Cancer Survivors Research Articles

Abstract 4136498: Analysis of Cardiovascular Events in Cancer Survivors: A Comparative Study of Solid Tumors and Hematologic Malignancies at a Tertiary Cardiovascular Center

Background: Cardiovascular disease (CVD) and cancer represent the leading contributors of death worldwide. Although advancements in antineoplastic therapies have notably enhanced prognoses, CVD now emerges as the primary cause of mortality in this population. Ojective: To assess the occurrence of CVD in cancer survivors and investigate disparities based on their previous cancer diagnosis, categorized into solid tumors or hematological malignancies. Methods: A cross-sectional study was conducted, including adult oncology survivors who had previously undergone oncological treatment and were referred to our center between 2010 and 2023 due to the presentation of major adverse cardiovascular events (MACE). They were categorized into two groups: those with hematological cancer and those with solid tumors. We used Chi2 test to assess differences between categorical variables and the Wilcoxon rank-sum test to evaluate differences in continuous parameters. Statistical analysis was performed using R 4.0 and StataMP 14.1. Results: A total of 214 oncological patients were included (median age: 69 [IQR: 55-80], women: 53%), comprising 164 (76.6%) with solid tumors and 50 (23.4%) with hematological cancer. Baseline characteristics were mostly similar between the groups (Table 1), with diabetes being more prevalent in patients with solid tumors (26% vs 12%, p=0.036). The prevalence of heart failure was predominantly NYHA I and II in solid tumors and NYHA III in hematological cancer (p=0.002) (Table 2). The incidence of coronary artery disease (CAD) was the most common MACE in solid tumors (39% vs 34%), but this was not statistically significant (p=0.04). In hematological cancer, the most frequent MACE was myocardial dysfunction, showing a significant difference (46% vs 24%, p=0.002). Similarly, valvular heart disease (VHD) appeared more frequently in this group (38% vs 20%, p=0.01). The remaining MACEs did not show significant differences, nor did the count of MACEs upon hospital arrival. Conclusion: Myocardial dysfunction and VHD exhibited a higher incidence in hematological cancer compared to solid tumors. Conversely, the incidence of CAD was higher in the solid tumor group; however, similar to the occurrence of other MACEs, there was no significant difference between the two groups. These findings could emphasize the importance of closely monitoring specific cancer types to enhance prevention strategies but still need further analysis to also determine the exact etiologies.

Abstract 4118444: Right Ventricular Contractile Reserve and Right Ventricular-Pulmonary Arterial Coupling Are Impaired in Long-Term Survivors of Childhood Cancers

Background: Childhood cancer survivors are at risk of right ventricular (RV) dysfunction in relation to cardiac toxicity due to chemotherapy and radiation therapy. This study tested the hypothesis that RV contractile reserve and RV-pulmonary arterial (PA) coupling are altered in long-term survivors of childhood cancers. Methods: Thirty survivors (60% men) aged 24.3 ± 5.2 years at 15.3 ± 6.3 years after completion of chemotherapy and thirty healthy control subjects (47% men) were studied. Resting and submaximal supine bicycle stress echocardiography was performed for assessment of RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), left ventricular (LV) and RV longitudinal strain, mitral and tricuspid annular velocities and myocardial acceleration during isovolumic contraction (IVA). The slope of the RV force-frequency relationship was derived from the change in IVA with the change in heart rate during exercise (△IVA/△heart rate), while RV-PA coupling was determined by the ratio between TAPSE and pulmonary arterial acceleration time indexed to RV ejection time (PAATi). Results: At rest, tricuspid annular systolic velocity and RV systolic strain were significantly lower in survivors ( P < 0.05 for both), while RV FAC, TAPSE and IVA were similar between the two groups ( P > 0.05 for all). During submaximal exercise testing, all RV systolic functional indices were significantly lower in survivors than controls ( P < 0.05 for all). The slope of the RV force-frequency relationship was significantly flatter in survivors compared to controls (0.038 ± 0.002 vs 0.059 ± 0.003 m/sec 2 beats/min, P < 0.001). For RV-PA coupling, TAPSE/PAATi was similar between survivors and controls at baseline but became significantly lower in survivors during submaximal exercise ( P = 0.002). Conclusions: The RV contractile reserve and RV-PA coupling are impaired during exercise in long-term survivors of childhood cancers. Future studies aimed at determining the clinical and prognostic significance of these impairments are warranted.

