Health Of Survivors Research Articles

Associations between social determinants of health and cardiovascular and cancer mortality in cancer survivors: a prospective cohort study.

The cause-specific mortality implications of social determinants of health (SDOH) in cancer survivors were unclear. This study aimed to explore associations between SDOH and cardiovascular and cancer mortality in cancer survivors. Data from 2013 to 2017 National Health Interview Survey were used for this prospective cohort study. Social determinants of health were quantified using a 38 point, 6 domain score, with higher points indicating worse deprivation. Associations between SDOH and outcomes (primary: cardiovascular mortality; secondary: cancer and all-cause mortality) were assessed using cause-specific multivariable Cox regression, with cancer survivors and individuals without cancer modelled separately. Post hoc analyses were performed among cancer survivors to explore associations between each domain of SDOH and the risks of outcomes. Altogether, 37 882 individuals were analysed (4179 cancer survivors and 33 703 individuals without cancer). Among cancer survivors, worse SDOH was associated with higher cardiovascular [adjusted hazard ratio (aHR) 1.31 (1.02-1.68)], cancer [aHR 1.20 (1.01-1.42)], and all-cause mortality [aHR 1.16 (1.02-1.31)] when adjusted for demographics, comorbidities, and risk factors. Among individuals without cancer, SDOH was associated with cardiovascular mortality and all-cause when only adjusted for demographics, but not when further adjusted for comorbidities and risk factors; no associations between SDOH and cancer mortality were found. Among cancer survivors, psychological distress, economic stability, neighbourhood, physical environment and social cohesion, and food insecurity were varyingly associated with the outcomes. Social determinants of health were independently associated with all-cause, cardiovascular, and cancer mortality among cancer survivors but not among individuals without cancer. Different domains of SDOH may have different prognostic importance.

Evaluating Biomarkers of Bone Health After an 8-Week Walking Program in Non-Ambulatory Stroke Survivors: A Pilot Study

Background/Objectives: Stroke survivors have a significantly increased likelihood of developing osteoporosis, a condition characterized by weak and brittle bones as well as an elevated risk of bone fractures. However, previous studies on exercise intervention have mostly been on stroke survivors who are able to walk. The objective of this study was to examine the effect of walking exercise on bone health in non-ambulatory stroke survivors. Methods: This pre- and post-test study enrolled a group of chronic non-ambulatory stroke survivors. They were instructed to complete an 8-week aerobic walking exercise program, three sessions per week. Serum concentrations of osteocalcin (OC) and carboxy-terminal telopeptides of type I collagen (ICTP) were evaluated at baseline and after completing the walking exercise program. In addition, we assessed the ambulation capacity and balance control using the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. Results: A total of 9 out of 10 non-ambulatory stroke survivors who were recruited completed the intervention. The serum concentration of OC significantly increased from 8.51 ± 2.28 ng/mL to 9.39 ± 2.97 ng/mL (p < 0.10). The serum concentration of ICTP significantly increased from 4.45 ± 2.58 ng/mL to 5.31 ± 2.92 ng/mL (p < 0.10). Both FAC and BBS scores significantly improved from 1.0 ± 0 to 1.33 ± 0.5 (p < 0.1) and from 7.22 ± 10.02 to 15.78 ± 14.81 (p < 0.01), respectively. Conclusions: The findings of this pilot study suggest that walking exercise may improve bone health by initiating a bone remodeling process in chronic non-ambulatory stroke survivors.

Factors Influencing Suicidal Ideation in Young and Middle-aged Adults in Korea: A Nationwide Study

Abstract Objectives This study aims to analyze various factors influencing suicidal ideation among young (19-39 years) and middle-aged (40-64 years) adults using nationwide longitudinal data in South Korea, which has the highest suicide rate among OECD countries for more than 20 years. Methods An analysis was conducted using the WAVE II data (2016-2017) from a nationwide longitudinal study on the mental health of suicide survivors (LoSS). The sample included 2,002 participants (1,290 young adults, 712 middle-aged adults) recruited through stratified proportional quota sampling. Multiple regression analysis was performed to identify factors influencing suicidal ideation in each age group. Results In young adults, being female, having a high school education or lower, being unmarried/divorced/widowed, and having higher levels of depression were positively associated with suicidal ideation. Higher levels of social support and better subjective physical health were negatively associated with suicidal ideation. In middle-aged adults, being unemployed, living alone, drinking alcohol more than once a week, and having higher levels of depression were positively associated with suicidal ideation, while higher levels of social support were negatively associated with suicidal ideation. Conclusions Factors influencing suicidal ideation differ between young and middle-aged adults. Age-specific suicide prevention strategies considering these factors are needed to promote social health and stability in South Korea. Key messages • Different factors influence suicidal ideation in young and middle-aged adults in South Korea. • Age-specific suicide prevention strategies are necessary to effectively address suicidal ideation and promote social health and stability in South Korea.

