Long-term Cancer Survivors Research Articles

Prevalence and determinants of diabetes mellitus in 2,338 long-term Dutch childhood cancer survivors (DCCS-LATER2 Study).

Diabetes mellitus (DM), a possible adverse effect of childhood cancer treatment, is strongly associated with cardiovascular disease and early mortality in adult childhood cancer survivors (CCS). Here, we assess the prevalence and determinants of DM in our nationwide CCS cohort. In this cross-sectional study, the prevalence of DM was assessed in 2,338 CCS, using the Lifelines cohort (n=132,226 adults with no history of cancer) as a reference. DM was defined through serum glucose measurement (fasting glucose ≥7.0mmol/L or non-fasting ≥11.1mmol/L) and/or self-report (previous diagnosis and/or medication use). Multivariable logistic regression models, adjusted for age, sex, and BMI, were used to assess the cohort effect on the presence of DM. Multivariable logistic regression analysis was used to identify determinants of DM in CCS. Survivors (median age 34.7 years, median follow-up time 27.1 years) showed increased odds for hyperglycemia (aOR=2.72, 95%CI=2.06-3.59), previous DM diagnosis (aOR=3.03, 95%CI=2.33-3.95), and anti-diabetic medication use (aOR=2.94, 95%CI=2.17-3.99), compared to the reference cohort. Age (OR=4.32, 95%CI=1.84-10.15, >35 versus 18-35 years), BMI (OR=1.12, 95%CI=1.08-1.16, per point), family history of DM (OR=2.38, 95%CI=1.51-3.76), prior abdominal/pelvic radiotherapy (OR=4.19, 95%CI=2.32-7.55), total body irradiation (OR=14.31, 95%CI=6.98-29.34), hypogonadism (OR=2.40, 95%CI=1.15-4.99), hypertension (OR=1.71, 95%CI=1.06-2.76), and dyslipidemia (OR=3.81, 95%CI=2.15-6.75) were associated with DM in CCS. A significant interaction between age and sex on the development of DM in survivors was identified. The identified three-fold increased risk of DM in CCS, along with the clinically relevant -and some modifiable- determinants, underscores the importance of early risk-based screening and the exploration of lifestyle interventions in this population.

Health-related quality of life in parents of long-term childhood cancer survivors: a report from the Swiss Childhood Cancer Survivor Study - Parents.

Having a child with cancer can profoundly impact parents' health-related quality of life (HRQOL). However, there is a lack of knowledge about the long-term effects of childhood cancer on parents' well-being. The current study aimed to (1) describe the HRQOL of parents of long-term childhood cancer survivors (CCS) and compare it with that of parents from the general population in Switzerland, and (2) investigate sociodemographic and cancer-related determinants of lower HRQOL in parents of CCS. In this cross-sectional study, a total of 751 parents of CCS (mean time since diagnosis = 23.7 years, SD = 6.7 years) and 454 parents from the general population reported their HRQOL by completing the Short Form-36 (SF-36v2). Sociodemographic and cancer-related characteristics were also collected. Multilevel regression analyses showed that parents of CCS and parents from the general population had similar physical and mental HRQOL. When comparing mothers and fathers separately, there were no differences between the samples, except for higher HRQOL in the domain of physical functioning in mothers of CCS. Cancer-related characteristics were not associated with HRQOL in parents of CCS. Several sociodemographic characteristics such as being female, being from the French or Italian-speaking part of Switzerland, having a lower education, having a chronic condition, and having a migration background were associated with lower HRQOL. Parents of CCS are doing well a long time after their child's cancer diagnosis. Nevertheless, tailored support should be provided for at-risk demographic groups.

Long-term survival of node-positive breast cancer with complete nodal response to neoadjuvant chemotherapy treated with sentinel lymph node biopsy alone: A meta-analysis.

