Age Survival Research Articles

Effect of Early Rehabilitation Services After Discharge on Social Activity Among Chronic Stroke Survivors: A Multicenter Prospective Study

BackgroundSocial inactivity after a stroke leads to adverse outcomes, making social activity after discharge important for chronic stroke survivors. ObjectivesTo investigate the effects of early rehabilitation services after discharge on social activity among chronic stroke survivors. MethodsThe participants were prospectively recruited from three convalescent hospitals. Receipt of early rehabilitation services after discharge for chronic stroke survivors was defined as the utilization of day care or home-based rehabilitation services by the Japanese long-term care insurance system. Social activity was assessed using the Frenchay Activities Index (FAI) premorbid and at 3, 6, and 12 months after discharge. In this study, the outcome was defined as the change in the FAI score from 3 to 12 months after discharge. Multivariate regression analysis was performed to examine the effect of access to rehabilitation on changes in FAI. ResultsNinety stroke survivors (age 67.2 ± 11.6 years, 52 male) were enrolled. The FAI showed improvements by 27.4% and 1.4% from 3 to 12 months after discharge in the rehabilitation and non-rehabilitation groups, respectively. Multivariate regression analysis showed that access to rehabilitation after discharge was positively associated with the FAI change from 3 to 12 months after discharge (B = 30.3, β = 0.38, 95% confidence interval = 11.13–49.47, p = 0.002). ConclusionEarly rehabilitation services after discharge were significantly associated with increased social activity.

“IF I AM OLD, YOU CAN NOT TELL ME THAT I HAVE JUST BREAST CANCER PATIENT”: A PHENOMENOLOGICAL STUDY

“IF I AM OLD, YOU CAN NOT TELL ME THAT I HAVE JUST BREAST CANCER PATIENT”: A PHENOMENOLOGICAL STUDY Abstract Objective: This study aimed to investigate the post-surgery experiences of elderly breast cancer survivors. Methods: Semi-structured interviews were conducted with 12 elderly breast cancer patients (> 65) after surgery. To evoke the themes illuminating these women's experiences, we employed phenomenological analysis. Results: Three main themes emerged as a result of the research: "This is not ideal at this age but there is nothing I can do," "I am no longer self-sufficient," and "We are different, I am old." For elderly women, the phrase "removing the breast" is difficult to hear. Most elderly people could not even look at or touch the area. They asserted, however, that being healthy is more crucial than caring about one's physical appearance given one's age. They were unable to care for themselves, carry out independent daily tasks, or clean the house. It had a significant impact on the elderly to be dependent on others for these tasks. Those who were assisted felt grateful; those who were not supported felt helpless. The elderly were burdened more because of their age and various health issues. On the other hand, elderly patients who underwent cancer surgery experienced a fear of passing away. The elderly wanted information or assistance with their issues, but they were unsure of where to turn. Conclusion: Elderly breast cancer patients experience different issues due to the particular challenges of old age. Based on this knowledge, members of the healthcare team should follow a different roadmap than the particular strategy for performing breast cancer surgery on elderly patients. Cancer diagnosis, breast loss, the physical burden of comorbidity, the psychological burden of dependency, and the inability to care for oneself should all be considered when providing care and treatment for elderly individuals. Keywords: Breast cancer surgery; elderly patients; experience; geriatric oncology; phenomenology.

Mapping aging phenotypes in childhood cancer survivors: A report from the St. Jude Lifetime Cohort.

10069 Background: Childhood cancer survivors experience accelerated aging manifest as physical, cognitive and/or emotional impairments. Aging populations respond to behavioral interventions that address impairment combinations. We aimed to identify and characterize phenotypes (classes) of physical, cognitive and emotional impairments in childhood cancer survivors to inform targets for future intervention. Methods: Factor analysis using St. Jude Lifetime Cohort data (N=4051, 52.2% male, mean [SD] age at diagnosis 8.7 [5.7], assessment 33.9 [10.1] years) generated 9 impairment domains (Table) using 40 items from the Neurocognitive Questionnaire, Brief Symptom Inventory 18 and NHIS Health Status/Limitation of Activities. Latent class analysis estimated impairment patterns and class membership probabilities. Descriptive statistics characterized survivors by class for deficit accumulation index (DAI) score (range 0-1, >0.25 frail), Fried Frailty (FF) score (range 0-5, ≥3 frail), diagnosis and treatment exposures. Logistic regression comparing emotional or cognitive impairment class to the physical impairment class examined associations between survivor characteristics and class membership, adjusting for diagnosis and assessment ages, sex and race/ethnicity. Results: Three classes (phenotypes) differentiated survivors reporting only physical from those reporting both physical and cognitive or emotional impairments. Mean [SD] DAI (cognitive 0.40 [0.10], emotional 0.56 [0.16], physical 0.16 [0.11]) and FF scores (cognitive 1.5 [1.0], emotional 1.8 [1.0], physical 0.9 [0.9]) were highest in the emotional impairment class. Compared to solid tumor survivors (17.1%), brain tumor (33.7%, OR 3.5; 95% CI 2.7-4.4) and leukemia (21.7%, OR 1.5; 95% CI 1.2-1.8) survivors were more likely to be in the cognitive impairment class. Leukemia (OR 1.4; 95% CI 1.1-1.7) and lymphoma (OR 1.4; 95% CI 1.1-1.9) diagnoses increased risk for emotional impairment class membership. Cranial radiation was associated with cognitive (OR 1.8; 95% CI 1.5-2.2) or emotional (OR 1.3; 95% CI 1.1-1.6) impairment class membership. Chest radiation (1.4; 95% CI 1.2-1.7) was associated with emotional impairment class membership. Conclusions: These data provide foundational information for development and testing of targeted behavioral interventions to remediate accelerated aging in survivors. [Table: see text]