Association of physical activity with health-related quality of life in rectal cancer survivors

Abstract Background Health-related quality of life (HRQoL) in rectal cancer survivors after completion of surgical treatment may be influenced by various factors including physical activity. The purpose of this study was to examine the association between regular exercise and physical and mental health in rectal cancer survivors. Methods People who underwent surgical resection of rectal cancer with temporary ileostomy from 2018 to 2021 were invited to participate. Participants were drawn from the Clinic for Digestive Surgery and the Clinic for Emergency Surgery of the University Clinical Center of Serbia, as well as the nationwide laparoscopic program - LapSerb consortium. Data were collected through interviews in late 2022 and early 2023. The HRQoL was evaluated using the physical composite score (PCS) and mental composite score (MCS) of the Short Form-36 (SF-36) questionnaire. Socio-demographic, clinical and behavioral characteristics including the frequency of exercise were analyzed in multiple linear regression models. Results A total of 134 rectal cancer survivors were tested. Few participants (18.7%) exercised regularly, while most of the study population occasionally (41.8%) or never engaged (39.5%) in physical activity. Rectal cancer survivors who exercised regularly had significantly higher scores of physical (75.5 vs. 62.8, p = 0.019) and mental quality of life (78.9 vs. 63.8, p = 0.008). Regular exercise remained associated with better physical and mental health after the adjustment for demographic, clinical and behavioral characteristics. Conclusions Consistent physical exercise seems to be significant contributor of better physical and mental quality of life in rectal cancer survivors after completion of surgical treatment. Key messages • Physical exercise may help rectal cancer survivors improve their physical and mental health. • Promotion of physcial activity in rectal cancer survivors could optimize recovery after surgery.

Fear of recurrence and its association with mental health outcomes after spontaneous coronary artery dissection (SCAD)

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, predominantly affecting younger women with few traditional cardiac risk factors. The condition is characterised by relatively high rates of recurrence. Recent qualitative studies demonstrate that SCAD survivors often experience fears about the future, particularly relating to SCAD recurrence and death. Research in psycho-oncology demonstrates that experiencing fear of cancer recurrence predicts worse outcomes for mental health and quality of life, an association that is also likely in cardiac patients. To date, no quantitative research has investigated fear of recurrence and its association with mental health in SCAD survivors. Purpose The aim of this study was to investigate the prevalence of fears relating to SCAD recurrence and the association of fear of recurrence with mental health outcomes. Methods 293 SCAD survivors completed an online questionnaire assessing the psychosocial impacts of SCAD. Participants rated whether they experienced these impacts ‘not at all’, ‘a small amount, ‘a moderate amount’ or ‘a large amount’ within the first six months of their SCAD. Items related to fears about the future, recurrence, and death were extracted for analysis. Participants also completed measures of anxiety (Generalised Anxiety Disorder-7), depression (Patient Health Questionnaire-9), distress (Cardiac Distress Inventory - Short Form), and mental health related quality of life (Short Form 12, mental health component). Results In the six months following their SCAD, 97.6% of survivors experienced some level of worry about having another SCAD, 95.6% were concerned about triggering another SCAD, 95.6% experienced fear of the future, and 82.6% experienced fear of dying. Reports of experiencing ‘a large amount’ of fear in these areas were 54.6%, 45.1%, 42.7%, and 30.4% respectively. The amount of worry reported about having another SCAD was significantly associated with increased levels of anxiety, depression, and cardiac distress, and reduced mental health quality of life. Conclusions Almost all SCAD survivors reported fears, worries, and concerns related to recurrence. Worry about SCAD recurrence was significantly associated with important mental health outcomes. Cardiac health professionals should monitor fears of recurrence in their patients, as a large amount of worry may be indicative of poor mental health, and referral to psychology services may be appropriate.Rates of fears of SCAD recurrence

The Relationship Between Dyadic Coping and Mental Health in Stroke Survivors and Their Spouse Caregivers: An Actor-Partner Interdependence Model.

To investigate the relationship among dyadic coping, mental health and the individual and mutual influences on stroke survivors and their spouse caregivers. A cross-sectional descriptive study was conducted in China from November 2019 to August 2020. The STROBE checklist was used to report the present study. The analysis included 224 dyads of stroke survivors and their spouse caregivers in China. Data on stroke survivors and their spouse caregivers were collected using the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire nine-item scale (PHQ-9) and the Generalised Anxiety Disorder seven-item scale (GAD-7). The dyadic analysis was conducted based on the Actor-Partner Interdependence Model (APIM). Regarding actor effects, spouse caregivers' dyadic coping and perceived dyadic coping had a negative predictive effect on their own anxiety and depression. Stroke survivors' perceived dyadic coping had a negative effect on their own depression. Regarding partner effects, spouse caregivers' perceived dyadic coping also had a negative predictive effect on the depression of the patients. In contrast, stroke survivors' perceived dyadic coping was positively associated with spouse caregivers' anxiety and depression. These findings suggested that mental health of stroke survivors and their spouse caregivers was affected by various dyadic coping dimensions. Our research has the potential to contribute to the understanding dyadic coping and mental health of stroke survivor-spouse caregiver dyads. The findings reveal that the coping strategies employed by stroke couples are closely related to the mental health of both partners. This study provides evidence for the significant impact of dyadic coping on the psychological well-being of stroke survivors and their spouse caregivers. Therefore, dyadic interventions aiming at strengthening dyadic coping may have positive effects on their mental health. This study directly involved the patients and family caregivers in hospital settings.

Daily functioning and (health-related) quality of life of young adult survivors of childhood bacterial meningitis.

Young adult survivors of childhood BM reported similar and even better levels of daily functioning, HRQoL, and overall QoL than age-matched Dutch reference scores. However, clinicians and healthcare workers should be mindful of poor mental and physical health of some survivors of childhood BM because these survivors also face problems with functioning in daily life. • Acute bacterial meningitis is a life-threatening infection which may lead to devastating lifelong disabilities. • Health-related quality of life is decreased in school-age survivors of bacterial meningitis. • The present study shows that HRQoL in survivors of childhood BM improves over time • However, especially poor mental health in adolescent and young adult survivors is associated with impaired functioning in daily life.

Cardioprotective strategies in the management of chemotherapy-induced cardiotoxicity: Current approaches and future directions

Background: Chemotherapy-induced cardiotoxicity (CIC) is a significant challenge in cancer treatment, leading to heart failure and myocardial infarction. With rising cancer survival rates, the long-term cardiovascular health of survivors has gained importance. While several cardioprotective medications have been studied to mitigate chemotherapy’s harmful effects on the heart, more research is needed to confirm their effectiveness and optimal use. Methodology: This review synthesizes evidence on cardioprotective drugs in managing CIC. We conducted a comprehensive literature search of peer-reviewed articles, clinical trials, and meta-analyses published between January 2000 and May 2024. Studies were selected based on relevance, quality, and focus on mechanisms, efficacy, and clinical outcomes of cardioprotective agents such as beta-blockers, ACE inhibitors, ARBs, statins, and dexrazoxane. Results and Discussion: Cardioprotective medications show potential in alleviating the impact of chemotherapy on heart function. Beta-blockers and ACE inhibitors effectively reduce heart failure incidence and improve cardiac outcomes. Statins, with their anti-inflammatory and antioxidative properties, and dexrazoxane, which reduces anthracycline-induced cardiotoxicity, also show promise. However, variability in study designs, patient groups, and chemotherapy treatments complicates the establishment of standardized treatment protocols. Conclusion: Cardioprotective drugs hold significant promise in managing CIC and improving cardiac outcomes for cancer patients. Current evidence supports the efficacy of beta-blockers, ACE inhibitors, statins, and dexrazoxane. Further research is needed to establish standardized protocols, evaluate long-term safety, and optimize treatment timing. Integrating cardioprotective strategies into oncological care can enhance the quality of life and prognosis for cancer survivors.

7770 Damage of Ovarian Vasculature by Chemotherapies induces Ovarian Dysfunction in Mice

Abstract Disclosure: W. So: None. R. Dong: None. Y. Luan: None. A. Abazarikia: None. S. Kim: None. Background: Chemotherapy demonstrates efficacy to destroying cancer cells; however, it can inadvertently impact normal healthy cells, leading to irreversible side effects, particularly affecting the ovaries in female patients. Female cancer survivors encounter endocrine dysfunction and infertility due to ovarian damage caused by gonadotoxic cancer therapies. The ovary, a vital organ responsible for producing oocytes and endocrine hormones, faces significant challenges following such treatment. A study with premenopausal breast cancer patients reported a significant reduction in ovarian blood flow and volume immediately following chemotherapy. The preservation of ovarian function depends on the ovarian vasculature in supporting the development and maintenance of ovarian follicles. Despite its importance, the relationship between ovarian vasculature and follicle following chemotherapy has not been studied. Results: To investigate the direct impacts of chemotherapy, ovaries from postnatal 5 CD-1 mice were subjected to testing with three chemotherapeutic agents: cisplatin (CDDP), cyclophosphamide (CPA), and doxorubicin (DOXO). The expression of CD31/PECAM-1 (platelet endothelial adhesion molecule) exhibited a significant decrase after 96 hours of culture with 4-HC, an active metabolite of CPA. This reduction implies that ovarian vasculature was also compromised when chemotherapy eliminated immature follicles. In order to evaluate the influence of vascular endothelial growth factor (VEGF) in safeguarding both vasculature and ovarian follicles, ovaries were co-cultured with VEGF165 or VEGF165b in combination with chemotherapy. Interestingly, pre-treatment with VEGF165 before 4-HC led to an increased expression of CD31 in the cortex area, while VEGF165b further diminished CD31 expression compared to treatment with 4-HC alone. Additionally, adolescent CD-1 mice were intraperitoneally injected with CDDP, CPA, or DOXO, and ovaries were harvested one week after injection. Ovaries treated with chemotherapeutic agents exhibited a reduction in ovary weight and decreased CD31 expression compared to control mice. Conclusions: We propose that these chemotherapeutic agents not only induced the loss of ovarian follicles but also affected ovarian vasculature in mice. This suggests a potential decrease in folliculogenesis within the ovary, coupled with the depletion of ovarian reserve, as the delivery of nutrients and oxygen to growing ovarian follicles may be compromised. VEGF165 may play a beneficial role in maintaining ovarian function by safeguarding ovarian vasculature following chemotherapy. Understanding these intricate dynamics is essential for developing strategies to mitigate the negative impact of cancer therapies on reproductive health in female cancer survivors, particularly in preserving endocrine function and reproductive lifespan. Presentation: 6/2/2024

The importance of the feeling of isolation and loneliness among French Holocaust survivors after the 7 October terrorist attack

IntroductionThe 7 October terrorist attack in southern Israel and the increase in anti-Semitic acts have had a significant impact on the mental health of Holocaust survivors (HS), with some experiencing feelings of isolation and loneliness associated with an increased risk of mortality. The main objective of our work was to assess the incidence and intensity of perceived stress among French HS suffering from feelings of isolation and loneliness following the 7 October attack. The secondary objective was to determine the impact on health and to establish a link with the Holocaust period. Materials and methodsThe study was conducted between 30 October and 15 December 2023 among HS living in France who were contacted by mail through HS support organisations. They completed a questionnaire that included sociodemographic data and experiences during the Holocaust, an assessment of perceived stress using the PSS-10 scale, the presence or absence of feelings of isolation and loneliness, and health consequences and reactions to the 7 October attacks. Statistical analyses were performed using SPSS 21.0, with Mann-Whitney tests, chi-squared and Student's t-tests used to compare HS experiencing loneliness and isolation with those not experiencing loneliness and isolation, with a p-value of < 0.05 considered statistically significant. Results94 respondents completed the questionnaire, of whom 29 (30.5 %) were men. The HS had a mean PSS-10 score of 17.7 ± 6.0 (min 5 - max 35). Thirty (31.6 %) reported feeling isolated or alone after the 7 October massacre. Those who felt isolated or alone were more likely to feel that they had no support from those around them (73.3 % vs. 19.7 % p < 0.05). The PSS10 scores of HS suffering from isolation and loneliness were significantly higher than those of other HS (21.2 ± 5.2 vs. 16.0 ± 6.2, p ≤ 0.05). After the 7 October massacre, 93.3 % of HS suffering from loneliness and isolation felt that their Holocaust experience had reawakened their vulnerability, especially aggravated health problems (34 %). They tend to think about the Holocaust period more often (96.7 % vs. 80.3 %, p ≤ 0.05) and are significantly more worried about the future of their children and grandchildren as Jews (93.3 % vs. 77.0 %, p ≤ 0.05). ConclusionThis is the first study to assess the importance of stress among HS, particularly those suffering from loneliness and isolation, following the 7 October terrorist attack. It highlights the importance of implementing intervention programmes to support the last eyewitnesses of the Holocaust period.

Bone health in childhood cancer survivors, is there really a problem? Pitfalls of assessment, calculating risk and suggested surveillance and management for osteonecrosis and low and very low bone mineral density.

Childhood cancer survivors are at increased risk of developing (long-term) skeletal adverse effects, such as osteonecrosis, impaired bone mineral density, and fractures. This paper provides an overview of the current understanding of bone health in these survivors, examining whether it represents a significant concern. It focuses on the challenges of assessing and managing bone health in childhood cancer survivors, highlighting diagnostic pitfalls, methods for accurately identifying those at high risk, and suggested strategies for surveillance and management of osteonecrosis and impaired bone mineral density. The need for improved surveillance strategies, particularly for high-risk survivors, alongside potential prevention and management options, including pharmacological and lifestyle interventions, is emphasised. Given the lack of consensus on optimal prevention and treatment strategies, the paper emphasises the need for further research to optimise care and improve long-term outcomes for childhood cancer survivors with bone health impairments.

Association Between Dietary Flavonoid Intake and Cardiovascular Health in Cancer Survivors: A Cross-Sectional Study.

Flavonoids are naturally occurring compounds with diverse health-promoting properties. The purpose of this study was to explore the associations between dietary flavonoid intake and cardiovascular health in cancer survivors. We obtained data from the National Health and Nutrition Examination Survey (NHANES) 2007-2008, 2009-2010, and 2017-2018 cycles. Weighted linear regression and restricted cubic spline (RCS) were used to explore the correlation between dietary flavonoid intake and cardiovascular health (Life's Essential 8 (LE8) score) in cancer survivors. Then, weighted quantile sum (WQS) regression and quantile-based g-computation (qgcomp) models were performed to assess the mixed effects of the six flavonoid subclasses and to determine the major flavonoid types. Additionally, the protective effect of high flavonoid intake on cardiovascular health was further evaluated in different subgroups, and mediation analysis was used to explore mediating factors. After adjusting for all covariates, compared to those in the first quartile, participants in the fourth quartile of total flavonoids, anthocyanidins, flavonols, flavanones, and flavones intake exhibited increases in LE8 scores of 3.24% (95% CI: 0.45-6.03, P for trend=0.030), 6.25% (95% CI: 3.14-9.36, P for trend<0.001), 3.01% (95% CI: 1.33-4.69, P for trend= 0.003), 3.23% (95% CI: 0.18-6.27, P for trend=0.030), and 5.01% (95% CI: 2.42-7.61, P for trend<0.001), respectively. Meanwhile, significant non-linear relationships were supported by the RCS models. However, the weighted linear regression and RCS models did not reveal any clear correlations between isoflavone or flavan-3-ol intake and the LE8 score. Regarding mixed effects, anthocyanidin, flavonol, flavanone, and flavone intake were positively related to the LE8 score according to both the WQS and qgcomp models, and anthocyanidin intake was the major contributor. Our study indicated that dietary flavonoid intake is positively associated with cardiovascular health in cancer survivors, among which anthocyanidin intake might provide the most benefit.

Health and wellbeing of survivors of sexual violence and abuse attending sexual assault referral centres in England: the MESARCH mixed-methods evaluation.

One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk 'triad' of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk 'triad' underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

Hidden scars: the persistent multifaceted health and psychosocial consequences for Syrian torture survivors.

Background: The impact on the physical and mental health of those who survived torture and their close circles in the Syrian regime's detention facilities remains under-studied.Objective: This qualitative study explored Syrian refugees' narrations of captivity and torture, and the consequences of such extreme traumatic events on their physical and psychosocial health.Method: Thirteen audio-recorded interviews were conducted in Arabic with Syrian refugees. Study participants were at least 19 years of age, resided in diverse urban areas of Jordan, had experienced captivity and torture in Syrian detention facilities, and voluntarily agreed to participate in the study. Participation was anonymous, only oral consent was required, and no incentives were provided to participants. Interviews were transcribed and translated into English by a team of researchers, followed by analysis of repetitive themes according to the narrative paradigm.Results: Analysis of interviews elicited three major themes: extreme traumatic experiences of torture, and its physical and psychosocial health consequences. The first major theme was divided into two sub-themes: torture experienced by the participants themselves, and torture experienced by participants' close circles. The second major theme, pertaining to physical health, was divided into two sub-themes: acute and chronic health sequelae. The third major theme, related to psychosocial health, was divided into four sub-themes: mental health symptomatology, impacts on professional life, impacts on interpersonal relationships, and social consequences.Conclusions: Torture experiences of Syrian refugees had adverse consequences for the physical and psychosocial health, functioning, and the overall well-being of survivors and their close circles. Interventions may seek to improve both the acute and chronic health consequences, as well as the mental health symptoms and associated impacts on livelihood, professional, and relationship dynamics. They should span clinical, legal, and advocacy spheres, given that a holistic approach may contribute immensely to survivors' healing process.

Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation

AbstractDuring the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management. The physical and emotional effects of living with CVD are ongoing with broad challenges ranging from the individual to system level. However, post-discharge care of people with coronary disease continues to follow a 50-year-old cardiac rehabilitation model which focuses on the sub-acute phase and is of a finite in duration. The aim of this paper is to consider the concept of supporting survivors to live well with CVD rather than ‘rehabilitating’ them and propose factors for consideration in reframing secondary prevention towards optimizing cardiovascular health. We discuss deeply-held potential considerations and challenges associated with the concept of supporting survivors achieve optimal cardiovascular health and live well with CVD rather than ‘rehabilitating’ them. We propose the concept of 5 x P’s for reframing traditional cardiac rehabilitation towards the concept of cardiovascular health for survivors beyond ‘rehabilitation’. These include the need for personalization, processes, patient-centered care, parlance, and partnership. Taken together, consideration of challenges at the systems and population level will ultimately improve engagement with secondary prevention as well as outcomes for all people who need it.

The Impact of Long-COVID on Mental Health: A Systematic Review

Long-COVID, a chronic disease, poses threats not just to the patient’s physical health but also their mental well-being. This study seeks to examine the impact of long-COVID on mental health in COVID-19 survivors through a literature review of 38 studies from 19 countries. The analysis results reveal that depression and anxiety disorders are the most pronounced mental health issues in this population, and that personal factors like gender, age, and economic status and environmental factors can all influence long-COVID’s effects on their mental well-being. The study highlights the concerning prevalence and severity of mental health issues associated with long-COVID and the importance of increasing psychological support services for individuals with the post-COVID-19 syndrome and bolstering public knowledge about the condition.

COVID-19 Recovery and Cardiovascular Health: The Interplay Between Fetuin-A and Blood Pressure.

COVID-19 has been shown to impair cardiovascular function, and further studies have proven that this effect can be long-term on several cardiovascular biomarkers. Fetuin-A, a multifunctional protein involved in calcification and inflammation, has emerged as an important biomarker in this process. This study investigates the relationship between recovery from COVID-19, cardiovascular health, and concentrations of fetuin-A in patients with high blood pressure. Seventy-nine men and 36 women were admitted to the Nasiriyah Heart Center in Iraq between March and August 2023, with ages ranging from 5 to 93 years. Clinical data were collected on admission along with blood samples, and serum levels of fetuin-A were measured using an enzyme-linked immunosorbent assay (ELISA). The results were analyzed using Python libraries Pandas and SciPy to perform independent sample t-tests to determine mean levels of fetuin-A in various patient subgroups. A p-value of less than 0.05 was considered statistically significant. The study showed that patients who had survived COVID-19 had significantly higher levels of fetuin-A compared to healthy controls, with a mean concentration of 103.64 mg/L versus 19.199 mg/L (p < 0.001). Additionally, it was found that patients with high blood pressure had increased levels of fetuin-A compared to those without high blood pressure, with a mean concentration of 109.01 mg/L versus 95.88 mg/L (p = 0.025). These results suggest that COVID-19 may alter the usual relationship between blood pressure and cardiovascular biomarkers. This study emphasizes the complex interaction between recovery from COVID-19 and cardiovascular health, primarily through the levels of fetuin-A. The increase in fetuin-A among hypertensive patients suggests that COVID-19 may enhance cardiovascular risk, highlighting the need for stricter monitoring and tailored treatment strategies. Further studies are needed to elucidate the underlying mechanisms, which will help develop effective clinical guidelines for managing cardiovascular health in COVID-19 survivors.

Abstract C041: A systematic review of cardiovascular health among cancer survivors

Abstract Purpose: The most common non-cancer cause of death among cancer survivors is cardiovascular disease. Health behaviors (e.g., diet, physical activity, sleep, smoking) and health factors (e.g., blood pressure, hemoglobin A1C, cholesterol) associated with cancer mortality are also associated with cardiovascular mortality. The American Heart Association has termed these behaviors and factors “cardiovascular health” (CVH) or “Life’s Essential 8,” providing a metric to determine poor, intermediate, and high (ideal) CVH. Less than ideal CVH is associated with higher cancer mortality; however, little is known about the CVH of cancer survivors. The purpose of this systematic review is to examine the extant literature on CVH among cancer survivors. MethodsIn accordance with PRISMA guidelines, we are systematically examining cardiovascular health among cancer survivors (including patients) within PubMed, Scopus, CINAHL, and Embase databases without date limitations. Two reviewers are accessing articles at each level of review to determine concordance with inclusion criteria, coming to consensus via a shared discussion. Data from studies that meet inclusion criteria will be abstracted, assessed for risk of bias. and synthesized to understand themes of CVH among cancer survivors. Results To date, we have retrieved 1,990 studies from the named databases. Preliminary review of the title and abstracts suggests that CVH as a metric may be seldom used within extant literature. This review is ongoing. Conclusion: Given the co-morbid and iatrogenic nature of cardiovascular disease among cancer survivors, it is important to understand metrics that can be applied to both identify cancer survivors with increased risk of poor outcomes and educate/empower cancer survivors to make modifiable changes to reduce their risk. This review will provide much needed evidence to support future research, practice changes, and policy implications to support the long-term health of cancer survivors. Citation Format: Miriam A. Miles, Le’Andrea Anderson-Tolbert, Abigail A. Ninson, Cha-Breia Means, Tuchondriana Smith, Reagan Coleman, Laura Rogers, Joshua Joseph, Timiya S. Nolan. A systematic review of cardiovascular health among cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C041.

Abstract C059: Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality

Abstract Introduction: Cancer survivorship often entails considerable psychological distress. Colorectal cancer (CRC) presents distinct stressors including the use of colostomy and multimodality treatments resulting in side effects for many patients. These factors increases the likelihood of social isolation, body image issues, intimacy problems, and marital strain which affect mental health of CRC survivors. However, information about the prevalence of psychological distress in this population and its association with clinical outcomes are lacking. We examined the prevalence of psychological distress and its association with emergency room usage (ER) and all-cause mortality among CRC survivors. Methods: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The NHIS is an annual cross-sectional, nationally representative, in-person survey of the civilian, noninstitutionalized population in the United States. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress, and ER usage and all-cause mortality, respectively. The models were adjusted for age, gender, survey year, race/ethnicity, marital status, education, smoking, geographic region, visit to mental professionals, general health status, comorbidities, and time since cancer diagnosis. Results: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. In the 12 months preceding the survey, 29.8% of CRC survivors had ER usage and 41.5% deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR=1.86; 95% CI, 1.11–3.10) or moderate (aOR=1.60; 95% CI, 1.22–2.11) psychological distress had high odds of reporting ER use. Similarly, after adjusting for covariates, CRC survivors with severe (aHR =1.32; 95% CI, 1.30–1.34) or moderate (aHR =1.02; 95% CI, 1.01–1.02) psychological distress had higher risk of all-cause mortality compared with survivors experiencing low/no psychological distress. Conclusion: CRC survivors with severe or moderate psychological distress have higher ER usage and all-cause mortality. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usage and lower mortality rates among CRC survivors. Citation Format: Mrudula Nair, Pranali Patel, Chaitali S Dagli, Nada Al-Antary, Oluwole A Babatunde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C059.

Sexual health and emotional wellbeing of adolescent and young adult survivors of haematological malignancies

Sexual health and emotional wellbeing of adolescent and young adult survivors of haematological malignancies