There exist concerns regarding the use of sentinel lymph node (SLN) biopsy alone in node-positive breast cancer patients who have a clinical/radiological complete response in the axilla and are negative on histopathology after neoadjuvant chemotherapy (NACT). We hereby conducted a meta-analysis examining 5-year overall survival (OS) and disease-free survival (DFS) of such patients. PubMed, the Cochrane CENTRAL library, Embase, Web of Science, and Scopus were searched up to 30th July 2024 for studies reporting survival data. OS and DFS were pooled in a meta-analysis. Subgroup analysis was conducted based on the location of the study, pre-NACT node assessment, and SLN mapping technique. Random-effects meta-regression was conducted for the following moderators: age, initial T3-4, initial N2-3, breast-conserving surgery, breast pathological complete response (pCR), number of SLN removed, adjuvant radiotherapy, endocrine therapy, and follow-up Results: 16 studies with 5249 patients were included. Meta-analysis showed that node-positive breast cancer patients showing nodal pCR after NACT and undergoing only SLN biopsy had a 5-year OS and DFS of 94% (95% CI: 92%, 96%) and 89% (95% CI: 87%, 92%) respectively. There was not much variation in the survival rate on sensitivity and subgroup analyses. Meta-regression showed that OS and DFS were higher in studies with a greater number of patients receiving endocrine therapy. Breast cancer patients with cN+ who achieve a complete clinical/radiological axillary response after NACT and subsequently become SLN biopsy negative may have high rates of DFS and OS after 5 years. Given the high degree of heterogeneity, results should be interpreted with caution. We do not recommend change in treatment plans given the high risk of bias and large heterogeneity in the patient population included in the studies. Only high-quality large multicentric randomised trials can provide better evidence.

Personalized frailty risk assessment in long-term survivors of colorectal cancer.

65 Background: Frailty, a pathologic form of aging, is associated with reduced quality of life and increased risk of death. Its incidence increases with age. Frailty is a concern for cancer survivors, especially since this population is surviving longer and increasing in size. There is a need to predict which patients are at risk of frailty to tailor preventative measures, particularly in early-stage colon and rectal cancer survivors, the largest group in gastrointestinal cancer survivors. Methods: This was a retrospective cohort study of individuals aged 66 and older in the SEER-Medicare linked database, diagnosed with stage I-III colon or rectal cancer between 2003-2012. Patients included in the study received definitive surgical treatment and survived for at least 5 years after diagnosis. Frailty was assessed using administrative claims codes with the Kim frailty index. Patients already frail at year 5 were excluded from the analysis. An increase in frailty score, indicating the onset of frailty or worsening to moderate or severe frailty, occurring within 5-10 years following cancer diagnosis was the primary outcome. Predictors of frailty were identified using restricted mean survival time (RMST) regression, with results less than 1 indicating a shorter time to frailty, and significant factors were used to develop a clinical prediction model and stratify patients into risk tertiles. Results: At 10 years or end of available follow-up, 58% of the patients had developed new onset or worsening frailty. There were no significant differences in RMST by patient race, sex, cancer stage and grade. Receipt of systemic therapy 4-5 years after diagnosis, having an ostomy present in years 4-5, advancing age, comorbidities, and living in an area with a greater proportion of residents below the federal poverty line were all associated with shorter time to frailty; the largest effects were seen with advancing age and comorbidities (Table). Our clinical prediction model incorporated age>85 and having multiple comorbidities for both cohorts and ostomy in years 4-5 for the colon cohort. Conclusions: Our population level analysis provided a clinical prediction model for frailty 5-10 years after cancer diagnosis in colon and rectal cancer survivors and may help inform long-term survivorship management. RMST for selected variables. Selected Variables RMST for Colon Cohort (95% CI) RMST for Rectal Cohort (95% CI) Age 85-89 (ref: age 71-74) 0.76 (0.73, 0.79) 0.79 (0.74, 0.84) Age 90+ (ref: age 71-74) 0.67 (0.64, 0.70) 0.74 (0.66, 0.82) 20-100% area-level poverty (ref: 0-<5%) 0.95 (0.92, 0.98) 0.96 (0.91, 1.02) Receiving systemic therapy in years 4-5 0.89 (0.85, 0.92) Not selected Ostomy in years 4-5 0.80 (0.69, 0.92) 0.97 (0.92, 1.02) Elixhauser Comorbidity Index (ECI) 1-2 (reference: ECI 0) 0.77 (0.75, 0.79) 0.79 (0.76, 0.82) ECI 3 (ref: ECI 0) 0.60 (0.57, 0.64) 0.67 (0.59, 0.76)

Cyclophosphamide is not associated with clinically relevant late pulmonary dysfunction in Dutch survivors of childhood cancer - The DCCSS-LATER 2 PULM sub-study.