Abstract 4132752: The immune checkpoint landscape in human atherosclerosis: influence of lipid lowering and type 2 diabetes

Immune checkpoint inhibitor (ICI) therapies substantially increase the risk of atherosclerotic cardiovascular events in cancer survivors. Here, we mapped the expression of immune checkpoints (ICs) within human atherosclerotic plaques, unraveling an intricate local network of immune cell-cell interactions in the context of relevant comorbidities like dyslipidemia and diabetes. Our findings identified a population of mature, regulatory CCR7 + FSCN1 + dendritic cells as pivotal orchestrators of IC-mediated signaling within human and murine plaques, a function akin to their role in tumor environments. In clinical cohorts, type 2 diabetes diminished CCR7 + FSCN1 + dendritic cells within atherosclerotic plaques and dampened interactions steered by PD-1 or CTLA4 consistently across immune cell subpopulations. This effect was also present and further decreased by lipid lowering in the circulation, where CD86–CTLA4 was among the most prominent IC pairs signaling between regulatory T cells and myeloid populations including CCR7 + FSCN1 + dendritic cells. These findings underline the vulnerability of atherosclerotic plaques to cancer immunotherapies and underscore the critical impact of cardiometabolic disease and lipid-lowering strategies on the atherosclerotic IC landscape, offering a framework toward the reshaping of clinical approaches.

PCSK9 inhibitor with cause-specific mortality amongst cancer survivors: a chance to kill two birds with one stone.

PCSK9 inhibitor with cause-specific mortality amongst cancer survivors: a chance to kill two birds with one stone.

Personalised exercise rehabilitation in cancer survivorship: Findings from a triage and referral feasibility study.

Screening, triage and referral systems are proposed as efficient, needs-based models of cancer rehabilitation. This study aimed to evaluate the feasibility of the PERCS triage and referral system. Utilising a pre-post design, the feasibility of PERCS was evaluated quantitatively in the context of a physiotherapy-led clinic for patients diagnosed with cancer during COVID-19. Assessments at baseline and 12weeks (T1) included medical, social and physical activity history; patient-reported outcomes and performance-based measures. Following the assessment, the PERCS system allocated participants to one of three exercise pathways. Sixty-four participants were recruited over 5months (25.2% recruitment rate; female n = 39; mean age 61.4 (12.4) years). Almost all participants (90.6%) required support to become more physically active. The majority (n = 43, 66%) were referred to community exercise programmes, and n = 15 (23%) required physiotherapy rehabilitation. Five required medical pre-clearance, and one was re-triaged at 1week. The mean cost per participant for community exercise services was €107.70. At T1, adherence to physical activity guidelines increased for aerobic (44 to 83%) and resistance (13 to 67%) exercise. Improvements were observed in hand grip strength (x̄ 2.59kg, p = 0.001), 30-s sit-to-stand (x̄ + 3.7 stands, p < 0.001) and 6-min walk test (x̄ + 37.3m, p = 0.001). PERCS appropriately triaged patients to the right level of exercise and rehabilitation for individual needs. Participants experienced improvements in physical activity and physical functioning metrics. The PERCS triage and referral system is feasible to complete and may support the effective and patient-centred implementation of exercise into cancer care. ClinicalTrials.gov registration: NCT05615285.

Investigation of the efficacy of siRNA-mediated KRAS gene silencing in pancreatic cancer therapy

Aim Pancreatic carcinoma is an aggressive cancer that progresses without many symptoms. The difficulty of early diagnosis and an inadequate response to traditional treatments also cause the survival rate of pancreatic cancer to be low. Current research is focusing on methods of diagnosis and treatment, such as gene therapy, to increase survival rates. Small interfering ribonucleic acid (siRNA) has emerged as a promising advanced therapeutic strategy for cancer treatment. This study sought to silence the KRAS gene in the human pancreatic carcinoma cell line using a complex of small interfering ribonucleic acid (siRNA) and gold nanoparticles (AuNP). Methods In this study, 25 nM siRNA and gold nanoparticles at 0.5 mg/ml, 0.25 mg/ml, and 0.125 mg/ml concentrations were used to silence the KRAS gene in the CAPAN-1 cell line. Real-time PCR analysis, agarose gel electrophoresis, and double staining were carried out, and xCelligence real-time cell analysis (RTCA) was used to measure proliferation. Results The PCR analysis revealed crossing point (CP) values of actin beta (ACTB) ranging from 33.04 to 35.98, which was in the expected range for all samples. The interaction between the gold nanoparticle/siRNA complex in the double staining analysis revealed that the most effective concentration of gold nanoparticle was 0.125 mg/ml. The WST-1 technique showed that siRNA/AuPEI cells in application groups had a viability rate of over 90%, indicating no toxicity or side effects. The xCELLigence RTCA® showed that at hour 72, there was a significant difference in proliferation in the 0.5 mg/mL PEI/AuNP-siRNA, 0.25 mg/mL PEI/AuNP-siRNA, and 0.125 mg/mL PEI/AuNP-siRNA application groups compared to the control and siRNA groups (p &lt; 0.05). By hour 96, all three groups were statistically different from the control and siRNA groups in terms of proliferation (p &lt; 0.05). Conclusions The results of this analysis suggest that the AuPEI/siRNA complex can be effectively used to silence the target gene, but more studies are needed to verify these results.

