Survivors Of Adult-onset Cancer Research Articles

Chapter 17 - Neuroepidemiology of cancer and treatment-related neurocognitive dysfunction in adult-onset cancer patients and survivors

Cancer and treatment-related neurocognitive dysfunction (CRND) - impairments in aspects of cognition commonly including attention and memory, information-processing speed, and executive functioning - can negatively affect patients' and survivors' participation in routine activities of daily living and overall quality of life. CRND can be enduring, and varies in severity level. The epidemiology of CRND is not yet clearly established; reported incidence has ranged from 17% to 75% among patients and survivors of noncentral nervous system malignancies, including breast, prostate, cervical, and colorectal cancers. Progress in the development of strategies for assessing and treating CRND has been delayed by limitations in the knowledge of the precise etiology of this adverse condition, as well as the lack of sufficiently sensitive and reliable methods to determine its presence and quantify its severity. In this chapter, we present a brief description of the concept of CRND and its clinical presentation, and discuss the descriptive epidemiology, pathophysiology, risk factors, and availability of treatment interventions. This neuroepidemiologic perspective provides a framework for characterizing CRND, determining its etiology, and understanding its negative effects on routine activities of daily living, to help support the development and testing of reliable interventions to treat this deleterious condition for patients and survivors.

Self-reported memory problems in adult-onset cancer survivors: effects of cardiovascular disease and insomnia

BackgroundCancer and its treatments can deleteriously affect memory. Cardiac function and insomnia can exacerbate memory problems. ObjectiveTo examine the relationships among cardiovascular disease, insomnia, and self-reported memory problems (SRMP) in adult-onset cancer survivors. MethodsWe included data from participants (41–64 year-old) of the 2007–2008 National Health and Nutrition Examination Survey, a nationally representative probability sample of the civilian, non-institutionalized population of the US. We excluded participants with brain cancer/stroke history since these conditions are expected to cause cognitive problems. Using binary logistic regression, we determined the prevalence of SRMP relative to cardiac problems and insomnia by weighting our results proportionally. We adjusted for predictors of memory problems: age, sex, race, education and general health. ResultsThe sample included 2289 adults (49% females), 9% with a cancer history. The results pertain only to cancer survivors. Those with insomnia were 16 times as likely to have SRMP. Only insomnia symptoms (OR, 15.74; 95% CI, 1.73–143.30; p < 0.01) significantly predicted SRMP, uniquely explaining 12% of the variance. Insomnia accounted for 18.8% of the association between cardiac issues and SRMP, demonstrating mediation (Sobel p < 0.05). The large CI is a consequence of analyzing a sub-group of a subpopulation. Among participants without a cancer history, cardiovascular disease and insomnia were not associated with SRMP (p > 0.05). LimitationsWe could not determine severity and time-related changes in SRMP. ConclusionLikelihood of SRMP was higher in cancer survivors with a history of cardiovascular disease and insomnia symptoms. Future studies are needed to delineate the cardiac–insomnia–memory interrelationships.

Characterizing self-reported memory problems in adult-onset cancer survivors in the United States: Importance of sleep duration and insomnia.

9588 Background: Memory dysfunction is a debilitating adverse effect of cancer and its treatments. We examined the relationships between self-reported memory problems (SRMP) and sleep disorders in adult-onset cancer survivors. Methods: We used data from 151 adults, 41-64 years old, cancer survivors who completed the 2007-2008 National Health and Nutrition Examination Survey. Population-weighted binary logistic regression analyses examined SRMP as outcome and included age, sex, education, race-ethnicity, income, and overall health as covariates. Sleep duration was categorized as very short ( =9hrs). Initial insomnia was assessed as difficulty falling asleep. Middle insomnia was assessed as difficulty maintaining sleep. Late insomnia was assessed as waking too early. These insomnia subgroup were categorized as none, mild ( =15 days/month). A combined insomnia variable categorized individuals as insomnia if they had severe insomnia...

