Journal of Cancer Survivorship最新文献

Purpose: Identifying tobacco products use (TPU) patterns among cancer survivors (CSs) is critical to optimize survivorship care. This study examines exclusive cigarette/e-cigarette, dual (two tobacco-products) and poly (≥ 3 tobacco-products) use among CSs (vs. no cancer history) and its sub-types: smoking-related-cancers (SRCs) vs. non-smoking-related cancers (NSRCs) while also exploring socio-demographic factors.

Methods: The study analyzed 86,551 adults from the 2021-2023 National Health Interview Survey, including 10,846 (9.7%) CSs. Participants were categorized and analyzed based on their CSs status and TPU patterns. Weighted logistic regression models assessed the relationship between TPU and CSs status while adjusting for socio-demographic characteristics.

Results: CSs (vs. no cancer history) had a higher likelihood of ever-poly (aOR:1.24, 95%CI: 1.15-1.33), former-cigarette-only (aOR:1.22, 95%CI: 1.13-1.32), and former-dual (aOR:1.21, 95%CI: 1.14-1.29) use. SRC survivors had greater odds of being current-cigarette-only (aOR:2.26, 95%CI: 1.63-3.11), ever e-cigarette-only (aOR:3.41, 95%CI: 1.51-7.70), and ever-poly (aOR:1.32, 95%CI: 1.11-1.57) use than NSRC survivors. Among CSs, being male, single after marriage, or having lower educational attainment was linked to higher odds of exclusive, dual, or poly-tobacco use. CSs aged over 44 years had lower odds of being dual or ever-poly users compared to younger adults.

Conclusion: Disparities in TPU among CSs particularly between SRC and NSRC survivors calls for proactive cessation support. Oncologists must account for patients' former and current TPU pattern, related perceptions, and socio-demographic barriers in cessation by systematically incorporating tailored and integrated counseling into routine oncology visits.

Implications for cancer survivors: Persistent disparities in tobacco product use requires tailored cessation support in routine oncology visits.

Purpose: The supportive care needs (SCNs) of people with comorbid cancer and dementia (PWCD) and their caregivers, as well as the barriers and facilitators to meeting those needs, represent an important and under-researched area. This review aimed to systematically examine the SCNs of PWCD and their caregivers, and to identify the barriers and facilitators to these needs being met.

Method: Systematic searches were performed on CINAHL, Medline, PsychINFO, Embase, and Web of Science, and included both controlled vocabulary and free text terms. This study employed thematic synthesis to analyse extracted data.

Results: Of 3095 records identified, 11 studies met inclusion criteria. SCNs for PWCD included dementia-inclusive care, continuity of care, and tailored communication. Caregiver SCNs included access to cancer-dementia-specific information and effective coping strategies. Barriers included lack of dementia training for healthcare staff, stigma, and limited resources specific to comorbid cancer-dementia. Facilitators included healthcare professionals getting to know the PWCD, involvement of multidisciplinary teams, and person-centred approaches.

Conclusion: These findings highlight a need for more research regarding this comorbidity and the SCNs of PWCD and their caregivers, particularly in countries outside the U.K and a need for more cancer-dementia specific services and information.

Implications for cancer survivors: Cancer survivors with dementia face elevated risks of unmet needs and poorer care experiences. Addressing these gaps through dementia-informed, integrated care and caregiver support interventions may enhance quality of life and treatment outcomes. These findings provide actionable guidance for policy, clinical practice, and future research.

Purpose: Both short (< 7 h) and long (> 9 h) sleep duration are associated with poor health. Yet, little is known about sleep duration patterns and correlates in young adult childhood cancer survivors (CCS).

Methods: Data were from Project Forward, a population-based survey of young adult CCS in Los Angeles County. Average sleep duration, demographic and medical characteristics (e.g., treatment intensity), and mental (i.e., well-being, depressive symptoms) and physical (i.e., general health, comorbidities) health were measured via self-report. Chi-square and one-way ANOVAs assessed correlations between characteristics and short and long sleep duration (versus recommended; 7-9 h). Multivariable linear and negative binomial regressions examined relationships between sleep duration and mental and physical health.

Results: Participants (N = 1,062, Mean age = 26.2 years, 50% female, 51% Hispanic) were, on average, 14.5 years (range: 5-22) post-diagnosis. Overall, 30% reported short and 7% reported long sleep. Short sleep was associated with older age, being employed, and having children (ps ≤ .001). Unemployment and lower educational attainment were associated with long sleep (ps ≤ .001). Both short and long sleep were associated with lower well-being (ps ≤ .001), greater depressive symptoms (ps ≤ .001), poorer self-rated general health (ps ≤ .012), and more comorbid conditions (ps = .001), compared to recommended sleep duration. Associations with physical health remained largely significant controlling for depressive symptoms (ps < .025).

Conclusions: We found unique correlates of short and long sleep duration and associations with poorer mental and physical health among a large, diverse sample of young adult CCS.

Implications for cancer survivors: As a modifiable behavior, sleep duration is a relevant intervention target for improving outcomes after cancer.

Purpose: With advancements in early detection and treatment improving cancer survival rates, cancer survivors face an increased risk of cardiovascular-specific morbidity and mortality. Cardiovascular telerehabilitation has been a notable tool to enhance the quality of life and manage cardiovascular disease in cancer survivors. This systematic review aims to evaluate the effectiveness of different telerehabilitation technologies in improving cardiovascular fitness in cancer survivors.

Methods: This review was registered with PROSPERO under CRD420251012428 (07/05/2025). Six databases were searched, and of the 313 identified studies published between 2000 and 2025, 20 studies met the search criteria. Studies were only included if they examined the effectiveness of telerehabilitation technology on cardiovascular health and quality of life in cancer survivors.

Results: Early-stage breast cancer survivors were the most frequently studied group (n = 9; 60%) with mobile or web-based applications with a remote sensor or telephone call as the most common intervention (n = 11; 55%). Regardless of the mode of intervention and exercise protocol, cardiorespiratory fitness significantly improved in ten randomized controlled trials and one observational study. Significant improvement in quality of life was also demonstrated following telerehabilitation (n = 7; 70%). The high adherence rate (74-95%), overall high patient satisfaction, and absence of serious adverse events demonstrated that the interventions are feasible for cancer survivors.

Conclusion: Cardio-oncology telerehabilitation was associated with improved cardiorespiratory fitness and quality of life among cancer survivors despite variability in exercise protocol and intervention types. This review highlights the potential of telerehabilitation for improving cardiovascular disease management in cancer survivors.

Implications for cancer survivors: Cardio-oncology telerehabilitation offers an accessible, patient-centered intervention that can improve the long-term cardiovascular outcomes of cancer survivors. To increase the certainty of the evidence, longitudinal studies are needed to assess the sustainability of cardiovascular improvements in cancer survivors.

Purpose: The National Cancer Institute (NCI) identified survivorship research for people living with advanced and metastatic cancers as a priority in 2020. The goal of this portfolio analysis was to review all National Institutes of Health (NIH) grants newly funded in Fiscal Year (FY) 2021 to FY 2024 focused on this area.

Methods: Grants were identified using a text mining algorithm of survivorship-relevant terms from the NIH Research, Condition, and Disease Categorization (RCDC) system and double coded for grant characteristics (e.g., study design, cancer type, primary focus, and primary outcomes).

Results: Included in this analysis were 63 grants, funded by 7 NIH institutes. The number of newly awarded grants funded rose from 9 in 2021 to 25 in 2024. The majority of grants were R01s (62.9%). Cancer types most often included were breast (22.2%), prostate (15.9%), and lung (15.9%). The primary focus of studies was most often acute toxicities (33.3%) or late- or long-term effects (33.3%). No grants focused on the financial impact of an advanced or metastatic cancer diagnosis.

Conclusions: Results indicate a substantial growth in the number of grants funded from FY 2021 to FY 2024. Grants address some of the gap areas identified in previous NCI efforts, including longitudinal studies of symptoms. Scientific gap areas that persist include financial hardship and employment, models of care delivery, and prognostic uncertainty.

Implications for cancer survivors: Despite the growth in the grant portfolio, more research on survivors living with advanced and metastatic cancers is needed. This emerging population has unmet and understudied needs that will only expand given the growth in new therapies and targeted treatments.

Purpose: To identify latent subgroups of return-to-work readiness (RRTW) and self-efficacy (RTW-SE) in postoperative patients with breast cancer who had not resumed employment and to examine predictors of subgroup membership.

Methods: Using convenience sampling, 323 postoperative patients with breast cancer who had not returned to work were recruited from a tertiary hospital in Sichuan Province, China. Latent profile analysis was conducted to examine heterogeneity in RRTW and RTW-SE scores.

Results: Two subgroups were identified: a low readiness/low self-efficacy group (33.1%) and a high readiness/high self-efficacy group (66.9%). Scores on all RRTW dimensions, except pre-contemplation and RTW-SE, were higher in the high readiness group than in the low readiness group. Logistic regression showed that having a bachelor's or higher degree (odds ratio [OR] = 4.959), return-to-work intention (OR = 5.545), and not cohabitating with a spouse (OR = 2.305) were significantly associated with subgroup membership.

Conclusions: Our findings highlight the need for stratified interventions, such as cognitive support, enhanced social resources, and personalized rehabilitation, to help patients transition from the "patient role" to the "occupational role."

Implications for cancer survivors: Tailored return-to-work support is needed for breast cancer survivors. Interventions should address individual differences in readiness and self-efficacy through cognitive-behavioral strategies, targeted counseling, and strengthened social support. Collaborative efforts between healthcare providers and employers are essential to develop personalized plans that bridge the gap between recovery, intention, and sustainable workforce reintegration.

Purpose: To explore the experiences and opinions of women with breast cancer-related arm lymphoedema (BCRL), a common sequela of breast cancer treatment, and of lymphoedema practitioners regarding current lymphoedema treatment in the UK, priority outcomes and assessment methods, and acceptability of a future trial of lymphoedema treatment and use of intensive-decongestive lymphoedema treatment (DLT) for women presenting with BCRL.

Method: Two focus groups were conducted with 13 women and three focus groups with 13 lymphoedema practitioners. Discussions were transcribed and analysed using framework analysis.

Results: Usual UK lymphoedema care was self-treatment with hosiery. Women and practitioners supported the notion of early intervention although practitioners reported lack of capacity to provide intensive-DLT. All groups considered arm volume an important outcome but were unsure what treatment outcomes could be expected. Participants supported the need for a trial to identify effective treatment for women with previously untreated BCRL but could not describe criteria for a good clinical outcome.

Conclusions: Study findings demonstrate the need and desire of women and practitioners for robust research to determine the most effective treatment for women with early-BCRL, that is, within 12 months of BCRL onset, including intensive-DLT. However, UK lymphoedema services lack capacity to provide intensive-DLT, so the potential to conduct a future trial of effectiveness is likely to be limited.

Implications for cancer survivors: Women with arm BCRL can expect to receive self-treatment with hosiery. There is a need to identify effective treatment for women with arm lymphoedema and criteria for a good clinical outcome.

Purpose: To evaluate the implementation fidelity of a blended intervention aimed at optimizing physical recovery following gastrointestinal or lung cancer surgery, involving patients, dietitians, and physiotherapist.

Methods: Implementation fidelity was evaluated alongside a Randomized Controlled Trial (RCT) investigating the effect of the Optimal Physical Recovery After Hospitalization (OPRAH) intervention. For three months post-discharge, dietitians and physiotherapists remotely coached patients using data on physical activity and protein intake collected via a smartphone application and activity tracker. Carroll's framework guided the evaluation of the intervention using both quantitative and qualitative data.

Results: Patient adherence to wearing the activity tracker and monitoring protein intake was high. All patients received coaching from at least one of the two allied healthcare professionals. The frequency of coaching varied between patient populations, with the highest frequency for patients after gastrointestinal surgery. A negative moderating factor was that the OPRAH intervention was difficult to implement in the daily work routine. Positive moderating factors included positive responsiveness of physiotherapists, dietitians, and patients, well-functioning technology, and facilitation strategies that effectively engaged physiotherapists and dietitians.

Conclusions: As adherence to the intervention was high, the observed effects of the RCT can be more confidently attributed to the OPRAH intervention. The main challenge for long-term implementation is integrating the intervention into routine clinical practice.

Implications for cancer survivors: OPRAH can support cancer survivors during a vulnerable phase of recovery, with the potential to improve physical outcomes. Sustainable implementation requires embedding the intervention into standard care and maintaining close collaboration among healthcare providers.

Purpose: Adjuvant endocrine therapy (AET) reduces recurrence risk after hormone receptor-positive breast cancer, but non-adherence is common. We pilot-tested SOIE, a program to enhance AET experience and adherence, to assess its acceptability, feasibility, and effects on psychosocial precursors of AET adherence.

Methods: We conducted a 12-month pilot randomized controlled trial among women who had a first AET prescription. Intervention group received SOIE while control group received usual care. Psychosocial factors from the Theory of Planned Behavior (TPB) (intention - primary outcome -, attitude, subjective norm, behavioral control), additional constructs (AET knowledge, social support, coping planning), impact of AET services received, and adherence were measured by questionnaires at baseline, 3-month, and 12-month endpoints. Group patterns were compared using repeated measures analyses with generalized estimating equations.

Results: A total of 106 women were randomized (participation = 54.9%; intervention n = 52; control n = 54; retention = 93.8%). Among SOIE women, ≥ 90% received the program components and were satisfied. Both groups scored high on adherence intentions and group patterns over time were not statistically different. In the intervention group, AET knowledge and coping planning with side effects increased (group-by-time p-value = .002 and .016), a higher proportion reported that AET services received helped them take their AET (p < .05) and have a consistent daily intake (p = .01).

Conclusion: SOIE is feasible and acceptable for survivors with an AET. SOIE did not significantly impact adherence intentions but was beneficial for other program outcomes and daily intake.

Implications for cancer survivors: SOIE may represent an encouraging avenue to enhance supportive care and empower survivors with managing AET.

Purpose: Colorectal cancer (CRC) survivors with permanent stomas might be at higher risk of social isolation, and stigma can play an important role in the development of social isolation. However, the underlying psychological mechanisms are understudied. The current study examined how stoma acceptance and valuable actions mediated the relationships between stigma and social isolation among CRC survivors with permanent stomas.

Methods: A cross-sectional survey was conducted with a sample of 303 CRC survivors with permanent stomas. The chain mediation models were conducted using the PROCESS macro for SPSS to explore the pathways through which stigma can be associated with CRC survivors' social isolation, mediated by stoma acceptance and valuable actions.

Results: The results indicated that higher stigma was related to lower stoma acceptance, less personal values enactment, and higher social isolation, as well as lower objective social connectedness and subjective social belongingness among CRC survivors with permanent stomas. Additionally, the mediational analyses revealed that stoma acceptance and valuable actions jointly mediated the relationships between stigma and social isolation.

Conclusion: Social isolation among CRC survivors during the adjustment to both stoma and stigma may be alleviated through tailored interventions that improve stoma acceptance and valuable actions.

Implications for cancer survivors: The chain mediating roles of stoma acceptance and valuable actions highlight that tailored interventions, such as acceptance and commitment therapy, can be targeted for this population, considering this population's unique needs.