Late mortality and chronic health conditions in long-term survivors of nasopharyngeal cancers: The 20-year follow-up of territory-wide Hong Kong Nasopharyngeal Cancer Survivor Study (HKNPCSS).

12045 Background: The survival rate of patients with nasopharyngeal cancer (NPC) has significantly improved in the last decade. However, there are only a few studies that have quantified the long-term morbidity and mortality that follow NPC treatment. This study aims to analyze the chronic health conditions, all-cause mortality, and cause-specific mortality among NPC survivors. Methods: The Hong Kong NPC Survivor Study (HKNPCSS) is a retrospective cohort study conducted across all six oncology centers in Hong Kong. It included longitudinal follow-up of 5-year survivors diagnosed with NPC between 1997 to 2015. We compared the standardized mortality ratio (SMRs) of 7893 survivors to a matched population in terms of age, sex, and calendar year. We also calculated the frequencies of chronic conditions of 7893 survivors and 23679 healthy individuals with matched age, sex, and date of cohort entry. Chronic health conditions were classified using the Common Terminology Criteria for Adverse Events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for chronic health conditions. Results: The mean age of NPC survivors was 49.1 years, while healthy individuals had a mean age of 50.5 years. Among the 7893 NPC survivors, the 20-year cumulative all-cause mortality was 34.0% (95% CI, 29.1%-38.9%), with 1668 (59.9%) of 2785 deaths attributed to health-related causes. The SMR for NPC survivors compared to the general population was 3.81 (95% CI, 3.67-3.95), with the highest SMRs observed for pulmonary (SMR: 6.18, 95% CI, 5.73-6.64) and cardiovascular (SMR: 2.12, 95% CI, 1.90-2.36) causes. Among the survivors, 59.2% (n=4674) had severe, life-threatening, or fatal (grade 3-5) health conditions, with a 20-year cumulative incidence of 59.0% (95% CI, 56.4%-61.5%). The adjusted hazard ratio (HR) of grade 3-5 chronic condition in NPC survivors, compared to healthy cohorts, was 7.02 (95% CI, 6.64-7.42). Gastrointestinal (HR: 20.7), hearing, visual, and nasal (HR: 15.4), and neurological (HR: 8.39) conditions had the highest risks. Intensity modulated radiotherapy (IMRT), compared to non-IMRT, was associated with reduced risks of all-cause mortality (HR: 0.83, 95% CI, 0.74-0.91) and a trend towards reduced grade 3-5 chronic health conditions (HR: 0.89, 95% CI, 0.75-1.05). Conclusions: Even 20 years after diagnosis, NPC survivors still face increased risks of late mortality and morbidity. The findings emphasize the need for a comprehensive survivorship program to improve outcomes for NPC survivors.

Chemotherapy-Induced Peripheral Neuropathy and Falls in Cancer Survivors Relate to Digital Balance and Gait Impairments.

Chemotherapy-induced peripheral neuropathy (CIPN) and falls can be persistent side effects of cancer treatment. Standing postural sway and gait tests with body-worn, inertial sensors provide objective digital balance and gait measures that represent several different domains controlling mobility. Specific domains of balance and gait that related to neuropathy and falls are unknown. The aim of this study was to determine which domains of balance and gait differed between cancer survivors who report (1) CIPN symptoms versus no symptoms, (2) a history of falls in the past 6 months versus no falls, and (3) prospective falls over 12 months versus no falls. Postural sway during 30 seconds of quiet standing and gait characteristics from a 7-m timed up and go test were recorded with six synchronized inertial sensors (Opals by APDM Wearable Technologies, a Clario Company) in 425 older, female cancer survivors (age: 62 ± 6 years). A principal component analysis (PCA) approach was used to identify independent domains of mobility from 15 balance and gait measures. PCA analysis revealed five independent domains (PC1 = sway amplitude, PC2 = gait pace, PC3 = sway frequency, PC4 = gait spatial-temporal, and PC5 = turning) that accounted for 81% of the variance of performance. Cancer survivors who reported CIPN symptoms had significantly higher sway frequency (PC3) than asymptomatic survivors. Past fallers had significantly larger sway area (PC1) and slower gait pace (PC2) than nonfallers. Prospective fallers showed a significantly smaller stride length (PC4) than nonfallers. Digital balance and gait measures using wearable sensors during brief standing and walking tests provide objective metrics of CIPN-related mobility impairment and fall risk that could be useful for oncology clinical trials.

Personal symptom ecosystem predicts progression of chronic health conditions (CHCs) in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study (SJLIFE).

10076 Background: Survivors of childhood cancer experience a range of interconnected symptoms, forming a personal symptom ecosystem with unique structures and dynamics. Unlike prior research analyzing the main effect of each symptom, we created personal symptom networks to predict the onset/worsening of CHCs for cancer survivors. Methods: We analyzed data collected from 2007-2020 among 4044 adult survivors of childhood cancer enrolled in SJLIFE. At baseline and follow-up (FU), individual CHCs were clinically assessed, severity-graded (CTCAE), and classified into organ-based groups: cardiac, pulmonary, musculoskeletal and neurological. Progression of CHCs from baseline to FU was defined as onset (grade 0-1 to grade 2-4) or worsening (grade 2 to 3-4; grade 3 to 4). Baseline symptoms in 9 domains (cardiac, pulmonary, sensation, nausea, movement, pain, fatigue, anxiety, depression) and personal factors (age, sex, education, smoking) were self-reported; neighborhood adversity was assessed by the Social Vulnerability Index (SVI); treatment data were sourced from medical records. The Ising model incorporating personal/treatment/SVI factors as covariates was used to develop personal symptom ecosystems. The effect of symptoms on the CHC progression included both the influence of a symptom domain (mean main effect) and its interaction with other symptom domains (ecosystem effect). These effects were examined using LASSO regularized logistic regressions on the progression of CHC groups. Results: The mean age of survivors at baseline was 30.3±8.6 years, 52.2% were male; the mean years from baseline to FU were 4.3±1.7. Survivors with lower education, smoking, and living in poorer neighborhoods reported interconnected pain-depression (effect size [ES] 0.35), anxiety-fatigue (ES 0.57), and cardiac-fatigue (ES 0.35) symptom domains. Symptom domains significantly impacting the progression of CHC groups were cardiac symptoms on the pulmonary (OR 1.2) and neurological CHC groups (OR 1.5); movement symptoms on the musculoskeletal (OR 1.4) and neurological CHC groups (OR 1.7); pain (OR 2.4) and fatigue (OR 1.8) on the neurological CHC group. Significant ecosystem effects of symptom domains impacting the progression of CHC groups were pain on the cardiac CHC group (OR 1.2); pulmonary symptoms on the pulmonary CHC group (OR 1.2); cardiac symptoms on the musculoskeletal CHC group (OR 1.4). The 95% confidence intervals were omitted since LASSO does not estimate standard deviation for variables identified as significant. Conclusions: The symptom network approach shows promising ecosystem effects of individual symptom domains beyond its main effects on CHC progression. This study improves our understanding of dynamic, interconnected symptoms underlying CHC progression, and highlights avenues for future intervention research.

A stepped wedge trial of a healthcare provider–focused intervention to increase human papillomavirus (HPV) vaccine initiation among survivors of childhood cancer.

10010 Background: Childhood cancer survivors are at increased risk for human papillomavirus (HPV)-related cancers. HPV vaccination is highly protective against HPV acquisition. However, we have previously shown that initiation rates among survivors are low, primarily due to lack of healthcare provider recommendation for the vaccine. Methods: We conducted a stepped wedge trial from 2021 to 2023 to evaluate the effectiveness of an evidence-based healthcare provider-focused intervention (HPV PROTECT; NCT04469569) in increasing HPV vaccine initiation rates 1y following implementation. The intervention includes provider communication training to enhance vaccine recommendation skills, audit/feedback regarding clinic vaccination rates, and patient-directed resources in multiple languages tailored to pediatric oncology settings. We measured the effectiveness of the intervention in a racially, ethnically, and geographically diverse sample of HPV vaccine naïve childhood cancer survivors, aged 9-17y, and ≥1y post-completion of therapy returning to pediatric oncology clinics for follow-up care at 6 sites. The primary outcome of interest was HPV vaccine initiation rates (abstracted from state vaccine registries) at end of each study year. Baseline data were collected for all sites in Y1, three sites were randomly selected to receive the intervention in Y2, and the remaining three in Y3. The intervention effect was tested using a longitudinal logistic regression model for initiation with intervention as the main fixed effect, adjusting for survivor age, cancer diagnosis, time off-therapy, sex, race, ethnicity, and receipt of hematopoietic cell transplantation. The secular trend (estimated using pre-intervention data from Y1 and Y2) was included as an offset, and site was included as a random effect. The intervention effect was reported as odds ratio (OR) for initiation with 95% confidence intervals (CI). Results: A total of 1779 unique vaccine naïve survivors (47.1 % leukemia; 55.1% male; 51.5% non-Hispanic white) completed 2689 clinic visits across 6 sites. Median (range) age at diagnosis was 5.1y (0-16.5), at study entry was 12.3y (9-17.9), and median time off-therapy was 5.5y (1.0-17.3). Overall incident HPV vaccine initiation was 16.0% at baseline. The adjusted odds of vaccine initiation were 1.3-fold (95%CI, 1.03-1.6; p = 0.03) higher post-intervention vs. pre-intervention, accounting for secular trend OR of 1.1. Overall prevalence of vaccine initiation increased from 51.9% pre-intervention to 61.3% post-intervention. Conclusions: The improvement in childhood cancer survivor HPV vaccine initiation rates in a diverse sample following implementation of a healthcare provider-focused intervention underscores the potential for pediatric oncology providers to positively impact HPV vaccine uptake in this vulnerable population. Clinical trial information: NCT04469569 .

Improvements in motor control are associated with improved quality of life following an at-home muscle biofeedback program for chronic stroke.

Chronic stroke survivors with severe arm impairment have limited options for effective rehabilitation. High intensity, repetitive task practice (RTP) is known to improve upper limb function among stroke survivors who have some volitional muscle activation. However, clients without volitional movement of their arm are ineligible for RTP-based interventions and require hands-on facilitation from a clinician or robotic therapy to simulate task practice. Such approaches can be expensive, burdensome, and have marginal effects. Alternatively, supervised at-home telerehabilitation using muscle biofeedback may provide a more accessible, affordable, and effective rehabilitation option for stroke survivors with severe arm impairment, and could potentially help people with severe stroke regain enough volitional activation to be eligible for RTP-types of therapies. Feedback of muscle activity via electromyography (EMG) has been previously used with clients who have minimal or no movement to improve functional performance. Specifically, training to reduce unintended co-contractions of the impaired hand using EMG biofeedback may modestly improve motor control in people with limited movement. Importantly, these modest and covert functional changes may influence the perceived impact of stroke-related disability in daily life. In this manuscript, we examine whether physical changes following use of a portable EMG biofeedback system (Tele-REINVENT) for severe upper limb hemiparesis also relate to perceived quality of life improvements. Secondarily, we examined the effects of Tele-REINVENT, which uses EMG to quantify antagonistic muscle activity during movement attempt trials and transform individuated action into computer game control, on several different domains of stroke recovery. For this pilot study, nine stroke survivors (age = 37-73 years) with chronic impairment (Fugl-Meyer = 14-40/66) completed 30 1-hour sessions of home-based training, consisting of six weeks of gaming that reinforced wrist extensor muscle activity while attenuating coactivation of flexor muscles. To assess motor control and performance, we measured changes in active wrist ranges of motion, the Fugl-Meyer Assessment, and Action Research Arm Test. We also collected an EMG-based test of muscle control to examine more subtle changes. To examine changes in perceived quality of life, we utilized the Stroke Impact Scale along with participant feedback. Results from our pilot data suggest that 30 sessions of remote training can induce modest changes on clinical and functional assessments, showing a statistically significant improvement of active wrist ranges of motion at the group level, changes that could allow some people with severe stroke to be eligible for other therapeutic approaches, such as RTP. Additionally, changes in motor control were correlated with the perceived impact of stroke on participation and impairment after training. We also report changes in corticomuscular coherence, which showed a laterality change from the ipsilesional motor cortex towards the contralesional hemisphere during wrist extension attempts. Finally, all participants showed high adherence to the protocol and reported enjoying using the system. Overall, Tele-REINVENT represents a promising telerehabilitation intervention that might improve sensorimotor outcomes in severe chronic stroke, and that improving sensorimotor abilities even modestly may improve quality of life. We propose that Tele-REINVENT may be used as a precursor to help participants gain enough active movement to participate other occupational therapy interventions, such as RTP. Future work is needed to examine if home-based telerehabilitation to provide feedback of individuated muscle activity could increase meaningful rehabilitation accessibility and outcomes for underserved populations.

Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study.

The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase. We evaluated the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age. We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population. Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26% lower risk of developing SPCs (SIR 0.74, 95% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28% higher in young (<40 years) cancer survivors (SIR 1.28, 95% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27% lower in middle-aged and older (≥40 years) cancer survivors (SIR 0.73, 95% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6%) and prostate (15.2%) cancers in men and breast (18.9%) and lung (12.2%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors. The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs.

Bone age and dental late effects in childhood cancer survivors: Radiographic findings in a Brazilian sample.

Changes in bone age and tooth development are late side effects of cancer therapy and can be identified by imaging examination. To evaluate the late effects of antineoplastic treatment on bone age and dental development in childhood cancer survivors. This is a retrospective case-control study on paediatric cancer survivors of both sexes who underwent antineoplastic treatment with 5-15 years of survival. Carpal radiographs were assessed for bone age and growth curve, and panoramic radiographs were used to evaluate dental development and alterations. Carpal radiographs were analyzed using the Greulich and Pyle inspection method, and the Martins and Sakima method was used to analyze the growth curve. All tests were applied with a confidence level of 95%. The study and control groups comprised 28 and 56 patients, respectively. There was no significant difference in bone age and growth curve between the study and control groups. Nonetheless, when sex was compared to chronological and bone ages, there was a significant difference in bone age (p = 0.019) and an underestimation in both groups and sexes in the Greulich and Pyle method. As to late dental effects, dental agenesia, microdontia, gyroversion, and unerupted teeth were found. Dental shape alterations mainly involve the root region. Close multidisciplinary collaboration is necessary during the follow-up period of young patients who have survived cancer.

Abstract PO5-12-10: Eyebrow and eyelash loss in breast cancer survivors

Abstract Background: Eyebrow and eyelash loss, known as madarosis, can occur secondary to breast cancer-directed therapy. However, the incidence and predictors of this phenomenon are not well-known. The purpose of this study is to ascertain the proportion of breast cancer survivors who experience madarosis, potential contributing factors to eyebrow and eyelash loss, and associations between this symptom and mental health. Methods: Breast cancer survivors were invited to participate in an ongoing longitudinal cohort study, the Mayo Clinic Breast Disease Registry (MCBDR), after having been seen at least once for breast cancer at Mayo Clinic in Rochester, MN. Those who consented were mailed a survey approximately one year after diagnosis. Respondents were asked to report their degree of eyebrow and eyelash loss experienced since their diagnosis on a 4-point scale of “no loss” (0) to “complete loss” (3). The proportions of participants who reported eyebrow and eyelash loss were evaluated overall and according to treatment type by descriptive statistics. Relationships between eyebrow and eyelash loss and mental health scores collected using the PROMIS-10 project scales (ranging from 0-20), with the poorest mental health indicated by scores under 8, were explored. Results: 838 registry participants responded to the year 1 survey’s alopecia questions. The median age of breast cancer survivors was 59.4 years (range 22-100 years). The majority were diagnosed at stage I-II (69%). 315 (37%) had received chemotherapy (+/- endocrine therapy), 415 (50%) had received endocrine therapy only, and 108 (13%) had received neither. Nearly half reported eyebrow loss (49%) or eyelash loss (49%). Eyebrow loss was reported by 89% of chemotherapy recipients, 27% of endocrine therapy only recipients, and 19% of those not treated with chemotherapy or endocrine therapy. 102 (32%) of those with chemotherapy-associated eyebrow loss reported that it was complete. Eyelash loss was reported by 274 (87%) of chemotherapy recipients, 112 (27%) of endocrine therapy only recipients, and 23 (21%) of those who received neither. Although no formal statistical testing was performed, there was a numerically higher proportion of patients with eyebrow and/or eyelash loss who reported poor mental health. Conclusions: Madarosis is a bothersome symptom in cancer survivors, particularly after chemotherapy. Future investigation into the incidence, predictors, and treatment of anti-neoplastic medication-related madarosis is needed. Table. Global mental health scores on PROMIS scale for eyebrow and eyelash loss Citation Format: Sarah Premji, Kathryn Ruddy, Nicole Larson, Charles Loprinzi, Brittany Dulmage, Maryam Lustberg, Fergus Couch, Janet Olson, Elizabeth Cathcart-Rake. Eyebrow and eyelash loss in breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-10.