Clinical correlates of memory problems in middle-aged adult-onset cancer survivors in the United States: A national cross-sectional study.

e20588 Background: Cancer and its treatments can deleteriously impact cognitive functioning in cancer patients and survivors. The etiology of cancer/treatment-related memory problems is generally attributed to various genetics, biological, and psychosocial factors. The present study assessed clinical predictors of self-reported memory problems (SRMP). Methods: We analyzed data from 160 adult cancer survivors, aged 41-64 years, who completed the 2007-2008 National Health and Nutrition Examination Survey. Participants with a history of brain tumor/stroke were excluded since these conditions generally cause direct brain insults/cognitive impairments. Clinical variables assessed obesity (body mass index evaluated [1] continuously or [2] dichotomized at 30kg/m2), hypertension ([1] previous diagnosis and/or current treatment for hypertension and [2] measured blood pressure >140/90mmHg), high cholesterol ([1] previous diagnosis and/or current treatment for high lipids and [2] serum cholesterol, assessed continuo...

Survivorship: Introduction and Definition

Many cancer survivors experience physical and/or psychosocial side effects, which can be severe, debilitating, and sometimes permanent. These NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment for health care professionals who work with survivors of adult-onset cancer in the posttreatment period. These introductory sections of the guidelines include the panel's definition of cancer survivors, a discussion of the effects of cancer and its treatment, general principles and standards for survivorship care, and guidance regarding screening for problems that require further assessment.

Physical Functioning and Rehabilitation for the Cancer Survivor

There are more than 13.8 million survivors of cancer living in the United States. Up to 20% of survivors of childhood-onset and 53% of survivors of adult-onset cancer have problems with physical function as a result of their cancer and or its treatment. These problems may be immediately apparent, during, or soon after initial cancer treatment, or may appear days, months, or years later as the cancer survivor ages. Unfortunately, rehabilitation services and providers are not easily or systematically accessible in today's healthcare system. Rehabilitation services that restore or ameliorate early functional loss or that protect against or minimize the impact of later-onset organ system dysfunction are available, at least in larger comprehensive cancer center settings. This report describes physical function, details the evolution of cancer rehabilitation, and identifies cancer survivors who may benefit from rehabilitation services. Additionally, the evidence for specific approaches to rehabilitation, intervention, and prevention of functional loss are reviewed. Finally, we summarize the mechanisms used to measure physical function and stress the need for additional research to support rehabilitation services for cancer survivors.

Abstract B20: Self-reported memory problems in adult-onset cancer survivors in the United States: Effects of cardiac complications, short sleep duration, and general health

Abstract Background: Memory impairments are debilitating adverse effects of malignant tumors and their various treatments. Factors such as cardiac complications and sleep loss/impairment can exacerbate memory problems for cancer patients and survivors. We examined the relationships among history of cardiac complications, short sleep duration, and self-reported memory problems (SRMP) in adult-onset cancer survivors. Methods: We included data from middle-aged (41 to 64 years) participants who completed the 2007-2008 National Health and Nutrition Examination Survey (NHANES), a nationally representative, stratified, multistage probability sample of the civilian, non-institutionalized population of the United States. We excluded participants with a history of brain cancer or stroke since these conditions are expected to cause cognitive problems because of direct insults to the brain. Using binary a logistic regression, we determined the prevalence of SRMP in cancer survivors relative to cardiac complications and short sleep duration (&amp;lt; 5 hours/night) by weighting our results proportionally. We controlled for demographic predictors of memory problems: age, sex, race, education and general health. Results: The sample included 2,289 adults (49% female). There were 46% Whites, 20% Blacks, 29% Hispanics, and 4% Asian/other. A total of 9% of the sample were cancer survivors. Cardiac complications (Odds ratio (OR), 6.97, p &amp;lt; 0.029; 95%CI, 1.21 to 40.05) and short sleep duration (OR, 25.30, p &amp;lt; 0.002; 95%CI, 3.35 to 191.28) statistically significantly predicted SRMP that interfere with activities of daily functioning. Short sleep duration partially mediated the relationship between cardiac complications and SRMP to the order of 9.18% (p &amp;lt; 0.0001). Among participants without a cancer history, neither cardiac complications nor short sleep were associated with SRMP (p &amp;gt; 0.05). Conclusion: The likelihood of SRMP is higher in cancer survivors with a history of cardiac complications or short sleep duration. Future studies are needed to systematically delineate the cardiac-sleep-memory relationships, which could inform the development of reliable assessment and intervention to mitigate memory impairments and sleep problems for cancer survivors. Citation Format: Pascal Jean-Pierre, Michael Grandner, Elizabeth Henry. Self-reported memory problems in adult-onset cancer survivors in the United States: Effects of cardiac complications, short sleep duration, and general health. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B20.

