Journal of Cancer Survivorship最新文献

Purpose: Frailty is a major concern in the aging cancer population. It can progress to severe frailty or death or improve to pre-frail or non-frail states. However, frailty transitions in older cancer survivors are not well understood. This study aimed to explore frailty transitions and associated factors in older cancer survivors.

Methods: We analyzed data from the National Health and Aging Trends Study (NHATS) in 2017-2022, focusing on older adults aged ≥ 65 who have been diagnosed with cancer. Frailty was assessed annually using the Fried Frailty Phenotype. Multi-state Markov models were used to explore transitions between frailty states (non-frail, pre-frail, frail, and death) and examine the association with sociodemographic factors, comorbidities, and inflammatory biomarkers (IL-6 and CRP).

Results: Among 1219 survivors, 25.27% were non-frail, 52.34% pre-frail, and 22.40% frail at baseline. Over 5 years, there were 1396 transitions: 950 (68.05%) progressed or deceased, and 446 (31.95%) reversed. Pre-frail individuals transitioned to frailty slightly more than they reversed to non-frailty (0.25 vs. 0.21). Frail individuals were more likely to decease than to reverse (0.30 vs. 0.28). Factors associated with frailty progression included older age, lower education, more comorbidities, and higher IL-6 and CRP levels. Being female and obese were protective against the frailty-to-death transition.

Conclusions: The results showed dynamic frailty transitions in older cancer survivors and identified key sociodemographic and physiological factors.

Implications for cancer survivors: These findings can guide targeted interventions, highlighting the importance of early identification and tailored approaches to prevent frailty progression in older cancer survivors.

Purpose: Despite advancements in treatment that have extended survival, multiple myeloma (MM) remains a distressing diagnosis with significant health impacts, including an elevated risk of suicide. This study aims to investigate suicide risk among MM patients and develop a predictive model to identify high-risk individuals.

Methods: We analyzed 83,333 MM cases from the latest Surveillance, Epidemiology, and End Results (SEER) database (2001-2020) to identify suicide risk predictors and develop prediction nomograms. The cohort was randomly allocated into training and validation groups. Validation included assessing the consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve.

Results: Among the cohort, 89 MM patients died by suicide, reflecting a significantly higher rate compared to the general US population (SMR = 2.186). Key risk factors included household income ≤ $50,000 (SMR = 3.82), male sex (SMR = 3.68), and age ≥ 80 years at diagnosis (SMR = 3.05). Additional predictors were unmarried status, Black race, and diagnosis post-2007. The nomogram incorporating these factors demonstrated strong predictive accuracy in both training and validation groups.

Conclusion: This study identified critical suicide risk factors in MM patients and developed a predictive nomogram that aids physicians in the early identification of at-risk individuals, facilitating more effective preventive measures.

Implications for cancer survivors: Utilizing the factors and predictive model for suicide risk among MM survivors allows for earlier identification and intervention, significantly enhancing their quality of life and psychological relief in the context of improved MM survival rates.

Introduction: Breast cancer-related lymphedema (BCRL) is a complication that requires lifelong control, with patients taking responsibility for self-care. Mobile applications (apps) can be an effective health education strategy to help manage BCRL by promoting collaborative learning environments in physical therapy. The objective of this study was to design and validate the content for the development of a mobile application for self-care in the health of the BCRL.

Methods: The Delphi technique was used through two rounds with data collection instruments using Research Electronic Data Capture (REDCap) and consensus was obtained among a group of experts regarding the content.

Results: Thirty experts participated in the first round to suggest content and 11 content menus, and 48 sub-content menus were suggested. The second round included 19 experts to validate the content. The content validity coefficient values were considered good, both for clarity and relevance (CVCt = 0.93) and for the relevance (CVCt = 0.92) of the contents, with the CVCt of the scale being 0.92, giving its content validity according to the analysis methods used in this research.

Conclusion: The Delphi technique helped to obtain a consensus that the content is clear, relevant, and pertinent. The results indicate that the application will be a useful and effective tool, offering the necessary functionality to guide these patients' self-care, and is ready for development.

Implications for cancer survivors: This app will assist in proactive prevention before BCRL diagnosis, provide comprehensive knowledge and information during the treatment process for diagnosed patients, and support long-term self-management, while enhancing the learning of education provided to them by healthcare professionals such as physiotherapists.

Purpose: The increasing number of people living longer with advanced cancer presents unique physical, psychosocial, financial, legal, practical and complex care needs. Supportive care interventions aim to address these needs by improving symptom management, promoting wellbeing, enhancing quality of life and potentially improving prognosis. To integrate supportive care interventions into clinical practice, a comprehensive review of existing studies is needed. This scoping review maps the evidence on non-pharmacological supportive care interventions for people with advanced cancer and identifies gaps to inform future research.