377. Psychological Resilience Modulates the Association Between Neighborhood Disadvantage and Accelerated Epigenetic Aging in Recent Trauma Survivors

377. Psychological Resilience Modulates the Association Between Neighborhood Disadvantage and Accelerated Epigenetic Aging in Recent Trauma Survivors

Quality of life in chordoma survivors: results from the Chordoma Foundation Survivorship Survey.

Chordomas are rare malignant bone tumors whose location in the skull base or spine, invasive surgical treatment, and accompanying adjuvant radiotherapy may all lead patients to experience poor quality of life (QOL). Limited research has been conducted on specific demographic and clinical factors associated with decreased QOL in chordoma survivors. Thus, the aim of the present study was to investigate several potential variables and their impact on specific QOL domains in these patients as well the frequencies of specific QOL challenges within these domains. The Chordoma Foundation (CF) Survivorship Survey was electronically distributed to chordoma survivors subscribed to the CF Chordoma Connections forum. Survey questions assessed QOL in three domains: physical, emotional/cognitive, and social. The degree of impairment was assessed by grouping the participants into high- and low-challenge groups designated by having ≥ 5 or < 5 symptoms or challenges within a given QOL domain. Bivariate analysis of demographic and clinical characteristics between these groups was conducted using Fisher's exact test and the Mann-Whitney U-test. A total of 665 chordoma survivors at least partially completed the survey. On bivariate analysis, female sex was significantly associated with increased odds of significant emotional (p = 0.001) and social (p = 0.019) QOL burden. Younger survivors (age < 65 years) were significantly more likely to experience significant physical (p < 0.0001), emotional (p < 0.0001), and social (p < 0.0001) QOL burden. Skull base chordoma survivors had significantly higher emotional/cognitive QOL burden than spinal chordoma survivors (p = 0.022), while the converse was true for social QOL challenges (p = 0.0048). Survivors currently in treatment were significantly more likely to experience significant physical QOL challenges compared with survivors who completed their treatment > 10 years ago (p = 0.0074). Fear of cancer recurrence (FCR) was the most commonly reported emotional/cognitive QOL challenge (49.6%). Only 41% of the participants reported having their needs met for their physical QOL challenges as well as 25% for emotional/cognitive and 18% for social. The authors' findings suggest that younger survivors, female survivors, and survivors currently undergoing treatment for chordoma are at high risk for adverse QOL outcomes. Additionally, although nearly half of the participants reported a FCR, very few reported having adequate emotional/cognitive care. These findings may be useful in identifying specific groups of chordoma survivors vulnerable to QOL challenges and bring to light the need to expand care to meet the QOL needs for these patients.

A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process

BackgroundGiven the increasing number of young adult cancer survivors and the impacts of cancer on various life domains, interventions addressing the psychosocial needs of young adult survivors are crucial. However, such intervention research is limited, and the existing literature has often: 1) overlooked young adult survivors' psychosocial needs; 2) targeted depression, anxiety, or fear of recurrence – rather than positive outcomes like well-being; and 3) failed to consider scalable approaches, like digital health. MethodsThis paper documents the development and refinement of an 8-week digital, coach-assisted intervention targeting hope among young adult cancer survivors (ages 18–39, within 3 years of treatment completion) and presents the protocol of the 2-arm RCT (comparing intervention vs. attention control). The intervention builds upon a 2017–2018 pilot trial (n = 56); intervention refinements were based on subsequent semi-structured interviews among young adult survivors (n = 23). ResultsThe pending trial design involves an increased sample size (n = 150) to increase power and diversified recruitment efforts (i.e., clinic-based, social media, community-based organizations, etc.) to facilitate intervention reach, accessibility, and scalability. The intervention was enhanced by integrating highly relevant theoretical and therapeutic frameworks, specifically the concept of hope and Acceptance and Commitment Therapy, as well as updating intervention delivery technology. Intervention outcomes include feasibility and acceptability at end-of-treatment and preliminary efficacy on hope (primary outcome) and quality of life measures (secondary outcomes) at end-of-treatment and 16-week follow-up. ConclusionsThis paper may facilitate discussion regarding approaches for addressing the significant psychosocial challenges faced by young adult survivors and catalyze dissemination of trial results.Trial Registration:NCT05905250

The association of pre-cancer diagnosis cardiovascular risk factors with memory aging after a cancer diagnosis, overall and by race/ethnicity.

Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998-2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups.

Impact of sociodemographic factors, stress, and communication on health-related quality of life in survivors of pediatric cancer.

While most research has largely focused on medical risks associated with reduced health-related quality of life (HRQOL) in survivors, sociodemographic and family factors may also play a role. Thus, we longitudinally examined sociodemographic factors and family factors associated with survivor HRQOL, including adolescent's cancer-specific stress, mother's general stress, and mother-adolescent communication. Mothers (N=80) and survivors (ages 10-23, N=50) were assessed 5years following initial diagnosis. Mothers completed measures regarding sociodemographic background adolescent's cancer-specific stress, mother's general stress, mother-adolescent communication, and adolescent HRQOL. Survivors also reported on their own HRQOL. Two hierarchical multiple regressions examined predictors of (a) mother's report of adolescent HRQOL, and (b) survivor's self-report of HRQOL. The final model predicting mother-reported adolescent HRQOL was significant, F(5,74)=21.18, p<.001, and explained 59% of the variance in HRQoL. Significant predictors included adolescent stress (β=-.37, p<.001), mothers' stress (β=-.42, p<.001), and communication (β=.19, p=.03). The final model predicting survivor-reported HRQOL was also significant, F(5,44)=5.16, p<.01 and explained 24% of the variance in HRQOL. Significant predictors included adolescent stress (β=-.37, p=.01) and communication (β=-.31, p=.04). Sociodemographic factors were not a significant predictor of HRQOL in any model. Family stress and communication offer potential points of intervention to improve HRQOL of pediatric cancer survivors from mother and survivor perspectives. While additional research is needed, healthcare professionals should encourage stress management and strong mother-child communication to enhance survivors' long-term HRQOL. Such interventions may be complimentary to efforts targeting the known sociodemographic factors that often affect health.

Relatively Unworthy Victims? Middle-Aged Women as Rape Survivors.

This study examines how the age of female survivors impacts public perceptions of rape in China. In our online survey experiment, participants consider rape as less serious when the survivor is a middle-aged woman compared to other groups of women (younger, older, or age unknown). Participants also request shorter sentencing when the survivor is a middle-aged woman than a younger woman. In China, moral codes surrounding chastity and respect for elders lead to greater emotional responses toward rape against younger and older survivors than middle-aged survivors. Our study expands studies of rape perception by theorizing public attitudes toward middle-aged survivors.

Association of depressive symptom severity and suicidal ideation with health-related quality of life among stroke survivors, NHANES 2005-2018

Stroke, a critical health issue in the US, not only has physical repercussions but also potentially affects the health-related quality of life (HRQoL) through neuropsychiatric outcomes like depressive symptoms and suicidal thoughts. This study utilized a nationally representative sample of 1302 US stroke survivors (age ≥ 20) from the US National Health and Nutrition Examination Survey (2005–2018) to assessed relationships between QoL via the CDC HRQOL-4 and evaluated depressive symptoms and suicidal ideation using the Patient Health Questionnaire-9 (PHQ-9). Participants (mean age: 64.4; 56.0 % female) showed that 40.7 % had at least mild depressive symptoms, and 18.8 % exhibited major depressive symptoms. Suicidal ideation was reported by 8.1 %. After sociodemographic and health condition adjustments, mild and major depressive symptoms, along with suicidal ideation, were associated with poorer general health status and more physically and mentally unhealthy days and activity limitation days. A dose-response relationship between PHQ-9 scores and HRQoL outcomes was evident (All P for trend <0.001). Stroke survivors with suicidal ideation also experienced more physically and mentally unhealthy days and activity limitation days. Depressive symptoms and suicidal ideation are associated with reduced HRQoL among US stroke survivors, underscoring the importance of thorough neuropsychiatric evaluations and interventions to bolster stroke survivors' well-being.

Abstract 6296: Biomarkers associated with atherosclerosis-related cardiovascular dysfunction in cancer survivors treated with anthracyclines