Late side effects of testicular cancer and treatment: a comprehensive review.

Testicular cancer is a rare solid organ tumour associated with high cure rates and young age at diagnosis, hence it has a sizeable cohort of survivors worldwide. As it is one of the earliest tumours to be cured, a lot of studies have highlighted the late side effects of cancer and its different treatment modalities including surgery, radiotherapy and chemotherapy. While we are trying to identify the population at higher risk of platinum based chemotherapy and reduce its exposure, cisplatin based regimes remain an important tool to cure testicular cancer. The list of late side effects include a number of fatal and morbid conditions including but not limited to the second malignant neoplasms, cardiovascular disease, hypogonadism, infertility, metabolic syndrome, chronic respiratory disease, renal insufficiency, hearing loss, peripheral neuropathy, infertility and psychological illnesses like stress and anxiety. These complications eventually result in compromised social and economic health as well as lower life expectancy compared to the normal population. This article provides a comprehensive review of the latest data regarding the late side effects in testicular cancer survivors. A review of these conditions can help us develop recommendations and guidelines to improve the morbidity and mortality in survivors of testicular cancer.

Automatic segmentation-based multi-modal radiomics analysis of US and MRI for predicting disease-free survival of breast cancer: a multicenter study.

Several studies have confirmed the potential value of applying radiomics to predict prognosis of breast cancer. However, the tumor segmentation in these studies depended on delineation or annotation of breast cancer by radiologist, which is often laborious, tedious, and vulnerable to inter- and intra-observer variability. Automatic segmentation is expected to overcome this difficulty. Herein, we aim to investigate the value of automatic segmentation-based multi-modal radiomics signature and magnetic resonance imaging (MRI) features in predicting disease-free survival (DFS) of patients diagnosed with invasive breast cancer. This retrospective multicenter study included a total of 643 female patients with invasive breast cancer who underwent preoperative ultrasound (US) and MRI for prognostic analysis. Data (n = 480) from center 1 were divided into training and internal testing sets, while data (n = 163) from centers 2 and 3 were analyzed as the external testing set. We developed automatic segmentation frameworks for tumor segmentation by deep learning. Then, Least absolute shrinkage and selection operator Cox regression was used to select features to construct radiomics signature, and corresponding radiomics score (Rad-score) was calculated. Finally, six models for predicting DFS were constructed by using Cox regression and assessed in terms of discrimination, calibration, and clinical usefulness. The multi-modal radiomics signature combining intra- and peri-tumoral radiomics signatures of US and MRI achieved a higher C-index in the internal (0.734) and external (0.708) testing sets than most other radiomics signatures in predicting DFS, and successfully stratified patients into low- and high-risk groups. The multi-modal clinical imaging model combining the multi-modal Rad-score and clinical traditional MRI model-score resulted in a higher C-index (0.795) than other models in the external testing set, and it had a better calibration and higher clinical benefit. This study demonstrates that the multi-modal radiomics signature derived from automatic segmentations of US and MRI is a promising risk stratification biomarker for breast cancer, and highlights that the appropriate combination of multi-modal radiomics signature, clinical characteristics, and MRI feature can improve performance of individualized DFS prediction, which might assist in guiding decision-making related to breast cancer.