Treatment for childhood cancer may increase the risk of long-term pulmonary complications and dysfunction. Pulmonary surveillance is recommended after established pulmonary toxic exposures, including bleomycin, busulfan, carmustine (BCNU), lomustine (CCNU), radiotherapy to a field exposing the lungs, and pulmonary surgery. However, the role of cyclophosphamide as a pulmonary toxic agent is debated. To establish whether cyclophosphamide is associated with late pulmonary dysfunction among survivors of childhood cancer. In this multicenter Dutch Childhood Cancer Survivor Study (DCCSS)-LATER 2 PULM sub-study, we included 828 survivors with a median follow-up of 26.6 years, treated with cyclophosphamide and/or established pulmonary toxic treatment, or neither. Pulmonary function tests were used to measure the primary outcomes of diffusion impairment (diffusing capacity for carbon monoxide (DLCO) z-score), restriction (total lung capacity (TLC) z-score), and obstruction (forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) z-score). Secondary outcomes comprised chronic cough, recurrent respiratory tract infections, shortness of breath, and supplemental oxygen need. Diffusion and restrictive abnormalities were highly prevalent among those treated with established pulmonary toxic treatment, with cyclophosphamide (41.0% and 50.4%, respectively) and without (34.3% and 41.9%, respectively), and occurred less frequently in survivors treated with cyclophosphamide only (12.9% and 7.3%, respectively) or in survivor controls (9.9% and 12.4%, respectively). In multivariable analyses, cyclophosphamide did not have a clinically relevant effect on the primary or secondary outcomes. This study suggests that cyclophosphamide is not associated with clinically relevant pulmonary dysfunction in long-term childhood cancer survivors.

Peripheral blood immunoinflammatory biomarkers: prospective predictors of postoperative long-term survival and chronic postsurgical pain in breast cancer

BackgroundTumor progression and chronic postsurgical pain (CPSP) in patients with breast cancer are both significantly influenced by inflammation. The associations between immunoinflammatory biomarkers and long-term survival, as well as CPSP, remain ambiguous. This study examined the predictive value of immunoinflammatory biomarkers for both long-term survival and CPSP.MethodsData on the clinicopathological characteristics and perioperative peripheral blood immunoinflammatory biomarkers of 80 patients who underwent breast cancer surgery were retrospectively collected. Optimal cut-off values for preoperative immunoinflammatory biomarkers, including the preoperative systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune-inflammation value (PIV), were established via receiver operating characteristic (ROC) curves. Kaplan−Meier curves and Cox regression analysis were used to evaluate the relationships between preoperative immunoinflammatory biomarkers and long-term survival. The relationships among the perioperative neutrophil count (NEU), monocyte count (MONO), lymphocyte count (LYM), platelet count (PLT), SII, SIRI, NLR, PIV, dynamic changes in peripheral blood cell counts, and CPSP were further assessed using logistic regression analysis.ResultsKaplan−Meier curves revealed a considerable prolongation of disease-free survival (DFS) and overall survival (OS) in the low preoperative SII, SIRI, NLR, and PIV groups. Multivariate Cox regression analysis revealed that only an elevated preoperative SIRI was an independent risk factor for postoperative DFS (HR=8.890, P=0.038). The incidence of CPSP was 28.75%. Univariate logistic regression analysis revealed that body mass index (BMI), postoperative NEU, MONO, SIRI, and PIV were negatively correlated with the occurrence of CPSP, whereas subsequent multivariate logistic regression analysis revealed that only BMI was independently associated with CPSP (OR=0.262, P=0.023).ConclusionElevated preoperative SIRI was an independent risk factor for poor DFS in breast cancer patients after surgery. In contrast, perioperative immunoinflammatory biomarkers had limited potential for predicting CPSP in patients who underwent breast cancer surgery.

Fear of cancer recurrence in long-term colorectal cancer survivors: a nationwide cross-sectional study.