Psychosocial health in survivors of adult versus childhood cancer.

9609 Background: The growing population of cancer survivors is characterized by two subgroups, those diagnosed as children and those diagnosed as adults. While psychosocial challenges are recognized in these survivors, little data exists comparing the psychosocial health between these two subgroups. Our objective is to compare adult and childhood cancer survivors for symptoms of depression, anxiety, somatic complaints, and post traumatic stress disorder (PTSD). Methods: At entry to the Vanderbilt Cancer Survivorship program, survivors of childhood and adult onset cancer, ages 15 – 55 years old, completed the Achenbach System of Empirically Based Assessment and the revised Impact of Event Scale. Using normalized T scores, independent sample t tests,and χ2 analyses, responses were compared to normative data for each group and responses of the two survivor groups were compared to one another. Results: There were 172 survivors of childhood cancer (M= 9 years old at diagnosis) and 125 survivors of adult cancer (M= 41 years old at diagnosis). Childhood cancer diagnoses included hematologic cancer (56%), sarcoma (17%), brain tumor (8%), and other (19%). Adult cancer diagnoses included breast cancer (45%), colon cancer (8%), hematologic cancer (14%), sarcoma (4%), and other (29%). After adjusting for age-related population norms, adult survivors were significantly more likely to have symptoms of depression (p=.011), anxiety (p=.029), somatic problems (p=.043), and PTSD (p=.004) compared to their childhood counterparts. Compared to age-expected norms, significantly more adult, but not child, survivors scored in the clinical range for depression (29%, p&lt;.001; vs. 18% n.s) and somatic problems (23%, p=.013; vs. 12%; n.s.). Time elapsed from cancer diagnosis to completion of the questionnaires was not significantly correlated with any of the measures. Conclusions: Survivors of adult onset cancer face a significantly higher amount of psychologic distress, particularly depressive and somatic symptoms, compared to their childhood counterparts and age-expected norms. Analyses are ongoing to evaluate other demographic, disease, and treatment related risk factors that may contribute to this age-related phenomenon in order to develop interventions.

Depression and self-reported memory problems in adult-onset cancer survivors.

9586 Background: Memory impairments are debilitating adverse effects of cancer and its treatments. Depression may predispose or exacerbate memory problems. We examined the relationship between depression and memory problems in adult-onset cancer survivors. Methods: We included data from individuals who completed the National Health and Nutrition Examination Survey, a nationally representative, stratified, multistage probability sample of the civilian, non-institutionalized population of the United States from 2005 to 2010. We excluded individuals with a history of brain cancer or stroke since these conditions are expected to cause cognitive problems because of direct brain insults. We determined the prevalence of depression and its relationship to memory problems in cancer survivors by weighting our results proportionally. We controlled for demographic predictors of memory problems. Results: The sample included 14249 adults (6875 men and 7274 women) age 20 years and older. There were 6959 Whites, 2792 Blacks, 3903 Hispanics, and 589 other race/multiracial. Overall, individuals in the United States with a history of depression were 8.4 times more likely to report memory problems (Odds Ratio (OR), 8.406; 95%CI, 6.73 to 10.64). We further explored the depression-memory relationship in a subsample of cancer survivors. Adjusting for age, sex, race-ethnicity, education, income, and general health, cancer survivors with a history of depression were approximately 5 times more likely to report memory problems (N=1283; OR, 4.921; 95%CI, 2.141 to 11.313) than those without a history of depression. Other predictors of memory problems were age (≥ 60 years old, OR = 4.756, 95%CI, 1.957 to 11.560) and lower income (OR, 3.721; 95%CI, 1.951 to 7.098). Conclusions: The likelihood of memory problems is higher in cancer survivors with a history of depression. Future studies are needed to systematically delineate the depression-memory problems relationship, and to inform the development of interventions to treat these conditions for cancer survivors.

Aetiology, genetics and prevention of secondary neoplasms in adult cancer survivors

Second and higher-order malignancies now comprise about 18% of all incident cancers in the USA, superseding first primary cancers of the breast, lung, and prostate. The occurrence of second malignant neoplasms (SMN) is influenced by a myriad of factors, including the late effects of cancer therapy, shared aetiological factors with the primary cancer (such as tobacco use, excessive alcohol intake, and obesity), genetic predisposition, environmental determinants, host effects, and combinations of factors, including gene-environment interactions. The influence of these factors on SMN in survivors of adult-onset cancer is reviewed here. We also discuss how modifiable behavioural and lifestyle factors may contribute to SMN, and how these factors can be managed. Cancer survivorship provides an opportune time for oncologists and other health-care providers to counsel patients with regard to health promotion, not only to reduce SMN risk, but to minimize co-morbidities. In particular, the importance of smoking cessation, weight control, physical activity, and other factors consonant with adoption of a healthy lifestyle should be consistently emphasized to cancer survivors. Clinicians can also play a critical role by endorsing genetic counselling for selected patients and making referrals to dieticians, exercise trainers, and others to assist with lifestyle change interventions.

Mental and Physical Health–Related Quality of Life among U.S. Cancer Survivors: Population Estimates from the 2010 National Health Interview Survey

Despite extensive data on health-related quality of life (HRQOL) among cancer survivors, we do not yet have an estimate of the percentage of survivors with poor mental and physical HRQOL compared with population norms. HRQOL population means for adult-onset cancer survivors of all ages and across the survivorship trajectory also have not been published. Survivors (N = 1,822) and adults with no cancer history (N = 24,804) were identified from the 2010 National Health Interview Survey. The PROMIS® Global Health Scale was used to assess HRQOL. Poor HRQOL was defined as 1 SD or more below the PROMIS® population norm. Poor physical and mental HRQOL were reported by 24.5% and 10.1% of survivors, respectively, compared with 10.2% and 5.9% of adults without cancer (both P < 0.0001). This represents a population of approximately 3.3 million and 1.4 million U.S. survivors with poor physical and mental HRQOL. Adjusted mean mental and physical HRQOL scores were similar for breast, prostate, and melanoma survivors compared with adults without cancer. Survivors of cervical, colorectal, hematologic, short-survival, and other cancers had worse physical HRQOL; cervical and short-survival cancer survivors reported worse mental HRQOL. These data elucidate the burden of cancer diagnosis and treatment among U.S. survivors and can be used to monitor the impact of national efforts to improve survivorship care and outcomes. We present novel data on the number of U.S. survivors with poor HRQOL. Interventions for high-risk groups that can be easily implemented are needed to improve survivor health at a population level.

Second Malignant Neoplasms: Assessment and Strategies for Risk Reduction

Improvements in early detection, supportive care, and treatment have resulted in an increasing number of cancer survivors, with a current 5-year relative survival rate for all cancers combined of approximately 66.1%. For some patients, these survival advances have been offset by the long-term late effects of cancer and its treatment, with second malignant neoplasms (SMNs) comprising one of the most potentially life-threatening sequelae. The number of patients with SMNs is growing, with new SMNs now representing about one in six of all cancers reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. SMNs reflect not only the late effects of therapy but also the influence of shared etiologic factors (in particular, tobacco and excessive alcohol intake), genetic susceptibility, environmental exposures, host effects, and combinations of factors, including gene-environment interactions. For selected SMNs, risk is also modified by age at exposure and attained age. SMNs can be categorized into three major groups according to the predominant etiologic factor(s): (1) treatment-related, (2) syndromic, and (3) those due to shared etiologic exposures, although the nonexclusivity of these groups should be underscored. Here we provide an overview of SMNs in survivors of adult-onset cancer, summarizing the current, albeit limited, clinical evidence with regard to screening and prevention, with a focus on the provision of guidance for health care providers. The growing number of patients with second (and higher-order) cancers mandates that we also further probe etiologic influences and genetic variants that heighten risk, and that we better define high-risk groups for targeted preventive and interventional clinical strategies.

Can the distress thermometer (DT) identify significant psychological distress in long-term cancer survivors?: a comparison with the Brief Symptom Inventory-18 (BSI-18)

As the number of cancer survivors continues to grow, identification of brief, valid psychological screening measures is critical for providing these survivors with appropriate psychosocial care. The distress thermometer (DT) is a one-item distress screening recommended by the National Comprehensive Cancer Network (NCCN) for screening cancer patients during their treatment. In this study, the validity of the DT for identifying psychological distress in cancer survivors was evaluated by comparing results of the DT to the Brief Symptom Inventory-18 (BSI-18) in a sample of 120 survivors of adult onset cancer. Results indicated that when using the NCCN suggested cutoff score of 5, the DT only identified 10 of the 21 BSI-18 positive cases of psychological distress (sensitivity 47.6%; specificity 90.9%). Using an alternative DT cutoff score of 4, 12 of the 21 BSI-18 positive cases were identified (sensitivity 51.7%; specificity 89.9%). The results do not support the validity of the DT in survivors of adult cancers.

Health-Related Quality of Life of Young Adult Survivors of Childhood Cancer: A Review of Qualitative Studies.

Purpose: The occurrence of late effects, combined with traditional growth and developmental issues, can significantly affect the health-related quality of life (HRQOL) of young adult survivors of childhood cancer (YASCC). Limited HRQOL measurement tools have been developed or validated for YASCC. The purpose of this study was to identify the domains of HRQOL that are unique to YASCC by conducting a systematic review of qualitative studies. Specifically, we compared the findings to the classical framework of HRQOL that was developed for survivors of adult-onset cancer and identified specific domains not being assessed in existing HRQOL instruments for YASCC. Methods: We searched qualitative studies published in peer-reviewed journals from 2000 to 2010 in the PsychINFO, PubMed, and EBSCOhost databases. A set of keywords and inclusion/exclusion criteria were utilized to identify eligible studies with a focus on survivorship and HRQOL issues of YASCC. Results: Sixteen studies met the inclusion/exclusion criteria and were investigated in this study. Six important domains of HRQOL were identified (physical, social, psychological, spiritual, fertility/sexual, resilience, and body appearance) with several sub-domains. Conclusion: Use of the classical HRQOL framework and existing instruments is not comprehensive enough for YASCC. Adding unique domains to the classical framework and existing instruments will make them valuable tools for measuring the HRQOL of YASCC and increase health professionals' ability to identify if and when psychosocial services are needed for this unique population.

Clinical practice guidelines for the psychosocial care of cancer survivors

Upon completion of their primary treatment, many cancer survivors become "lost in transition," and receive inadequate or, at best, poorly coordinated follow-up care. Unmet psychosocial and educational needs figure prominently among the concerns identified by survivors of adult-onset cancers in the post-treatment period. This article focuses on the role clinical practice guidelines could play in improving the quality of psychosocial care provided to these post-treatment survivors. After defining clinical practice guidelines and describing their development, the article provides an overview of existing clinical practice guidelines for the psychosocial care of cancer patients and identifies their strengths and weaknesses. A major weakness relevant to this article is that none of the existing guidelines focus on the post-treatment period. Two recent efforts in the field of cancer survivorship are identified that should stimulate and inform the development of guidelines for psychosocial care in the post-treatment period. One effort is the growing movement to implement survivorship care planning at the end of primary treatment. Assessing and addressing unmet and anticipated psychosocial needs have been identified as major components of survivorship care planning. The other effort is the release by the Children's Oncology Group of Long-term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. These guidelines provide a useful model of how guidelines for the psychosocial care of survivors of adult-onset cancers might be developed, organized, and implemented.

