End Of Cancer Treatment Research Articles

Opioid tapering and discontinuation for head and neck cancer (HNC) survivors.

366 Background: Older HNC survivors often experience post-treatment pain, and they fill opioid prescriptions more often than similar cancer-free adults for the first 5 years after HNC diagnosis. To better understand whether ongoing opioid use is likely explained by continued opioid prescribing from the time of cancer treatment, we aimed to quantify the extent to which opioids prescribed near the end of treatment are reduced in dose (tapered) and discontinued after treatment completion. Methods: Using linked Surveillance, Epidemiology, and End Results (SEER) registry and Medicare claims data, we identified adults age >65 diagnosed 2014-2017 with stage I-III HNC with ≥6 months treatment-free follow-up prior to censoring at further treatment, new cancer, hospice, 3 months prior to death, or end 2019. We evaluated the presence of a new or ongoing opioid prescription 2 weeks following treatment completion (baseline) and calculated daily baseline dose in morphine milligram equivalents (MME). Among those with an opioid prescription (“on opioids”) at baseline, we described cross-sectional metrics of opioid receipt and dose every 30 days: proportion of survivors on opioids (who were also on opioids the prior month), initial and current dose of opioids for those currently on opioids, and proportion of survivors on opioids whose dose declined ≥50% from baseline. Results: Among 5135 HNC survivors, 894 were on opioids at baseline (average daily dose 44 MME). By 1 month, 29% of survivors on opioids at baseline (N=260) had a current opioid fill, and 7% had an opioid dose <50% of the baseline dose. Discontinuation of opioids increased each month; median daily dose each month ranged from 44 MME at 30 days to 60 MME at 180 days. Those who remained on opioids over 6 months had the highest opioid dose than those who discontinued earlier (median 45 MME at 90 days; Table). Conclusions: About 1 in 6 HNC survivors had an opioid prescription filled at the end of cancer treatment, and opioids were generally discontinued within a few months. Given the low median dose at baseline, the limited evidence of tapering likely results from low initial opioid doses rather than a failure to taper from long-term or high-dose use. Opioid use among older treatment-free HNC survivors that is apparent years after treatment completion is unlikely to result from inadequate tapering. Instead, it may be due to new or worsening cancer-related pain, as well as to non-cancer pain. Dose reduction and discontinuation (N=894). Days after baseline Off opioids On opioids Starting dose in MME among those on opioids Current dose in MME among those on opioids Tapered to <50% starting dose N (%) N (%) Median (IQR) Median (IQR) N (%) 30 634 (71) 260 (29) 53 (30, 80) 44 (29, 60) 61 (7) 60 772 (86) 122 (14) 45 (30, 67.5) 44 (29, 60) 15 (2) 90 820 (92) 74 (8) 58 (30, 90) 45 (29, 60) 7 (1) 120 838 (94) 56 (6) 60 (30, 90) 45 (25, 60) 7 (1) 150 849 (95) 45 (5) 56 (30, 65) 48 (29, 60) 2 (<1) 180 856 (96) 38 (4) 51 (30, 65) 60 (30, 90) 1 (<1)

Patients’ Perceived Valorization Toward Ringing the Cancer Bell at the End of Their Radiation Therapy

In recent times, "ringing the bell" at the end of cancer treatment has attracted the attention of health care providers with regard to how this experience impacts patients' mental and emotional health. In this context, a study was conducted at a radiation oncology center in Santiago, Chile, to assess the perceived valorization of patients toward "ringing the bell" at the end of their treatment. It was further determined whether this experience had a positive or negative impact on their mental health. Two hundred thirty-six patients were invited to respond to a printed anonymous survey that used a Likert scale to evaluate their perceived valorization of "ringing the bell" after radiation therapy. In this survey, patients were also asked questions regarding their background to examine possible trends related to different lifestyles and socioeconomic status. The results showed that 93.6% of participants classified the experience as "positive" or "very positive." There were 6 "negative" responses out of 708 (0.8%) to the 3 questions regarding perceived valorization of the experience and no "very negative" responses. "Ringing the bell" at the end of radiation therapy can be considered a psychological comfort that positively impacts patients' mental health. No trends related to socioeconomic status were observed.