Methods: We systematically searched four electronic databases-CINAHL, Medline, Cochrane and PsycINFO-for peer-reviewed original research on non-pharmacological supportive care interventions for adults with advanced cancer, published from January 1, 2013, to July 1, 2024.

Results: Out of 3716 studies, 84 publications met the inclusion criteria. These studies were categorised into key supportive care domains: physical activity, psychosocial support, patient care and autonomy, multimodal approaches and others. Most publications focused on interventions addressing physical and psychosocial needs, showing benefits such as reduced fatigue, pain and improved mood. However, significant gaps were found in research on interventions addressing practical needs essential to autonomy, including health system and information needs, patient care and support and financial needs.

Conclusion: Mapping the studies to the needs of the advanced cancer population showed that domains with greatest unmet needs have the fewest interventions available. Our scoping review suggests that non-pharmacological supportive care interventions can improve the wellbeing and quality of life of people living with advanced cancer. However, addressing methodological limitations requires further large-scale, multi-centre studies focusing on the identified gaps to inform the implementation of suitable supportive care programs.

Implications for cancer survivors: Non-pharmacological interventions can boost wellbeing and quality of life for advanced cancer survivors, but addressing gaps in practical and systemic support is crucial.

Purpose: Limited data exists on the long-term course of fear of cancer recurrence (FCR) in head and neck cancer (HNC) patients. One in five patients was found to experience persistent high FCR in the first months after diagnosis. This study assessed the 3-year trajectories and associated factors of FCR in newly diagnosed HNC patients.

Methods: Six hundred twenty-one patients from the NETherlands Quality of life and Biomedical Cohort study (NET-QUBIC) completed the FCR assessment at baseline, 3-, 6-, 12-, 24-, and 36-months posttreatment. Trajectories of FCR were identified using latent class growth analysis. Multinominal logistic regression analysis was used to assess associations between FCR trajectories and baseline demographic and medical variables, personality, and coping.

Results: Three FCR trajectories were identified: "consistently high" (n = 45, 7%), "elevated and declining" (n = 209, 34%), and "low and declining" (n = 367, 59%). Patients in the "elevated and declining" and "consistently high" trajectory were younger, had more comorbidities, higher negative adjustment, a higher level of neuroticism, more social support seeking, and more reliance on passive and palliative coping strategies.

Conclusion: Three years following diagnosis, the majority of HNC patients showed a resilient FCR trajectory whereas a small percentage of HNC patients (7%) showed persistent high FCR over time.

Implications for cancer survivors: Younger patients and those with a higher level of neuroticism or maladaptive coping strategies were more vulnerable to have a consistent high level of FCR over time. It is important to identify these patients to provide optimal and tailored psychosocial support.

Purpose: Childhood cancer survivors are at increased lifetime risk of morbidity and mortality, but adherence to periodic surveillance is suboptimal. One of the reasons that adult survivors of childhood cancer do not complete the recommended surveillance is that their parents may not have disclosed their cancer history to them. We sought to identify key barriers and enablers to talking to children about their cancer history.

Method: Semi-structured interviews were completed with parents of childhood cancer survivors who had delayed telling their child about their cancer diagnosis. The theoretical domain framework (TDF) informed the interview guide and analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the framework.

Results: Twelve interviews were conducted with parents of childhood cancer survivors. Parents expressed a desire to protect their children from the knowledge and awareness that they had cancer, as they thought it could lead to hypervigilance and impact their child's identity (TDF domain: belief about consequences). Parents were also afraid the conversation would "trigger" emotions for themselves related to the time their child had cancer (emotion). Due to these barriers, it was the influence of the clinical team that was described as the driving push to having this difficult conversation (social influences). Parents also had a strong conviction that their child had the right to know and that they could use this information to protect themselves and stay healthy (motivation).

Discussion: Parents thought telling their child they had cancer was important because "knowledge is power" and their child "has the right to know." However, this was a difficult conversation that was often avoided.

Implications for cancer survivors: This study confirms the need for an intervention that encourages and supports parents to have this difficult conversation with their child.

Purpose: This study sought to identify subgroups of adult cancer survivors with distinct food behavior patterns and to examine group characteristics.

Methods: Data from adult cancer survivors, ages 20-64, in the 2007-2016 National Health and Nutrition Examination Survey was used to conduct latent class analyses to identify food behavior subgroups, based on five indicator variables. Associations between latent food behavior class membership and key sociodemographic and cancer-related characteristics were examined using adjusted multinomial regression models.

Results: Four unique food behavior classes were identified and named, characterized by the degree to which they purchased and consumed convenience foods: Home Cooks (48.4% of the sample), Non-Cooks/Eats Out (29.8%), Need Convenience (11.3%), and Quick Food at Home (10.5%). Shorter time since diagnosis was associated with higher adjusted relative risk ratios (ARRR) of belonging to the Non-Cooks/Eats Out class (ARRR 12.4, 95% CI 2.3, 68.0) and the Quick Food at Home class (ARRR 18.6, 95% CI 3.5, 98.4). Older age, lower educational attainment, and larger household size were also associated with a higher likelihood of belonging to the Quick Food at Home class.