Knowledge about fear of cancer recurrence (FCR) among recurrence-free long-term colorectal cancer survivors (CRCS) is limited. This national cross-sectional study aimed to (1) assess the prevalence and correlates of FCR among CRCS; (2) investigate associations between colorectal cancer-specific symptoms and FCR; and (3) identify predictors of interest in engaging in FCR treatment. We identified 9638 living Danish CRCS, age above 18years, diagnosed between 2014 and 2018 through the Danish Clinical Registries. Electronic surveys were distributed between May 2023 and May 2024. FCR was measured on the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF). Associations with colorectal cancer-specific physical symptoms and psychological symptoms were analyzed using logistic regression models. Of 5480 respondents (56.9%; mean age: 73, range (30-99; 42% female), 5.3% of survivors reported clinical FCR (cFCR). In multivariate analyses, having severe abdominal pain (OR 8.7 (95% CI 4.8-15.8)), abdominal bloating, tension, or heaviness (OR 10.0 (95% CI (6.1-16.3)) and tiredness (OR 7.1 (95% CI (4.1-12.1)) were associated with increased odds of cFCR, as were psychological symptoms (health anxiety; OR 19.7 (95% CI (13.5-28.6)), anxiety; OR 11.2 (95% CI (6.4-19.6)), depression; OR 5.5 (95% CI (2.6-11.9)) compared to no FCR. Among those with cFCR, 75% were interested in treatment, with higher interest among males and chemotherapy recipients. FCR severity is strongly associated with specific colorectal symptoms, tiredness, and psychological symptoms. Addressing cancer-specific physical symptoms may be a promising strategy for reducing FCR.

Effect of Physical Activity on Physical and Mental Health in Young Cancer Patients and Survivors: A Systematic Review of RCTs and CCTs

Introduction Young cancer patients (YCP) face high risks of acute and long-term physical and mental health effects resulting from their malignancy and its treatment (Benzing et al., 2022; Siegwart et al., 2020). Physical activity (PA) is increasingly recognized as a strategy to address physical, mental, cognitive, and social challenges faced by YCP and survivors (Braam et al., 2016). This systematic review aimed to summarize findings from randomized controlled trials (RCTs) and clinical control trials (CCTs) evaluating the impact of PA interventions on physical and mental health outcomes in YCP and survivors. Methods A systematic search was conducted in APA PsycINFO, PubMed, SPORTDiscus, Web of Science, Embase, and Scopus. We examined RCTs and CCTs investigating PA interventions in children and adolescents with cancer, during or after treatment, that reported outcomes related to physical or mental health and/or quality of life. Two authors independently screened studies for inclusion, extracted data, and assessed the risk of bias. Results Of 1,164 articles screened, 32 RCTs and CCTs met eligibility criteria, involving 1,315 participants aged 4–19 years. Studies included inpatients (18), survivors (11), or both (2). Chronic PA interventions, such as aerobic, resistance, or combined motor-cognitive training, were implemented. All studies reported physical health outcomes, primarily focusing on cardiorespiratory fitness, muscle strength, and fatigue, while 18 studies assessed psychological outcomes, including depression and quality of life. Four studies objectively evaluated cognitive functions. Benefits were most frequently observed (>50%) for strength, fatigue, and self-efficacy, with no negative effects reported. Discussion/Conclusion Despite variability in session durations and intervention lengths, this review highlights the broad benefits of PA for YCP and survivors, with no indication of negative effects. Most studies have focused on physical and mental health outcomes (Braam et al., 2016), with limited attention to cognitive performance and motor ability, despite the high risk of cognitive late effects in this population (Krull et al., 2018). High-quality RCTs are needed to better understand the role of PA in motor and cognitive development among YCP and survivors. References Benzing, V., Siegwart, V., Spitzhüttl, J., Schmid, J., Grotzer, M., Roebers, C. M., Steinlin, M., Leibundgut, K., Everts, R., & Schmidt, M. (2021). Motor ability, physical self‐concept and health‐related quality of life in pediatric cancer survivors. Cancer Medicine, 10, 1860–1871. https://doi.org/10.1002/cam4.3750 Braam, K. I., van der Torre, P., Takken, T., Veening, M. A., van Dulmen‐den Broeder, E., & Kaspers, G. J. L. (2016). Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews, 3, CD008796. https://doi.org/10.1002/14651858.CD008796.pub3 Krull, K. R., Hardy, K. K., Kahalley, L. S., Schuitema, I., & Kesler, S. R. (2018). Neurocognitive outcomes and interventions in long-term survivors of childhood cancer. Journal of Clinical Oncology, 36(21), 2181-2189. https://doi.org/10.1200/jco.2017.76.4696 Siegwart, V., Benzing, V., Spitzhuettl, J., Schmidt, M., Grotzer, M., Steinlin, M., Leibundgut, K., Roebers, C., & Everts, R. (2020). Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors. Neuropsychological Rehabilitation, 32 (6), 922–945. https://doi.org/10.1080/09602011.2020.1844243

Fitness, Body Composition, and Health Behaviors in Long-Term Survivors of Adolescent and Young Adult Cancers.