Abstract Introduction: Cancer survival has increased in part due to treatment advances. However, anthracycline chemotherapy increases cardiovascular (CV) morbidity risk, including atherosclerotic CV disease (ASCVD). Among those receiving anthracyclines, it is yet unclear who is at greatest risk of ASCVD, a major cause of CV mortality. Elucidating pathophysiologic processes involved in the development ASCVD could shed light on strategies to identify those at risk. Methods: Analyses were performed on 279 lymphoma and breast cancer survivors enrolled in the PREVENT study [clinical trial WF-98213) through Wake Forest NCI Community Oncology Research Base (NCORP) and Alliance (A221501)]. CV dysfunction was measured via cardiac MRI (cMRI) at baseline (pre-treatment) and 6-months post-diagnosis to ascertain aortic distensibility and wall thickness in the descending aorta. Biomarkers were measured at baseline and 6-months and were log-transformed to base 2. Multiple linear regression was used to determine associations between biomarker and outcome at 6 months, adjusted for baseline biomarker and cMRI outcome, age, race, sex, body mass index, and smoking history. Results: The mean age (SD) of cancer survivors 49 (12) years; 92% were women. The mean aortic distensibility and mean wall thickness at baseline was 0.002 (0.0014) and 2.99 (0.41), respectively. Table 1 shows the associations between biomarkers and aortic distensibility and wall thickness of the descending aorta. After adjustment for confounders, Arginine, CRP, MPO, and ornithine were associated with 6-month aortic distensibility, and the HDL and SDMA were associated with aortic wall thickness. Conclusions: The findings of this study suggest that biomarkers in oxidative stress and inflammatory pathways may be involved in pathophysiology of ASCVD among cancer survivors receiving anthracyclines. These results require further study in larger cohorts to better define mechanistic pathways involved. Association of Biomarkers with Atherosclerosis-Related Cardiovascular Dysfunction Citation Format: Kerryn W. Reding, Alexi Vasbinder, Nathaniel O'Connell, Biniyam Demissei, Warren Szewczyk, Richard Cheng, Amy Ladd, Alexander Lucas, Juergen Meyer, Stephen Bowen, Fadi Salloum, Ralph D'Agostino, Glenn Lesser, Kathryn Weaver, Bonnie Ky, W. H. Wilson Tang, W. Gregory Hundley. Biomarkers associated with atherosclerosis-related cardiovascular dysfunction in cancer survivors treated with anthracyclines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6296.

Abstract 2244: Accelerated aging associated with cancer characteristics and treatments among breast cancer survivors

Abstract There are currently approximately four million breast cancer (BC) survivors in the US. BC survivors may experience accelerated aging, with greater physical dysfunction and cognitive decline than cancer-free women, potentially due to the detrimental effects of BC and/or its treatments (Tx). However, the aging trajectory after BC diagnosis has not been fully elucidated. A biological age measure, PhenoAge acceleration (PAA), derived from chronological age and nine clinical blood chemistry biomarkers, has been associated with aging-related health outcomes and mortality in the general population. Our study aims to evaluate PAA among BC patients by clinical characteristics, cancer Tx, and medications (chemotherapy and endocrine therapy drugs). The study included 1264 BC patients (age 54.7±11.7) recruited at Vanderbilt University Medical Center in 2004-2021. BC-related information and lab test results were obtained from the tumor registry and electronic health records. The differences in PAA (ΔPAA) by BC stage, grade, subtype, Tx, and medications at multiple time points were evaluated using linear mixed models, with the time interval between diagnosis and PAA assessments as a natural spline, and its interaction with the exposures under study as covariates. Associations of PAA with Tx and medications were estimated with adjustment for other Tx and medications. At 10 years post-diagnosis, stage III/IV (vs 0) and intermediate- and high- (vs low-) grade BC were associated with a higher PAA of 4.48 (p&amp;lt;0.001), 1.26 (p=0.03), and 1.95 (p=0.001), respectively; triple-negative (vs hormone receptor+/Her2-) BC was associated with a lower PAA (ΔPAA=-1.96, p=0.004). Compared with surgery, alone or with radiotherapy, surgery plus chemotherapy was associated with a higher PAA at 1 year (ΔPAA ranging from 1.96, p=0.03 to 4.61, p&amp;lt;0.001), while surgery plus endocrine therapy was associated with a higher PAA at 10 years post-diagnosis (ΔPAA ranging from 1.70, p=0.04 to 2.75, p=0.006). The associations of PAA with most chemotherapy agents diminished over time, reverting to negative or null at 10 years. Antimetabolites, on the other hand, were associated with an increased PAA at 2 years (ΔPAA=2.62, p&amp;lt;0.001) which increased further at 10 years post-diagnosis (ΔPAA=7.26, p&amp;lt;0.001). Endocrine therapy and PAA association at 10 years post-diagnosis was likely driven by aromatase inhibitors (AI) (ΔPAA=1.53, p&amp;lt;0.001). Selective estrogen receptor modulators were inversely associated with PAA at year 10 (ΔPAA=-1.03, p=0.01). Additional adjustment for BC stage, grade, and subtype did not materially change the results for Tx and medications. Our study found that BC patients had accelerated aging up to 10 years post-diagnosis, especially those with stage III/IV and high/intermediate-grade BC. The aging trajectory varied by cancer Tx and medications; antimetabolites and AI might accelerate aging in long term BC survivors. Citation Format: Cong Wang, Jill B. De Vis, Kirsten Nguyen, Brigitte Jia, Mason Alford, Anuradha Bapsi Chakravarthy, Xiao-Ou Shu. Accelerated aging associated with cancer characteristics and treatments among breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2244.