Abstract 4118178: Echocardiographic Measure of Right Ventricular-Pulmonary Arterial Coupling Predicts Survival in Lung Cancer

Background: Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer. We sought to test the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling, further enhancing the prognostic strength of echocardiography in lung cancer. Methods: This prospective observational study included 220 patients with non-small cell lung cancer (NSCLC) examined by Doppler, strain and 3D echocardiography before starting therapy. Prediction of overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses. Results: Echocardiographic examination was on average within normal limits, even though 30% of the patients had sPAP ≥35 mm Hg. In univariable analysis, overall survival was associated with measures of RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (HR: 5.766 [95% CI: 1.025–32.443]) and Eastern Cooperative Oncology Group performance status &lt;2 (HR: 0.332 [95% CI: 0.171–0.644]) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was −0.54%/mm Hg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP &gt;−0.54%/mm Hg) had worse survival than those with maintained RV-arterial coupling (HR: 2.8 [95% CI: 1.5–5.3]); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.57 [95% CI: 0.28–1.14]). Conclusion: RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.

Associations Between Dietary Patterns and Quality of Life in a Longitudinal Cohort of Colorectal Cancer Survivors

Purpose: To characterize dietary patterns and examine associations with cross-sectional and longitudinal changes in quality of life (QOL) over approximately one year after colorectal cancer (CRC) diagnosis. Methods: The ColoCare Study is an international, multi-center, prospective cohort study of newly diagnosed CRC survivors of any stage. A subset of participants with CRC in the United States completed patient-reported outcome measures at 6- and 12-months post-enrollment, including the Food Frequency Questionnaire (FFQ) and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Dietary patterns at 6 months (around the time of treatment completion) were identified using Principal Component Analysis (PCA) with varimax rotation. Adherence scores were calculated for participants within each dietary pattern, with higher scores indicating higher adherence. Mixed models were used to examine the effect of each dietary pattern on changes in QOL at 6- and 12-month follow-ups, controlling for cancer stage, biological sex, body mass index (BMI), smoking status, and age. Results: Participants (N = 174) were, on average, 56 ± 14 years old and were mostly female (51.5%), stage III or IV (51.7%), never smokers (60.2%), non-Hispanic (97.1%), and White (83.3%) with a BMI of 27.9 ± 6.1 kg/m2. PCA revealed two emerging dietary patterns: “Western diet”, characterized by processed meats, refined grains, and sugars, and “Prudent diet” characterized by lean proteins, fruits, and vegetables. Higher adherence to a Western diet was associated with worse social functioning at 6-month follow-up (FE = −12.6, p = 0.010). Loss of appetite from 6 to 12 months was associated with higher adherence to both the Western and Prudent dietary patterns (FE = 1.5, p = 0.044; FE = 1.3, p = 0.046, respectively). Neither dietary pattern was associated with global QOL score at 6- or 12-month follow-up (p’s &gt; 0.05). Conclusions: Among CRC survivors in the United States, the Western diet was concurrently associated with worse social functioning. Loss of appetite was reported by CRC survivors following both dietary patterns, suggesting that loss of appetite may be a global experience for CRC survivors during this timeframe. Further research is needed to understand specific social challenges experienced by CRC survivors and develop supportive care interventions to address appetite and nutritional concerns.

Abstract 4137985: Impaired Skeletal Muscle Condition and Stroke Volume Reserve Characterize Poor Exercise Performance in Childhood Cancer Survivors

Background: Childhood cancer survivors (CCS) frequently show poor exercise performance, but its pathophysiology and clinical significance are poorly understood. Methods: Poor exercise performers, defined as peak oxygen consumption (VO2)/kg &lt; 80% of predicted maximum VO2/kg, were enrolled, including 40 CCS (20 males, 20 females) and 32 controls (15 males, 17 females) from 79 CCS and 147 age-matched controls, respectively. Peak and submaximal CPET parameters were compared between CCS and controls with poor exercise performance. Submaximal slope parameters represent a trend up to anaerobic threshold (AT). Results: Ages and anthropometric measurements (weight, height, and body mass index) were comparable between CCS and controls in both sexes (Table 1). Both resting and peak heart rate (HR) were significantly higher in CCS than in controls in males. There was no significant difference in peak VO2/kg, peak oxygen pulse (OP)/kg, peak respiratory exchange ratio, or VO2/kg at AT (VAT/kg) between CCS and controls in both sexes. Peak work rate (WR/kg) was significantly lower in CCS compared with that in controls in both sexes, suggesting reduced muscle strength in CCS. Figure 1 demonstrates decreased muscle mass/strength in CCS than in controls. In males, Δ[VO2/kg]/ ΔHR was significantly lower in CCS than in controls, indicating limited stroke volume reserve (SVR) in male CCS. In female, although there was no significant difference in Δ[VO2/kg]/ΔHR between CCS and controls, HR-dependency expressed by ΔHR/Δ[WR/kg] was significantly higher in CCS than in controls, suggesting impaired SVR. ΔVO2/ΔWR, a marker for physical conditioning, was comparable between CCS and controls in both sexes. Conclusions: Poor exercise performance in CCS is characterized mainly by decreased muscle mass/strength and impaired SVR for both sexs. Impaired SVR may be an early sign of subclinical cardiotoxicity. Poor exercise performance in CCS should be improved to prevent future cardiovascular complications.