Purpose: To investigate cardiorespiratory fitness (CRF), body composition, health behaviors, and health-related quality of life (HRQoL) in adolescent and young adult cancer survivors (AYA-CS) compared with age-matched counterparts without a cancer diagnosis. Methods: This cross-sectional study recruited participants aged 15-25 years at the time of their cancer diagnosis and ≥ 5 years post-treatment. Participants completed cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, food diaries, physical activity (PA), fatigue, and HRQoL questionnaires. Results: We recruited 22 participants aged 27.9 (standard deviation [SD] 3.3) years (54.5% female) and 7.2 (SD 2.2) years post-treatment. AYA-CS had lower CRF compared with age-matched norms (female 27.1 vs. 39.1 mL/kg/min, p ≤ 0.0001; male: 39.7 vs. 45.6 mL/kg/min, p = 0.04). Bone mineral density Z-scores were all within normal ranges; however, male AYA-CS had higher body fat percentage (male: 27.1% vs. 21.2%, p = 0.01) and a trend toward higher body fat percentage in female AYA-CS (32.2% vs. 29.8%, p = 03). AYA-CS had lower HRQoL, with no difference observed with fatigue. A higher proportion of AYA-CS met recommendations for weekly PA (36.4% vs. 27.3%, p = 0.34) and daily servings of fruit and vegetables (13.6% vs. 3.9%, p = 0.02) compared with normative data, demonstrating better health behaviors. A higher proportion of AYA-CS reported one or more chronic diseases compared with Australian normative data (63.7% vs. 41.5%, p = 0.04). Conclusions: AYA-CS exhibit significantly lower CRF and unfavorable body composition to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase the risk of multimorbidity development. Interventions are needed to address these issues to improve health outcomes in AYA-CS.

Assessing the Relationship of Different Levels of Pain to the Health Status of Long-Term Breast Cancer Survivors: A Cross-Sectional Study

Purpose: This study investigated the relationship between different pain levels in the affected arm and health status in long-term breast cancer survivors (LTBCSs) and identified predictors of pain at this stage of long-term survivorship. Methods: A cross-sectional study of 80 participants categorized LTBCSs by pain levels in the affected arm into three groups: no pain (0–0.99), mild pain (1–3.99), and moderate to severe pain (4–10). Variables assessed at least 5 years since diagnosis include pain in the non-affected arm, pain interference, cancer-related fatigue (CRF), physical activity (PA) level, fitness condition, mood state, and health-related quality of life (HRQoL). Results: A total of 36.25% of LTBCSs have no pain, 30% have mild pain, and 33.75% have moderate to severe pain. Furthermore, pain presence was associated with increased pain in the non-affected arm, pain interference, CRF, mood disturbances, and physical inactivity, as well as a decreased HRQoL (all p < 0.05). Regression analysis found “upset by hair loss”, CRF “affective domain”, “dyspnea”, and “alcohol consumption” as significant predictors of higher levels of pain in the affected arm (r2 adjusted = 0.646). Conclusions: A total of 63.75% of LTBCSs continue to experience mild to moderate to severe pain in the affected arm, negatively impacting their physical, mental, and emotional health status, with increased pain severity ≥5 years beyond cancer diagnosis. “Upset by hair loss”, CRF “affective domain”, “dyspnea”, and alcohol consumption collectively explain 64.6% of the affected-arm pain level in LTBCSs.

Altered retinal vasculature in childhood cancer survivors: Data from the German CVSS-study.