Natural supplementation to effectively combat cancer-related fatigue: Evidence from a meta-analysis on the use of guarana.

e24087 Background: Cancer-related fatigue (CRF) is one of the most common symptoms reported and is estimated to affect up to 90% of cancer patients during the course of the disease. CRF may persist even after the end of cancer treatment. There is no definitive effective treatment with a high level of evidence and several alternatives have been sought after to aid traditional medications, with emphasis on natural supplements as a form of adjuvant treatment. In previous studies carried out by the Department of Oncology at ABC Medical School, a purified extract of Guarana ( Paullinia cupana), a plant native to the Amazon, showed promising results in clinical trials with patients undergoing chemotherapy, but with a limited number of patients and, thus, lower level of evidence. Therefore, the present study carried out a systematic review and meta-analysis of the supplementation of Guarana and its derivatives to combat CRF to produce more robust evidence regarding its possible therapeutic effect. Methods: Systematic review with meta-analysis registered at the International Prospective Register of systematic reviews (PROSPERO) under code CRD42023484144. Two independent researchers searched for articles in English on PUBMED, MEDLINE and Cochrane Library using controlled vocabulary (MeSH terms) and keywords related to CFR, Guarana and its related terms. Eligible studies were selected based on predefined criteria and were assessed for quality according to Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers – any discrepancies were resolved by a third researcher. On the rare occasions in which a study was published as an abstract and then published as a full article, only its complete version was considered eligible for inclusion to avoid duplicates and reduce risk of bias. All analyses were conducted with RevMan 5.4.1 and employed random-effects model. Results: Of the 117 articles found, 4 full articles and 1 abstract were added to the meta-analysis, comprehending a total of 229 patients and the years of 2007-2023. With high heterogeneity between studies (I² = 78%, Chi² = 18.51, df = 4, P = 0.0010), our analysis found benefit in using guarana to combat CRF: Standard Mean Difference -0.77 (IC95% -1.34; -0.21), Test for overall effect: Z = 2.68 (P = 0.007). Conclusions: Our analysis supports the use of Guarana to combat Cancer-Related Fatigue. Further investigation with prospective randomized controlled trials should be carried out to validate our findings.

We Are Done! Now What? Exploring End of Treatment Needs of Childhood Cancer Survivors and Their Parents.

Background: Increased childhood cancer survival rates have spurred a new body of research pertaining to the cancer-survivorship continuum. Literature suggests a lack of research and guidelines for care at the end of treatment (EOT). To improve the transition to survivorship and determine any posttreatment challenges, this study explored the experiences of childhood cancer survivors (CCSs), parents/caregivers, and pediatric oncology health care professionals (HCPs) at EOT. Method: This study employed a mixed methods design. EOT Questionnaires were completed by CCSs and parents/caregivers within 6 months of completing treatment, and by pediatric oncology HCPs. Results: A total of 75 CCSs and parents/caregivers and 21 HCPs completed the study. The majority of parents/caregivers (78%) and older CCSs (94%) recalled having an EOT "meeting." Most were satisfied with the meeting, but described unexpected worries/problems following EOT. Family members stating they were "very satisfied" with the EOT meeting increased significantly relative to the number of EOT topics addressed. In contrast, the omission of certain psychosocial discussion topics negatively correlated with satisfaction. Oncologists provided the majority of EOT services, with infrequent provision by other HCPs. Less than 20% of HCPs characterized families as "very satisfied" with EOT services and suggested improvements to meet families' needs. Discussion: This study found unmet psychosocial and anticipatory guidance needs, indicating a lack of preparedness. The results suggest that end of cancer treatment requires a more standardized, comprehensive, and multidisciplinary approach. Enhanced education and support services are needed to promote the successful navigation of all families through this period of transition.