Effectiveness of supervised combined aerobic and resistance exercise in fatigue of prostate cancer survivors under androgen deprivation therapy: a systematic review and meta-analysis

Abstract Objectives Cancer-related fatigue is prevalent in prostate cancer patients. This symptom can negatively affect patients’ performance and emotional well-being, but there is no consensus on the best therapeutic approach. Despite the growing evidence on the management of fatigue with exercise, there are recognised limitations in its use when considering the different cancer patients. Specifically, prostate cancer patients under androgen deprivation therapy present several contributors to fatigue, emotional distress, inactivity, and deconditioning. The aim of this research was to describe the current literature on the effects of supervised combined aerobic and resistance training on fatigue in patients under androgen deprivation therapy. Methods We conducted a literature search in PubMed, Scopus, and Web of Science. The GRADE and the Cochrane tools were used to assess the quality and risk of bias of the selected studies. Only randomised controlled trials in which combined aerobic and resistance training was used with prostate cancer patients under androgen deprivation therapy were included. A cancer-related fatigue meta-analysis was performed. Results Nine studies with a low risk of bias were included in the review. Regarding cancer-related fatigue, significant results that cannot be attributed to chance were found in favour of combined exercise (MD=0.71; 95 %; CI=0.05, 1.37; p=0.03; I2=91 %). The GRADE system showed a moderate recommendation. Conclusions Supervised combined aerobic and resistance training was proven to significantly improve fatigue in patients with prostate cancer under androgen deprivation therapy. These findings could provide clinicians with more information on the management of cancer patients under androgen deprivation therapy.

Abstract 4134306: Menopausal Status Protects Against Vascular Dysfunction Induced by Breast Cancer Chemotherapy

Introduction: Breast cancer chemotherapy is associated with an increased risk of cardiovascular events, particularly pronounced in postmenopausal women. Vascular damage and docetaxel-caused endothelial dysfunction may underlie these effects, although the role of estrogens and menopausal status remains undefined. Hypothesis: Estrogens protect premenopausal women from neoadjuvant chemotherapy-induced endothelial dysfunction (NACT regimen: docetaxel, doxorubicin, cyclophosphamide) and its component docetaxel. Methods: We studied vascular function and its molecular determinants in mammary artery branches from pre- and postmenopausal women undergoing breast cancer surgery, with or without prior NACT. Mechanisms were investigated in bilaterally ovariectomized female C57BL/6J mice treated with docetaxel or placebo. Results: While NACT evoked endothelial dysfunction characterized by the loss of nitric oxide bioavailability in blood vessels from postmenopausal women, premenopausal women were protected from this phenomenon (Fig. 1) . Furthermore, premenopausal women’s blood vessels exhibited resilience against NACT-induced vascular oxidative stress. In particular, NOX4 expression was markedly lower in NACT-treated arteries from premenopausal women compared to their postmenopausal counterparts. No differences were seen in the non-NACT groups. At the molecular level, NACT incited lower inhibitory phosphorylation of Thr495 eNOS in premenopausal women's arteries compared to those of postmenopausal women post-NACT. In mice following bilateral ovariectomy, docetaxel caused endothelial dysfunction, but did not perturb acetylcholine-induced vasodilation in non-ovariectomized mice. Docetaxel induced blood pressure only in the group of ovariectomized mice. Conclusions: NACT-induced vascular dysfunction, often observed in breast cancer survivors, is absent in premenopausal women. This can be partially attributed to the protective role of estrogens, which prevent excessive production of reactive oxygen species and inhibitory eNOS phosphorylation.