Psychological Distress in Long-term Survivors of Adult-Onset Cancer

As advances in cancer screening and treatment increase the number of long-term cancer survivors, it is important to understand the long-term psychological sequelae of the cancer experience. The 4636 respondents who identified themselves as survivors of adult-onset cancer of 5 years or more and 122 220 respondents who were never diagnosed as having cancer were identified in the 2002 to 2006 National Health Interview Survey. The primary outcome in this population-based study was serious psychological distress (SPD) defined as a K6 scale (a validated screening tool for mental illness) score of 13 or more. Among survivors, the median age at diagnosis was 50 years, the age at interview was 66 years, and the time since diagnosis was 12 years. The prevalence of SPD was significantly higher among long-term cancer survivors than among respondents who were never diagnosed as having cancer (5.6% vs 3.0%; P < .001). After adjustment for clinical and sociodemographic variables (age, sex, race, relationship status, educational attainment, insurance status, comorbidities, smoking history, and ability to perform instrumental activities of daily living), survivors remained significantly more likely to experience SPD (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.7). After adjustment for other clinical and sociodemographic variables, long-term survivors who were younger, were unmarried, had less than a high school education, were uninsured, had more comorbidities, or had difficulty performing instrumental activities of daily living were more likely to experience SPD. Long-term survivors of adult-onset cancer are at increased risk for psychological distress. This study identifies several clinical and sociodemographic factors associated with SPD that may help target high-risk survivors for psychological screening and support.

Psychological Distress in Long-term Survivors of Adult-onset Cancer: Results from a National Survey

Psychological Distress in Long-term Survivors of Adult-onset Cancer: Results from a National Survey

Pediatric Cancer Survivorship: Research and Clinical Care

Regardless of how one defines survivorship, more than 10 million individuals in the United States have been treated for a malignant disease; about 250,000 were younger than 21 years of age at diagnosis. Thirty years ago, pediatric oncologists recognized that children with cancer might be cured by adding chemotherapy to surgery and radiation. Studies were then begun of complications that could reduce survival or the quality of survival, and that might be associated with previous therapy. The complications were termed late effects, and studies focused on patients who were likely to be cured, or less likely to succumb to the original cancer than they were to experience disabilities. Clinical trials tested whether changes in therapy to reduce complications could maintain the same excellent survival rates. During the last 20 years, articles detailing late effects and the relationship between therapy and outcome have been published. This article reviews the progress made in understanding the outcomes reported and the efforts made to improve the quality of long-term survival for children and adolescents. Several questions remain regarding the long-term complications of therapy. Clinicians need more data regarding the effects of aging to guide them in managing former patients. Caregivers and pediatric cancer survivors who are now adults seek the optimal venue in which to receive care as independent adults. In addition, medical oncologists need to determine whether the models for research and clinical care of survivors created in pediatric oncology can be applied to survivors of adult-onset cancer.

Quality of life in long-term survivors of adult-onset cancers.

The long-term survival of cancer patients has risen dramatically during the last few decades, yet little is known about the quality of life experienced by these survivors. This paper reviews research on the quality of life in long-term cancer survivors to identify quality-of-life concerns in this population, to provide a critical evaluation of the literature, and to suggest areas for future research. Searches of computerized literature databases were conducted to identify all studies of quality of life in cancer survivors that were published in English language journals during the period from January 1, 1980, through February 12, 1998, and that were based on responses from individuals who have survived 5 or more years after the diagnosis of adult-onset cancers. Thirty-four papers were identified. Most studies utilized self-report questionnaires to measure quality of life. Although methodologies and cancer patient populations varied greatly, most studies showed that many survivors continue to experience negative effects of cancer and/or treatment on their daily lives well beyond the completion of therapy. Sexual functioning and/or satisfaction and psychological functioning were found to be concerns for many survivors. Several reports documented positive coping strategies and enhanced quality of life in long-term cancer survivors, supporting the need to measure positive aspects of quality of life as well as problems in this population. Study designs that more accurately measure quality of life among survivors of cancer by adjusting for the effects of aging and long-term therapy and the impact of second cancers should be utilized. Additional data are needed to understand the needs of long-term survivors, especially of those in groups underrepresented in published quality-of-life studies, and to determine what kinds of support survivors want.