Childhood cancer is a risk factor for cardiovascular diseases in later life. Retinal examination allows to non-invasively observe the vasculature of an end-organ. We observe alterations in long-term childhood cancer survivors (CCS). In the Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer-Study, 1002 CCS (23-48 years) having neoplasia prior to 15 years of age were prospectively enrolled in a general and ophthalmologic examination including fundus photography. Central retinal vessel equivalents (arterial: CRAE; venous CRVE) were measured and linear regression analysis was computed to compare CCS to controls from the population-based Gutenberg Health Study (GHS) with adjustment for potential cardiovascular and ophthalmological confounders. Differences in cancer types and treatments were explored. For 837 CCS (45.3% female), CRAE and CRVE were conducted. Both were smaller in CCS previously having leukaemia, central nervous system tumour, neuroblastoma, renal tumour, malignant bone tumour, soft tissue sarcoma and germ cell tumour than in GHS controls. No difference was found for CCS with prior lymphoma. Previous radiotherapy of head or neck was associated with a smaller CRVE. Higher mean arterial blood pressure and intake of antihypertensive medication were associated with smaller CRAE. Retinal vasculature is altered in CCS leading to smaller retinal arteries and veins. Our finding indicates that childhood cancer and its treatment leads to systemic alterations of the microcirculation on both branches of the vasculature system. While the retinal venous vasculature is altered by radiotherapy, the lower vessel width of the arterial branch is associated with arterial hypertension.

Single-cell transcriptomics reveals intratumor heterogeneity and the potential roles of cancer stem cells and myCAFs in colorectal cancer liver metastasis and recurrence.

Metastasis and recurrence are the primary obstacles to long-term survival in colorectal cancer (CRC) patients. In this study, we employed single-cell RNA sequencing (scRNA-seq) to comprehensively delineate the transcriptomic landscape of primary and liver metastatic CRCs, and revealed novel cellular crosstalk between cancer cell subpopulation and myofibroblastic CAFs (myCAFs) at single-cell resolution. We identified a cancer cell subpopulation termed stem/transient amplifying-like (stem/TA-like) cells, which expressed genes associated with stem cell-like characteristics and metastatic potential. MyCAFs in their microenvironment showed the potential to remodel the extracellular matrix (ECM), regulate angiogenesis, and support a pro-metastatic microenvironment through paracrine signaling involving FN1, BGN, and other ECM components. Notably, we found that they may communicate through the ligand-receptor pairs FN1-CD44 and GDF15-TGFBR2, which may be linked to the liver metastatic process. Additionally, our findings suggest that both stem/TA-like cells and myCAFs could be involved in CRC recurrence following chemotherapy. A unique gene signature generated using the gene expression characteristics of stem/TA-like cells and myCAFs (SM signature) can be used to assess recurrence risk in CRC patients. Collectively, these findings highlight the intratumor heterogeneity and the potential roles of cancer stem cells and myCAFs in CRC liver metastasis and recurrence, providing new targets and insights for the prognostic assessment of CRC patients and the improved selection of effective treatment options.

Prognostic factors for relapse-free 5-year survivors after gastrectomy for gastric cancer.

Few studies have examined the prognosis of long-term gastric cancer (GC) survivors after gastrectomy. This study aimed to identify the prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. A total of 721 patients with pathological stage Ⅰ-Ⅲ GC who underwent gastrectomy between 2005 and 2018 and survived for 5 years without recurrence were enrolled. Conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non-disease-specific survival (cNDSS) of 5-year recurrence-free survivors were calculated. The association between cOS, cDSS, and cNDSS and clinicopathological factors was evaluated using univariate and multivariate analyses. The mean age of the patients was 70.5 ± 10.1 years, 68.5% were male, and 491, 128, and 102 had stage Ⅰ, Ⅱ, and Ⅲ GC, respectively. Seventeen patients relapsed, and 65 patients died (disease-specific, non-disease-specific, and unknown: 12, 45, and 6, respectively) during a median follow-up of 36 months. The 5-year cOS, cDSS, and cNDSS rates were 90.3%, 97.3%, and 93.3%, respectively. Multivariate analysis showed that age ≥ 80 years and neutrophil-to-lymphocyte ratio (NLR) ≥ 2.7 were significantly associated with poorer cOS; stage Ⅲ GC was associated with decreased cDSS; and age ≥ 80 years, NLR ≥ 2.7, and mean corpuscular volume (MCV) ≥ 93.4 fl were associated with lower cNDSS. Age ≥ 80 years, stage Ⅲ GC, NLR ≥ 2.7, and MCV ≥ 93.4 fl were unfavorable prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. Long-term surveillance after gastrectomy could be tailored based on these factors.

Predictive factors for the occurrence of pre-hypertension in long-term adults survivors of childhood, adolescent and young adult cancer

Predictive factors for the occurrence of pre-hypertension in long-term adults survivors of childhood, adolescent and young adult cancer

Role of pre-diagnostic reproductive factors on long-term (10 years or greater) survival of epithelial ovarian cancer: The Extreme study.