Causes of death after oral cancer diagnosis: a population based study

BackgroundNowadays, the number of oral cancer survivors is increasing, emphasizing the importance of thoroughly understanding diverse causes of death in oral cancer survivors. Our study aimed to investigate the distribution of causes of death after oral cancer diagnosis.MethodsEligible patients were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. We calculated the number of deaths in different demographic and clinicopathological variables during each follow-up period. Standardized mortality ratios(SMRs) were generated for each cause of death after oral cancer diagnosis.ResultsA total of 30538 patients diagnosed with oral cancer were included, and 17654 deaths were reported during follow-up period. 27.08% of deaths were caused by non-caner reasons. The proportion of non-cancer related deaths increased with the extension of survival time, and non-cancer death accounted for 57.93% of all deaths when followed up more than 10 years. The most common non-cancer cause of death was cardiovascular disease (SMR 4.68#; 95%CI 4.46-4.92).ConclusionsNon-cancer causes of death should not be ignored in oral cancer patients. For oral cancer survivors, multidisciplinary follow-up strategy should be recommended to achieve longer survival time.

Impact of Non-Pharmacological Cognitive Interventions on Real-World Daily Function in Children With Cancer: A Systematic Review.

Childhood cancer survivors (CCS) frequently experience cognitive challenges, which impact their ability to participate in functional activities. This systematic review examines the effects of nonpharmacological cognitive interventions on functional outcomes (e.g., activities of daily living). We systematically searched eight databases (e.g., PubMed, EMBASE) from 2012 to 2023. Two team members independently screened articles and extracted article, intervention, sample characteristics, and outcome data. We assessed intervention reporting with the Template for Intervention Description and Replication. Fourteen studies met inclusion criteria, representing 12 unique trials. Four of the six trials evaluating Cogmed, a computerized working memory training program, demonstrated functional benefits; small to large effects were observed for academic achievement (Cohen's d = 0.28-0.87) and decreased inattention in daily life (d = -0.36 and -0.98). Other interventions included exergaming, math or reading interventions, occupational therapy, and neurofeedback. Less than half of studies reported on intervention personalization (n = 5), fidelity assessment (n = 4), or cost (n = 1). Study heterogeneity limited our ability to meta-analyze results for functional outcomes. Limited evidence and gaps in quality of intervention reporting are barriers to addressing the cognitive challenges of CCS. Standardizing functional outcome measurement, identifying effective interventions, and improving the quality of intervention reporting could accelerate the translation of intervention research to clinical practice.

Comparing cancer stage at diagnosis between migrants and non-migrants: a meta-analysis.

Migrants face barriers accessing healthcare, risking delays in cancer diagnosis. Diagnostic delays result in later stage diagnosis which is associated with poorer cancer survival. This review aims to compare the differences in cancer stage at diagnosis between migrants and non-migrants. We conducted a systematic review and meta-analysis of three databases from 2000 to 2023 for studies conducted in OECD countries that compared stage at diagnosis between migrants and non-migrants. Meta-analysis compared odds ratios (OR) for early (stage I and II) stage at diagnosis. The Risk of Bias in Non-randomised Studies of Exposure tool was used to assess study quality. 41 of the 11,549 studies identified were included; 34 studies had suitable data for meta-analysis. Overall, migrants were significantly less likely to be diagnosed with early stage cancer compared with non-migrants (OR 0.84; 95% CI 0.78-0.91). This difference was maintained across cancer types, although only statistically significant for breast (OR 0.78; 95% CI 0.70-0.87) and prostate cancer (OR 0.92; 95% CI 0.85-0.99). Published studies indicate that migrants are less likely to be diagnosed with early stage cancer. Variation by cancer type, study location and region of origin highlights the need for further research to understand these differences.

Prevalence of major depression, suicidal ideation, and mental health treatment among cancer survivors.

Cancer diagnosis and treatment can result in a significant psychological burden. This study sought to investigate the prevalence of major depression, associated treatments, and suicidal ideation in cancer survivors compared to a non-cancer cohort. This is a retrospective, population-based study using survey responses from the National Survey on Drug Use and Health collected from January 2015 to December 2019. Survey data sets were queried for all respondents who provided a cancer history. Respondents with a reported history of cancer ("cancer survivors") were further stratified by whether they reported a "recent" cancer diagnosis within the past 12 months. Survey responses were evaluated for recent diagnoses of and treatments for major depressive disorder and suicidal ideation. Among the 212,411 survey respondents identified, 7,635 (3.6%) reported a cancer history, with 1,486 (0.7%) reporting a recent cancer history. There were no differences in prevalence of major depression between cancer survivors and participants without cancer (9.3% vs 9.2%, p = 0.762), though the prevalence was slightly higher among recent cancer survivors (10.0% vs 9.2%, p = 0.259). Among respondents diagnosed with major depression, cancer survivors were significantly more likely to receive treatment for depression (78.6% vs 60.3%, p < 0.001). Suicidal ideation was significantly lower among cancer survivors (5.1% vs 6.2%, p < 0.001) including recent survivors (5.0% vs 6.2%, p < 0.001). There was no overall difference in the prevalence of major depression between cancer survivors and respondents without cancer. Survivors with major depression were more likely to receive treatments. Prevalence of major depression was higher in recent cancer survivors.

Alcohol and cannabis use associated with cardiometabolic biomarkers among "All of Us" cancer survivors.

Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex. Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018-2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs never) in the past three months and hazardous alcohol intake (AUDIT-C >3 for females, AUDIT-C >4 for males) vs non-hazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic systems biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for socio-demographic and clinical factors. In our sample (N=7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared to 7% of Black survivors. Compared to never users, co-users were 1.58(95% CI=1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences. Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities. The study investigates substance use and cardiometabolic biomarkers, urging more research on their effects on cancer survivors.

Impact of Persistent Alopecia on Quality of Life in Childhood Cancer and Transplant Survivors.

While alopecia associated with chemotherapy, radiation, or hematopoietic stem-cell transplant (C/R/HSCT) is transient in most children, prior reports indicate nearly one in seven childhood cancer survivors suffer from persistent alopecia after their treatment is completed. The objective of our study was to better characterize the impact of C/R/HSCT-associated persistent alopecia on patient quality of life. A cross-sectional cohort study of patients with a history of C/R/HSCT who were seen at Dana Farber Cancer Institute/Boston Children's Hospital Dermatology from August 2023 to February 2024 for any indication was conducted. Patients who completed their C/R/HSCT treatment regimen >6 months prior to visit were invited to fill out a survey on patient experience with persistent alopecia, including a modified Children's Dermatology Life Quality Index (CDLQI). Participants also underwent a full scalp examination. Twenty one out of 47 (44.7%) patients in our cohort self-reported persistent alopecia. For nine additional patients, alopecia was not self-reported but noted by a dermatologist on exam. Median self-reported alopecia severity was 3 (interquartile range [IQR] 2-5.25) on a visual analog scale of 1-10. The most common pattern of alopecia was diffuse thinning. Median CDLQI score was 5 (IQR 2-7) for those with persistent alopecia, indicating a small negative effect of disease on patient quality of life. Fifteen (31.9%) patients report receiving information about persistent alopecia prior to their C/R/HSCT. Nearly half of childhood cancer and transplant survivors evaluated by dermatology suffered from persistent alopecia, which negatively impacted their quality of life. Better counseling on persistent alopecia should be provided to childhood cancer patients.

Quality of Life of Adolescents and Young Adult Survivors of Childhood Cancer: A Qualitative Study.

To analyse how adolescents and young adults who survived childhood cancer experience their quality of life and to explore their meanings and conceptualisations of quality of life. Narrative design following Squire's method. In-person and virtual recruitment, due to the global COVID-19 pandemic, was carried out in Brazil between May and November 2021. Eighteen semi-structured virtual interviews were conducted with childhood cancer survivors. These data were analysed using reflexive thematic analysis and employing a triangulation of investigators. Four subthemes were identified, encompassing participants' perceptions and meanings of quality of life. Through the reflection and synthesis of these subthemes, a central theme emerged entitled 'New self', capturing the profound impact of the cancer and survival experience on every aspect of the self, along with participants' sense of having gained 'a new life' and a 'second chance'. The study provides a rich and nuanced understanding of quality of life for childhood cancer survivors. The results highlight that after all the changes in life due to cancer, integrating the new self becomes a central aspect of quality of life for survivors. Recognising the profound shifts in self-perception that survivors of childhood cancer undergo, nurses should engage early in empowering patients and families, offering education, space and support to help adolescents and young adults grow throughout their journey. The richness and depth inherent in qualitative data on quality of life can inform the development of care standards and health policies for survivors, guide the allocation of strategic resources and shape the development of plans and interventions focusing on childhood cancer survivors. The COREQ checklist was used. No patient or public contribution.