of income, 0.77; 95% CI 0.67, 0.89).

Conclusions: In this pan-Canadian longitudinal matched cohort study, we observed differences in socioeconomic outcomes between adult-aged childhood cancer survivors and cancer-free individuals. Given the cohort's young age, additional studies incorporating education data are warranted.

Implications for cancer survivors: Childhood cancer can impact a survivor's career path. This study provides insight into the financial trajectory of survivors in Canada.

Purpose: Colorectal cancer (CRC) survivors receiving oxaliplatin-based chemotherapy frequently develop chemotherapy-induced peripheral neuropathy (CIPN). This study investigated the impact of CIPN symptoms on psychological distress and health-related quality of life (HRQoL) among oxaliplatin-treated CRC survivors up to 5 years post-treatment.

Methods: 124 CRC patients treated with oxaliplatin-based chemotherapy participating in a prospective cohort study were included in the longitudinal analyses. CIPN symptoms were measured at diagnosis (pre-treatment) and at 6 weeks and 6, 12, 24, and 60 months post-treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN20 (EORTC QLQ-CIPN20). Psychological distress, including anxiety and depressive symptoms, and HRQoL were measured at all post-treatment time points using the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-Core 30 (EORTC QLQ-C30), respectively. Confounder-adjusted longitudinal associations of CIPN symptoms with psychological distress and HRQoL were analysed with linear mixed regression models.

Results: CIPN symptoms in oxaliplatin-treated CRC patients were highest at 6 weeks post-treatment, thereafter gradually decreasing over time. More severe CIPN symptoms were longitudinally associated with more psychological distress (HADS), including both higher anxiety and depressive symptoms, and with worse global health/QoL and physical and social functioning and more fatigue (EORTC QLQ-C30).

Conclusion: CIPN symptoms, persisting over time among oxaliplatin-treated CRC survivors, were longitudinally associated with more psychological distress and lower HRQoL up to 5 years after chemotherapy treatment.

Implications for cancer survivors: CIPN symptoms following oxaliplatin-based chemotherapy have a long-lasting impact on CRC survivors. Research on interventions aimed at mitigating CIPN symptoms is warranted.