European recommendations for short-term surveillance of health problems in childhood, adolescent and young adult cancer survivors from the end of treatment to 5years after diagnosis: a PanCare guideline.

Childhood, adolescent and young adult (CAYA) cancer survivors require ongoing surveillance for health problems from the end of cancer treatment throughout their lives. There is a lack of evidence-based guidelines on optimal surveillance strategies for the period from the end of treatment to 5years after diagnosis. We aimed to address this gap by developing recommendations for short-term surveillance of health problems based on existing long-term follow-up (LTFU) care guidelines. The guideline working group, consisting of healthcare professionals, parents and survivor representatives from 10 countries, worked together to identify relevant health problems that may occur in survivors between the end of treatment and 5years after diagnosis and to develop recommendations for short-term surveillance of health problems. The recommendations were drawn from existing LTFU guidelines and adapted where necessary based on clinical expertise. The working group developed 44 recommendations for short-term surveillance of health problems, which were divided into four categories based on the level of surveillance required: awareness only (n = 11), awareness, history and/or physical examination without surveillance test (n = 15), awareness, history and/or physical examination with potential surveillance test (n = 1) and awareness, history and/or physical examination with surveillance test (n = 17). The development of a guideline for short-term surveillance of health problems fills a critical gap in survivorship care for CAYA cancer survivors, providing much-needed support immediately after treatment up to 5years after diagnosis. This guideline will support healthcare professionals to provide appropriate follow-up care and improve the quality of life of CAYA cancer survivors.

Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination.

Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter-Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of -17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m2, and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (-19.1 ± 3.1% vs. -16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter-Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment.

The Place of Sick Peers in Adolescents and Young Adults with Cancer: Advantage, Disadvantage, and What Makes Barriers to the Encounter.

Purpose: The appreciation of peer support can vary from one country to another due to the cultural and relational differences. This study explores what perceptions French adolescents and young adults (AYAs) in post-treatment for cancer have of the place of sick peers during their treatment and what can make barriers to meet them. Methods: A semistructured interview has been proposed 6 months after the end of cancer treatments. A thematic analysis has been conducted to highlight the major themes and subthemes identified through the participants' discourses. Results: Twelve AYAs (mean age 23 y.o., standard deviation = 2.8; min = 19; max = 26) from two French cancer centers were interviewed. Five major themes were identified, but only two were presented in this article: the place of peers and the impact of coronavirus disease 2019 (COVID-19) epidemic on AYA facilities. AYA peers with cancer major theme demonstrated that meeting sick peers has benefits (e.g., identification, understanding, support, feeling of normalcy) but also has disadvantages (e.g., negative emotional influence). The benefits of peer-to-peer meetings seem to outweigh the disadvantages. Nevertheless, AYAs can face social barriers to this kind of relationship (e.g., fatigue, need to focus on oneself, confrontation to cancer and negative events, feeling of unnatural meeting). Finally, patients' encounters and the normal functioning of AYA facilities have been hampered by the COVID-19 pandemic. Conclusion: Even if AYA services systematically suggest a meeting with other sick peers, it is important to reiterate this proposal since the needs can evolve over time. It can also be interesting to propose places of life outside the hospital to make the encounters more comfortable and natural for AYAs. Clinical Trial Registration number: NCT03964116.

Factors associated with employment status among mothers of survivors of childhood cancer: a cross-sectional study.