Several reproductive factors are associated with ovarian cancer risk but the association with survival is less clear. The main aim was to examine the impact of pre-diagnostic reproductive factors on long-term ovarian cancer survival (≥10 years). We included all women with epithelial ovarian cancer in Denmark, 1990-2014. Information on reproductive factors and covariates were obtained from nationwide registers. Using pseudo-values, we estimated the absolute and relative 10-year survival probabilities and 95% CIs for each reproductive factor and ovarian cancer overall, restricted to serous tumors and stratified into localized and non-localized tumors. A relative survival probability >1 indicates better survival. Adjusted models considered age, diagnosis year, histology, stage, comorbidity, and income. In a sub-population sensitivity analysis, we also adjusted for residual disease. The cohort comprised 11,870 women. In the adjusted models, pre-diagnostic parity (relative survival probability 1.08, 95% CI 1.01 to 1.16) and endometriosis (relative survival probability 1.17, 95% CI 1.02 to 1.34) increased the likelihood of surviving ≥10 years in women with localized cancer. Previous infertility also improved the 10-year survival in women with localized ovarian cancer (relative survival probability 1.18, 95% CI 1.07 to 1.29) and in women with a non-localized tumor (relative survival probability 1.45, 95% CI 1.15 to 1.84). Pre-diagnostic pelvic inflammatory disease enhanced 10-year survival in women with localized serous (relative survival probability 1.24, 95% CI 1.03 to 1.49) and non-localized cancer (relative survival probability 1.35, 95% CI 1.04 to 1.76). Previous tubal ligation or hysterectomy were not significantly associated with 10-year survival. Adjustment for residual disease did not substantially change estimates, except for parity and pelvic inflammatory disease, where the associations disappeared. Pre-diagnostic reproductive factors, such as endometriosis or infertility, were associated with improved long-term survival. However, causality cannot be established in this observational study, and more research to confirm our findings and into potential mechanisms is warranted.

Factors Associated With Short- and Long-Term Survival in Metastatic HER2-Positive Breast Cancer.

We sought to evaluate prognostic factors in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and their relationship with short- and long-term overall survival (OS). Using the Surveillance, Epidemiology, and End Results (SEER) database, we evaluated patients with de novo HER2-positive MBC diagnosed from 2010 to 2018. Univariate analyses were performed to determine effect of each variable on OS. Significant variables were included in a multivariate Cox model for OS. Univariate and multivariate logistic regression were used to evaluate the association of each variable with short- (<2 years) and long- (≥5 years) term OS. Overall, 5576 patients were included. Median follow up was 48 months (interquartile range 25-73 months), and median OS was 41 months. The proportion alive at 2, 5, and 8 years was 63.3% (95% confidence interval [CI] 62.0%-64.7%), 37.8% (95% CI, 36.2%-39.4%), and 26.8% (95% CI, 24.8%-28.9%), respectively. Factors associated with short-term OS were older age; Black race; nonductal nonlobular; brain, liver, or lung metastases; estrogen/progesterone receptor (ER/PR)-negative disease, and lower income (all P < .04). Number of metastatic organ sites was not significant. Factors associated with long-term OS were younger age, White race, fewer metastatic organ sites, ER/PR-positive disease, and higher income (all P < .02). Specific organ sites were not significant. In this cohort with de novo HER2-positive MBC, OS improved significantly over the study period. We identified patient-specific and tumor-specific factors that were associated with short- and long-term survival in HER2-positive MBC.

The Lived Experience of Suffering by Nigerian Female Breast Cancer Survivors: A Phenomenological Perspective.