Conclusion: There are certain patterns of food behaviors among cancer survivors, and these patterns are related to both cancer-related and sociodemographic factors.

Implications for cancer survivors: As food purchasing and consumption behaviors are precursors to dietary outcomes, identifying the food behavior profiles of cancer survivors may help providers recognize those who could benefit from dietary interventions or supports and receive the necessary resources that would support patients in improving their diets.

Purpose: Comprehensive survivorship care involves cancer surveillance, management of post-treatment effects, health promotion and coordination between care sectors. This study aimed to understand current survivorship practices, build awareness and support improved survivorship care in Victoria, Australia.

Methods: This project had three components: (1) a survey of 20 Victorian clinical sites, assessing elements described in the Victorian Quality Cancer Survivorship Framework; (2) educational webinars for oncology health professionals, to increase survivorship knowledge and awareness; (3) implementation of targeted survivorship care quality initiatives in a sample of health services. Survey, evaluation and outcome data were reported descriptively.

Results: All sites responded to the survey (3 hospitals have a common operating model hence supplied a single response). Most (11/18, 60%) rated their survivorship care as 'developing' and did not have a clear survivorship care policy (13/18, 72%). The provision of post-treatment information was inconsistent, as was the assessment for needs. Most sites do not stratify survivors (< 25% of survivors received stratified care at 13/18 sites, 72%), provide survivorship care plans (< 25% survivors received SCP at 8/18 sites, 44%) and collect limited outcome data. Webinars were well received, with 98% of health professionals reporting improved knowledge and awareness. All seven sites valued targeted implementation support to improve aspects of survivorship care.

Conclusions: Current Victorian survivorship care appears suboptimal. There was good health professional engagement with educational webinars and with improvement activities.

Implications for cancer survivors: Results have informed survivorship improvement work, focusing on implementing policy, improving aspects of care delivery and building capability across the state.

Purpose: To examine how household income and county income inequality are linked to financial hardship among cancer survivors.

Methods: Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the average marginal effect (AME) was calculated.

Results: Compared to survivors residing in households with income of $90,000 or more (higher income), those with household incomes between $50,000 and $89,999 (middle income) had a significantly higher risk of ever being unable to cover their share of the cost of cancer-related medical care (AME = .104, p = .001), higher risk of foregoing care in the past 12 months because of cost, including dental care (AME = .124, p < .001), eye care (AME = .082, p = .005), and mental health care or counseling (AME = .067, p = .002). An increase in the Gini index from the 25th to 75th percentile was associated with an increased risk of unmet needs in paying for follow-up care or medications related to cancer (AME = .021, p = .014) and an increased risk of foregoing doctor visits (AME = .017, p = .02) and eye care (AME = .03, p = .002) because of cost in the past 12 months.

Conclusions: Local area income inequality was associated with certain aspects of cancer survivors' experience of financial hardship.

Implications for cancer survivors: It is important to consider refining and extending financial navigation programs to survivors residing in areas with high income inequality.

Objective: Evaluating the effects of Internet-based cognitive behavioral therapy (I-CBT) on anxiety and depression in breast cancer (BC) survivors.

Methods: Systematic searches were conducted on eight Chinese and English databases from inception to July 20, 2024, for relevant randomized controlled trials. The quality of included trials was evaluated using the Cochrane risk of bias (ROB 2.0) tool, and meta-analysis was conducted using RevMan 5.4 software.

Results: Seven studies, including 1016 BC survivors, were included. This meta-analysis found that I-CBT possessed significant effects on anxiety (SMD = - 0.14, 95% CI (- 0.27, - 0.01), P = 0.03) and depression (SMD = - 0.19, 95% CI (- 0.31, - 0.06), P = 0.003); subgroup analyses revealed that self-guided I-CBT significantly improved depression (SMD = - 0.21, 95% CI (- 0.38, - 0.04), P = 0.02); I-CBT lasting 8-12 weeks was effective for anxiety (SMD = - 0.2, 95% CI (- 0.36, - 0.04), P = 0.02) and depression (SMD = - 0.18, 95% CI (- 0.34, - 0.02), P = 0.02); I-CBT with one session per week was effective for depression (SMD = - 0.16, 95% CI (- 0.3, - 0.01), P = 0.04).

Conclusion: I-CBT had significant effects on anxiety and depression in BC survivors. The individual factors of a self-guided format, an 8-12 week duration, and one session per week each demonstrated greater efficacy for I-CBT in BC survivors; however, further research is needed to validate our conclusion and the long-term efficacy of I-CBT.

Implications for cancer survivors: I-CBT is advisable for BC survivors because of its significant effectiveness on anxiety and depression, and an autonomous and time-flexibility I-CBT program is recommended.