To identify the factors associated with employment status among mothers of childhood cancer survivors (CCSs). We conducted a questionnaire survey on mothers of survivors of childhood cancer to clarify practical factors such as care demands, psychological factors such as motivation to work, and support. After calculating descriptive statistics for all variables, binary logistic regression analysis was performed. Of 171 mothers, 129 (75.4%) were employed. The most common form of employment was non-regular (n = 83; 48.5%), including part-time, dispatched, and fixed-term workers. At the time of the survey, compared with nonworking mothers, working mothers tended to be more motivated to work and have lower scores for "Long-term Uncertainty" on the Parent Experience of Child Illness Scale. The results of the binary logistic regression analysis indicated that employment was related to higher motivation to work, the continuation of employment during treatment, more outpatient visits, and a higher amount of support. As employment of CCSs' mothers is associated with psychological factors such as motivation to work and long-term uncertainty, psychological support for CCSs' mothers might promote employment. In addition, because the continuation of employment during treatment affects the employment of mothers after the end of cancer treatment, a leave system that covers the treatment period for childhood cancer needs to be established.

Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge.

Patients with chronic inflammatory bowel diseases (IBD) have increased risk of developing intestinal and extraintestinal cancers. However, once a diagnosis of malignancy is made, the therapeutic management of Crohn's disease (CD) and ulcerative colitis (UC) can be challenging as major guidelines suggest discontinuing the ongoing immunosuppressant and biological therapies for at least 2-5 years after the end of cancer treatment. Recently, new molecules such as vedolizumab and ustekinumab have been approved for IBD and limited data exist on the real risk of new or recurrent cancer in IBD patients with prior cancer, exposed to immunosuppressants and biologic agents. Thus, a multidisciplinary approach and case-by-case management is the preferred choice. The primary aim of our review was to summarize the current evidence about the safety of reintroducing an immunosuppressant or biologic agent in patients with a history of malignancy and to compare the different available therapies, including gut-selective agents. The secondary aim was to evaluate the clinical course of the IBD patients under cancer treatment who do not receive any specific immunosuppressant treatment after the diagnosis of cancer.

Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis

Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. © 2022 Published by Elsevier Ltd. All rights reserved.

SY26-4 Long-term management of late cardiotoxicity and multidisciplinary collaboration in cancer survivors

While advances in cancer treatment have improved the prognosis of cancer patients, the increasing number of cases of cancer associated with cardiovascular disease has increased the chances of receiving tumor cardiovascular support in the acute phase of cancer treatment. However, the response to late complications that appear more than 5-10 years after the end of cancer treatment in cancer survivors is by no means sufficient. Moreover, late cardiotoxicity often follows a serious clinical course when it develops potentially, and there are many cases in which it is difficult to deal with it.

Low level laser therapy versus benzydamin in prevention and treatment of oral mucositis induced by anticancer treatments (clinical and biochemical study)

Objective: In this study, patients undergoing neck and head radiotherapy (RT) with or with no chemotherapywere contrasted to the low-level laser therapy (LLLT) efficacy against benzydamine hydrochloride in treating andpreventing oral mucositis (OM) (CHT). Material and Methods: This study included 90 individuals with neckand head cancer who were undergoing radiotherapy (RT) individually or in mixture with chemotherapy (CHT),varying in age from 18 to 80 years. Three equal groups were randomly formulated: Group, I patients were usingoral care only, Group II patients were using benzydamine hydrochloride mouth rinse, and Group III patientswere medicated by using low-level laser therapy. The National Institute of Cancer-Common Toxicity Criteria(NIC-CTC) and the World Health Organization (WHO) were used to rate the severity of OM, and the pain wasvalidated utilizing a visual analog scale (VAS). The salivary level of tumor necrotic factor-a (TNF- a) was assayed. Results: As per WHO and NIC, the grade of oral mucositis at the end of cancer treatment was less in the LLLTgroup than in the other two groups. The alteration in TNF-a level was not significant. The laser group is moreliable to have less salivary levels of the pro-inflammatory cytokines TNF- a. Conclusion: The incidence of oralmucositis severity has seemed to be reduced due to the prophylactic use of benzydamine hydrochloride and lasertherapy protocols. However, laser therapy was more efficient in controlling the shape and progression of OM. KEYWORDSOral mucositis; Photobiomodulation; Radiation therapy; Chemotherapy; Low-level laser therapy; Benzydamine

Питание и нутритивная поддержка детей со злокачественными новообразованиями после завершения лечения: основные аспекты

Children with malignant neoplasms are a high-risk group for developing nutritional and metabolic disorders, which are one of the key disabling factors that significantly reduce the effectiveness of medical and social rehabilitation. Dynamic monitoring, screening, and timely correction of identified problems, including nutritional ones, constitute an essential precondition for the success of rehabilitation. The basic principles of nutritional correction in pediatric oncology include the following: a personalized approach; avoidance of long intervals between meals; prescription of any restrictive diets only for reasonable indications; multidisciplinarity; sparing of the gastrointestinal tract; timely initiation of nutritional support; continuity, dynamic monitoring, and control of nutritional status. The aim of this study is to describe the main aspects of nutritional support in children with malignant neoplasms after the end of cancer treatment. Key words: children, nutritional support, oncology, nutrition, cancer

Use of acupuncture in women surviving breast cancer: an integrative review

Breast cancer is the most common cancer among women worldwide. The human suffering associated with this disease is vast and complex, including physical, mental, and spiritual aspects, which last even after the end of cancer treatment. Acupuncture is an integrative practice with solid evidence for treating and managing symptoms related to cancer and its treatments. In this sense, this study aimed to carry out an integrative literature review on the benefits of acupuncture for the symptoms of women survivors of breast cancer. This is an integrative review carried out through the scientific databases PubMed and SciELO. The search strategy used was “survivorship” AND “breast cancer” AND “acupuncture”, respecting the period between 2017 and 2022. In all, 220 articles were located. Studies that considered other types of cancer and that did not focus on acupuncture in cancer survivors were excluded from the analysis. In the end, 26 articles related to the proposed theme remained, which were read and analyzed in full. Results were discussed separately on the evidence-based use of acupuncture on symptoms and long-term side effects related to breast cancer and its treatments. The material analyzed in this review showed that acupuncture is relatively safe and effective, when used properly and by trained and certified acupuncturists, and it is essential that health services and professionals involved in cancer treatment be trained in cancer survival programs and guide patients about the benefits of acupuncture and how to use it properly.

Educational programs for post-treatment breast cancer survivors: a systematic review

Objectives: The purpose of this systematic review was to identify the state of the scientific evidence related to educational programs for post-treatment breast cancer survivors (BCSs) during the last twenty years. Methods: A systematic search of PubMed/MEDLINE, CINAHL, EMBASE, Web of Science, and PsycINFO databases from January 2000 through May 2020 included keywords related to research on educational programs for BCSs. Inclusion criteria included: (1) focus on an educational program for post-treatment breast cancer survivors; (2) original research; (3) peer-review journals; (4) English language; and (5) published between January 2000 to May 2020. EndNote X9 (software version: X9, manufacturer: Clarivate, website location: endnote.com) was used as the reference management software package to manage citations from search results. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart of the selection process is presented in this paper. Results: A total of 24 educational programs/interventions research studies include one mixed-method study, three qualitative studies, and twenty quantitative studies, were identified and analyzed. Three programs focused on BCSs’ self-management and self-efficacy, two programs focused on BCSs’ cognitive problems, seven programs focused on BCSs’ psychological distress, emotional support, and information seeking. In addition, one program focused on BCSs’ body image, body function, and sexual dysfunction issues, five programs focused on BCSs’ physical activities, nutritional levels, and normal body weight maintenance, two programs focused on BCSs’ supportive care and peer advocate support. Finally, one program focused on BCSs’ palliative care and end of life care, and three programs focused on BCSs’ post-treatment symptom clusters and overall quality of life. Conclusions: After breast cancer treatment ends, BCSs continue to suffer from long-term physical and psychological symptoms and report multiple unmet needs. Research on post-treatment breast cancer educational programs showed that programs assist BCSs with post-treatment symptom management and address their concerns while promoting supportive care and peer support to improve BCS’s overall quality of life.

KAJIAN TERAPI KOMPREHENSIF DENGAN PENDEKATAN ERGONOMI TOTAL PADA PASIEN KANKER PAYUDARA DENGAN CANCER RELATED FATIGUE YANG KEMBALI BEKERJA

A total ergonomic approach is needed to facilitate breast cancer patients who have been declared cured and return to work to be able to be comfortably and not lose productivity. Cancer Related Fatigue is one of the common symptoms that occur in patients with cancer. These symptoms are also experienced by cancer patients who receive chemotherapy, radiation therapy, bone marrow transplantation, or other cancer treatments. Patients who have recovered from cancer report that Cancer Related Fatigue is a symptom of the disorder that is experienced months or even years after cancer treatment ends. Fatigue that continues to occur in cancer patients can interfere with the patient's quality of life so that a good assessment and management of this condition is needed. The total ergonomics approach with a systemic, holistic, interdisciplinary and participatory approach through appropriate technology is made into a comprehensive therapy that combines physical activity, relaxation therapy and education is one of the most definitive forms of treating Cancer Related Fatigue.
 Keywords: Total Ergonomics Approach, Cancer Related Fatigue, back to work

Home-Based Aerobic and Resistance Exercise Interventions in Cancer Patients and Survivors: A Systematic Review.

Simple SummaryExercise interventions are increasingly being recognized as an important part of treatment and supportive care for cancer survivors. Although the beneficial effects of exercise interventions on a number of physical and psychosocial factors, which can mitigate the effects of cancer treatment, have been described, several barriers remain that affect the use of exercise interventions. An alternative form, home-based (HB) exercise, has the potential to overcome several accessibility barriers that limit cancer survivors from participating in exercise-based interventions under professional supervision. In addition, in the current situation associated with the COVID-19 pandemic, alternative remote access models and their variations are strongly supported. Since a comprehensive review of HB exercise interventions is lacking, we reviewed the current literature on the role of HB exercise during the rehabilitation period in a cancer survivor population. This article identifies the literature on the health effects of HB exercise interventions and evaluates studies’ methodological quality. The obtained results provide a starting point for further research directions and addressing challenges in this research area.Cancer is a chronic disease requiring long-term treatment. Exercise interventions are increasingly being recognized as an important part of treatment and supportive cancer care for patients and survivors. Previous reviews have evaluated the benefits of exercise interventions in populations of patients under supervision at a center, but none have explored the possibilities of a home-based (HB) approach in exercise during cancer rehabilitation and the period immediately following the end of cancer treatment. The aim of this descriptive systematic review was to identify the literature focusing on the health effects of HB exercise interventions in cancer survivors and to evaluate the methodological quality of the examined studies. Relevant studies were identified by a systematic search of PubMed and the Web of Science until January 2021. Nine randomized controlled trials were included. Most studies were on aerobic and resistance exercises, and the frequency, duration, intensity, and modality varied across the different interventions. Improvements in cardiorespiratory fitness (CRF), physical activity (PA) levels, fatigue, health-related quality of life (HRQOL), and body composition have been reported. However, all the studies were limited in methodology and the reporting of results. Nevertheless, the evidence in this new area, despite the methodological limitations of the studies, suggests that HB exercise interventions are feasible, and may provide physiological and psychological benefits for cancer survivors during the rehabilitation period. A methodologically rigorous design for future research is essential for making progress in this field of study.

Association between global longitudinal strain and cardiopulmonary fitness in patients with breast cancer

Abstract Background Anthracycline and trastuzumab therapies improve survival in the cancer population, but are limited by treatment induced cardiotoxicity. Echocardiography derived global longitudinal strain (GLS) permits more sensitive detection of cardiotoxicity than left ventricular ejection fraction (LVEF). However, the clinical implication of a reduction in GLS in cancer survivors is unknown. Purpose To define the association between GLS and cardiopulmonary fitness in women with breast cancer immediately post cancer therapy. Methods Women with HER2+ early stage breast cancer (EBC, Stage I-III) receiving anthracyclines followed by trastuzumab were recruited prospectively and followed between January 2015 and December 2019 with echocardiography during therapy. Left ventricular peak systolic GLS (GE EchoPAC, 3 apical views) and 3D-LVEF were measured prior to anthracyclines, and after completion of trastuzumab at 12 months. Exercise capacity was measured using a supine bicycle cardiopulmonary exercise test. Results of exercise testing at end of treatment were compared between patients with and without reduced GLS (absolute value ≤18% vs >18%) at the end of therapy. Results Amongst 128 women, 43 (34%) had a GLS ≤18% at the end of trastuzumab therapy. Baseline patient demographics including tumor characteristics and cardiac risk factors were similar between those with normal and abnormal GLS. During treatment 33 (25.8%) participants developed cardiotoxicity defined by the CREC criteria based on 3D-LVEF. Significant baseline (pre-cancer treatment) differences were found between groups for GLS (GLS 21.2±1.8 vs 19.6±2.2, p<0.001) and 3D LVEF (61.8±3.5 vs 60.2±3.7%, p=0.02) for those with GLS >18% and GLS ≤18% respectively at the completion of trastuzumab. Compared to those with GLS >18% those with GLS ≤18% had lower VO2peak (17.4±3.8 mL.kg-1.min-1 versus 20.2±4.9 mL.kg-1.min-1, p=0.001) despite similar effort (respiratory exchange ratio 1.14 versus 1.12, p=0.30). GLS following therapy (β coefficient: −0.596, SE 0.255; p=0.02) and age (β coefficient: −0.115, SE 0.057; p=0.047) were the only parameters associated with VO2peak after adjusting for relevant confounding factors. Conclusion A significant proportion of women receiving cancer therapy for HER2+ EBC had reduced GLS at end of treatment. Abnormal GLS at the end of cancer treatment was associated with lower VO2peak. Reduced VO2peak is strongly associated with late-occurring cardiovascular events and should prompt closer cardiac monitoring, cardiac risk factor management, and referral to exercise rehabilitation programs. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institute of Health Research

Exploring the reasons cancer survivors do not seek help for their concerns: a descriptive content analysis

PurposeTo understand reasons why adult cancer survivors do not seek assistance as they transition from the end of cancer treatment to follow-up care. Understanding these reasons should inform survivorship care,...

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case-Control Analysis.

(1) To identify factors associated with severe dysfunctional larynx leading to total laryngectomy after curative treatment of head and neck squamous cell carcinoma and (2) to describe swallowing and voice outcomes. Retrospective single-institution case-control study. Tertiary care referral center. A 10-year chart review was performed for patients who had previously undergone radiation or chemoradiation for head and neck mucosal squamous cell carcinoma and planned to undergo total laryngectomy for dysfunctional larynx, as well as a control group of matched patients. Controls were patients who had undergone radiation or chemoradiation for mucosal squamous cell carcinoma but did not have severe dysfunction warranting laryngectomy; these were matched to cases by tumor subsite, T stage, and time from last treatment to video swallow study. Main outcomes assessed were postoperative diet, alaryngeal voice, pharyngeal dilations, and complications. Twenty-six patients were scheduled for laryngectomy for dysfunctional larynx, of which 23 underwent surgery. Originally treated tumor subsites included the larynx, oropharynx, hypopharynx, oral cavity, and a tumor of unknown origin. The median time from end of cancer treatment to laryngectomy was 11.5 years. All cases were feeding tube or tracheostomy dependent or both prior to laryngectomy. As compared with matched controls, cases were significantly less likely to have undergone IMRT (intensity-modified radiotherapy) and more likely to have pulmonary comorbidities. Eighty-nine percent of cases with follow-up achieved functional alaryngeal voice, and all were able to have oral intake. Non-IMRT approaches and pulmonary comorbidities are associated with laryngectomy for dysfunction after radiation or chemoradiation.