Breast cancer is a significant public health concern globally, and its impact extends beyond physical survival. Survivors often grapple with a myriad of challenges, including psychological distress, social isolation, and financial hardship. These challenges are often exacerbated in low-resource settings like Nigeria, where limited access to quality healthcare, socioeconomic disparities, and cultural stigma surrounding cancer can significantly impact the quality of life for survivors. This study aims to explore the suffering perceived by long-term breast cancer survivors in Nigeria, focusing on their lived experiences during and after treatment. Using a phenomenological approach, in-depth interviews were conducted with 22 women who have survived breast cancer for over 5 years. Data were analyzed using thematic analysis to capture the essence of their suffering, allowing for a deep understanding of their lived experiences. Five main domains emerged: (1) Physical Suffering, (2) Emotional Distress, (3) Social Suffering, (4) Financial Strain, and (5) Spiritual and Resilient Coping. Participants described their suffering as a multifaceted journey marked by physical pain, emotional turmoil, social stigma, financial challenges, and resilience fostered through spirituality and support systems. The phenomenological analysis revealed that the participants' suffering extended beyond the physical, touching every aspect of their lives and reshaping their identities and perceptions of self. The findings highlight the complex nature of suffering among breast cancer survivors in Nigeria, underscoring the need for comprehensive survivorship care that addresses physical, psychosocial, and spiritual dimensions. By understanding the essence of their suffering, healthcare providers can develop more compassionate, context-specific care strategies that validate and support the holistic needs of survivors.

A controlled study of use and effectiveness of phosphodiesterase-5 inhibitors in long-term survivors after curative radiotherapy for prostate cancer (PCa).

We lack population-based data on the use and effectiveness of phosphodiesterase- 5inhibitors (PDE-5Is) in post-radiotherapy long-term prostate cancer survivors (PCaSs). In this cross-sectional survey performed 9 years after curative radiotherapy we explored PDE-5I use and the drugs'effectiveness in 1,092 nine-year PCaSs responding to the sexual items of EPIC-26. The findings from PCaSs were compared to those from 2,847 age-similar men from the general population (Norms). 13 % of the PCaSs and 9 % of the Norms were Current Users of PDE-5Ies, High sexual interest and, restricted to PCaSs, age below 70 years significantly increased the use of PDE-Is. In PCaSs and Norms, who used PDE-5Is the levels of the six sexual items of EPIC-26 and of the Sexual Domain Summary Score (DSS) were similar. The corresponding differences were large in Never Users of PDE-5Ies. High sexual interest in PCaSs, and use of PDE-5Is were significantly and positively associated with an acceptable level of the sexual domain in EPIC-26 (Score > 40), whereas the association was negative for age > 70 years, reduced health and obesity, CONCLUSION: At least 1 of 10 long-term post-radiotherapy PCaSs experience "some help" of their erectile dysfunction by use of PDE-5Is. These patients are identified by high sexual interest, age < 70 years and good health During long-term follow-up of PCaSs clinicians are challenged early to identify these, often relatively young men, based on their high sexual interest.

Frailty in Long-Term Prostate Cancer Survivors and Its Association With Quality of Life and Emotional Health.

Frailty is emerging as an important determinant for quality of life (QoL) and emotional health in older patients with cancer, and specifically in long-term prostate cancer survivors, but quantitative studies are lacking. The current study assesses the prevalence of frailty and its association with QoL and emotional health in long-term prostate cancer survivors after radical prostatectomy. A total of 2,979 prostate cancer survivors from the multicenter German Familial Prostate Cancer cohort completed questionnaires on frailty (Groningen Frailty Indicator [GFI]), QoL (EORTC QoL Questionnaire-Core 30), and emotional health (anxiety/depression symptoms via the Patient Health Questionnaire-4). Modified Poisson regression analysis was used to assess factors associated with frailty. Average patient age was 79.4 years [SD, 6.4 years] and average time since radical prostatectomy was 17.4 years [SD, 3.8 years]. Among the cohort, 33.1% (n=985) of patients were classified as frail (GFI ≥4). Frail patients reported worse emotional health than nonfrail patients (depression symptoms: 24.0% vs 4.0%; anxiety symptoms: 20.6% vs 2.0%; both P<.001) and lower QoL (mean [SD], 53.4 [19.2] vs 72.7 [16.0]); P<.001). Higher age (relative risk [RR], 1.02; 95% CI, 1.01-1.03) and worse depressive (RR, 1.18; 95% CI, 1.12-1.24) and anxiety symptoms (RR, 1.17; 95% CI, 1.11-1.23) were associated with frailty. Living in a partnership (RR, 0.76; 95% CI, 0.67-0.86) and a higher QoL (RR, 0.86 for a 10-point increase; 95% CI, 0.84-0.89) were associated with nonfrailty. In a large German cohort, every third long-term prostate cancer survivor after radical prostatectomy was frail. The association of frailty with lower QoL and poorer mental health indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes targeted to frail patients.

Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study.

In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence. In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.). Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women. In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues. BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA.