Late Effects Of Cancer Research Articles

Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study

IntroductionAdolescents and young adults (AYAs) affected by cancer are an understudied group. Effective interventions are needed to support coping with the late effects of cancer, its treatment and to promote...

Abstract PO1-11-08: Late effects of breast cancer treatment among long term breast cancer survivors in the Carolina Breast Cancer Study

Abstract Background: Improved precision in breast cancer treatment has contributed to better overall survival. Intensive breast cancer treatments may have long-term impacts on survivor quality of life. Survivors may experience late effects including lymphedema, peripheral neuropathy, and cardiotoxicity from surgery, radiation, or chemotherapy. Estimates of the long-term burden of chronic breast cancer related conditions are important for managing the care of survivors. Methods: The Carolina Breast Cancer Study 3 is a population-based study of female breast cancer survivors diagnosed from 2008 to 2013 in North Carolina. Black and younger (< 50 years at diagnosis) women were oversampled. We calculated the cumulative prevalence of self-reporting of ever being diagnosed with lymphedema, peripheral neuropathy, or cardiac/heart problems as a result of breast cancer treatment over a 10-year follow-up period. Prevalence differences (PD) and 95% confidence intervals (CI), adjusted for age and race, were calculated to describe the differences in late effects in relation to patient characteristics (including latent class SES and access to care barriers). Additionally, we assessed racial disparities in the prevalence of late effects. Results: We included 1133 women who completed follow-up assessments at a mean of 11.2 years (SD=0.5) post diagnosis. The sample was predominately diagnosed with early stage (89.2%) and ER+ disease (75.2%). Treatments included lymph node removal ( >5 lymph nodes 57.9%), anthracycline chemotherapy (34.1%), taxane chemotherapy (60.3%), breast conserving surgery (58.7%), and mastectomy (41.0%). The prevalence of self-reporting lymphedema was 39.9% and was more common among younger (< 50 vs ≥50 PD: 10.2%, CI 4.7-15.7) and Black women (vs. White PD: 19.1%, CI 13.5-24.7), and those with fewer access to care barriers (vs more PD: -19.5%, CI -31.1- -8). The prevalence of peripheral neuropathy was 64.9% and was more common among younger (< 50 vs ≥50 PD: 5.6%, CI 0.2-11.0) and Black women (vs. White PD: 16.5%, CI 11.1-21.9), and those of lower SES (high vs low PD: -11.7%, CI -17.6- -5.7). Rural survivors were less likely to report peripheral neuropathy (PD: -9.7%, CI: -17.5- -2.0). Cardiac problems were reported in 16.7% of the sample and were more common among those of high SES (vs. low PD: -7.7%, CI -12.5, -3.0). All three late effects were associated with higher stage disease, ER+ disease, number of lymph nodes removed, anthracycline chemotherapy, and taxane chemotherapy. Both lymphedema and peripheral neuropathy were associated with mastectomy. Lymphedema was associated with trastuzumab use. Peripheral neuropathy was associated with recurrence. In stratified analyses by ER status, Black women were 13.7-28.8% more likely to have lymphedema in both ER+ and ER- disease (ER+ PD Black vs. White: 13.7%, CI 7.9-20.3; ER- PD Black vs. White: 28.8%, CI 18.3-39.3). Similar patterns were seen in analyses stratified by number of lymph nodes removed and by taxane chemotherapy. Other associations were not suggestive of racial disparities; with one exception. Black women were more likely to have cardiac problems at both high and low levels of SES (High Black vs White PD: 2.8%, CI -3.0, 8.6; low Black vs White PD: -7.0%, CI -15.2, 1.2). Conclusions: This study identified patient characteristics associated with an increased burden of late effects. Black and younger women experience a higher burden of lymphedema and peripheral neuropathy. Disease stage, ER status, lymph nodes removed, and chemotherapy received were associated with a higher prevalence of all three late effects and this is consistent with the observation that the burden of late effects increases with factors associated with more advanced stage of disease. Improved surveillance and prevention measures for breast cancer late effects can help improve survivorship care. Citation Format: Rina Yarosh, Hazel Nichols, Rachel Hirschey, Erin Kent, Lisa Carey, Melissa Troester, Eboneé Butler. Late effects of breast cancer treatment among long term breast cancer survivors in the Carolina Breast Cancer Study [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 PO1-11-08.

A Systematic Review of the Characteristics and Effects of Physical Activity Interventions on Physical Activity Engagement, Long-Term and Late Effects, and Quality of Life in Adolescent and Young Adult Cancer Survivors.

Physical activity (PA) may minimize long-term and late effects experienced by cancer survivors. However, the efficacy of PA interventions in increasing PA engagement among adolescent and young adult (AYA) cancer survivors diagnosed between 15 and 39 is not well understood. This systematic review aimed to examine the effects of moderate- to high-intensity or strength training PA interventions on PA engagement in AYA cancer survivors. Secondary aims included describing intervention components unique to efficacious interventions, identifying symptom management in PA interventions, and evaluating intervention effects on quality of life (QoL), and long-term or late effects of cancer. We searched PubMed, CINAHL, PsycINFO, SportDiscus, Cochrane Library, and Scopus databases from inception to August 2022 and identified 12 articles, including 8 randomized controlled trials and 4 quasi-experimental studies. The effect of PA interventions on PA engagement was mixed, with four studies reporting increases in PA engagement ranging from 18.4 to 113.8 min/week postintervention. There was great diversity in PA intervention components. Motivational interviewing, supervised and unsupervised PA sessions together, moderate-intensity PA only, and mindful meditation were components unique to efficacious interventions. No intervention incorporated symptom management components. Studies provided some evidence of PA interventions on potential long-term effects of cancer, with positive impact on fatigue, and some evidence of improved anxiety, sleep, and QoL. Given limited research with AYA cancer survivors, additional research is needed to identify effective intervention components, integrate symptom management strategies into PA interventions, and track effects of PA interventions on late and long-term effects of cancer in this population.

Community Pharmacy Staff's Knowledge, Educational Needs, and Barriers Related to Counseling Cancer Patients and Cancer Survivors in Denmark.

The study aimed to determine Danish community pharmacy staff's knowledge, educational needs, and barriers when communicating with cancer patients/survivors. Furthermore, the study investigated whether pharmacy staff was interested in participating in education about cancer. A cross-sectional questionnaire survey was conducted among community pharmacy staff (pharmacists and pharmaconomists) in Denmark. Descriptive and bivariate (t-test and chi-square) statistics were used to analyze the data. In total, 134 staff members responded to the questionnaire. Their self-reported knowledge of cancer-related topics was between 'very little knowledge' and 'some knowledge'. The most well-known topics concerned risk factors for cancer and side effects from cancer treatments. The importance of learning more about the same topics was rated between 'important' and 'very important'. The largest barriers identified in counseling cancer patients/survivors were a lack of knowledge about cancer, a focus on healthcare problems other than cancer, and a traditional view of community pharmacies as a place to pick up medication. Pharmacy staff expressed interest in participating in educational programs about cancer treatment (91.0%), communication with cancer patients (88.1%), and late effects of cancer (93.3%). Community pharmacy staff show interest in participating in education regarding cancer, but need more knowledge to properly counsel cancer patients and survivors at the community pharmacies. This important barrier should be addressed in future educational programs for community pharmacy staff.

Cancer survivors’ views on involving community pharmacies in an intervention on late effects of cancer

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Adult Survivors of Childhood Cancer: Views on COVID-19 and Vaccination

Purpose/Objective(s)Adult childhood cancer survivors (ACCS) are at increased risk of developing late effects because of their childhood cancer treatment, including cognitive delay, diabetes, metabolic syndrome, and organ damage. Consequently, many ACCS may be at increased risk for worse outcomes with COVID-19 infection. It is important to determine ACCS views on the COVID-19 pandemic and vaccination.Materials/MethodsA non-validated survey was created using multi-disciplinary input. Prior to the widespread rollout of COVID-19 vaccinations in Canada, we emailed an online survey to 235 ACCS followed through the BC Cancer Late Effects and Follow-Up clinic who had provided informed consent to email contact, receiving 89 responses (37.9% RR) which were analyzed. Statistical analysis was calculated using Chi-Squared test of association.ResultsSurvey respondents were majority female (61%). The most common age range was 30-39 (30%) followed by 20-29 (28%). Most were of European descent (47%) and lived in an urban center (75%). The vast majority completed high school (97%), as well as post-secondary education (PSE, 73%). Only 29% did not use Complimentary or Alternative medicines (CAM), with herbal products being most common (48%), as well as massage therapy or other bodywork (46%). The most reported sources of health information were primary care practitioners (PCP, 80%), traditional media (60%), and specialized hospital clinics (46%). Of all respondents, 67% believed that ACCS should be prioritized for vaccination, with 87% indicating they would receive a COVID-19 vaccination if available. 78% and 89% believed that COVID-19 was a serious health problem for themselves or others, respectively. Views were evaluated across multiple subgroups. Respondents who had completed PSE were more likely to see COVID-19 as a risk to themselves (80% vs 71%, p = 0.358), to others (94% vs 75%, p = 0.012), and more likely to receive a vaccine (89% vs 79%, p=0.217). Respondents who received health information from traditional media felt COVID-19 was more likely to harm themselves (79% vs 75%, p=0.638), to harm others (93% vs 83%, p=0.181) and more likely to receive a vaccine (93% vs 78%, p=0.047). A similar trend was seen in those who receive information from a PCP, but without statistical significance. The opposite is true if health information is received from family or friends, with these respondents being less likely to feel COVID-19 poses a risk of harm to themselves (76% vs 78%, p=0.79), less likely to harm others (86% vs 90%, p=0.595), and a lower likelihood to get a vaccine (76% vs 92%, p=0.041). There was no discernable trend when examining by further subgroups, including CAM usage, age group, location, or other sources of health information.ConclusionMany ACCS appear to underestimate their risk from COVID-19; whether patients had completed PSE and the location from which they receive health information appeared to correlate most strongly with these results.

Engaging TEAM Medicine in Patient Care: Redefining Cancer Survivorship From Diagnosis.

New approaches to cancer survivorship care must address the rising number of survivors who need complex care; the need to personalize care to improve health equity; workforce shortages and clinician knowledge deficits about the long-term and late effects of cancer; the need to engage and coordinate oncology, primary care, and a large multidisciplinary team of subspecialists and programs to meet survivors' needs; and the need to control costs and deliver better value. This review proposes eight core tenets of an evolved standard of care to meet these needs by starting at diagnosis and continuing throughout oncology and into follow-up to: (1) facilitate team medicine by connecting oncology, primary care, subspecialists and programs, researchers, and patients and caregivers; (2) educate patients and support them in self-management; (3) mitigate toxicities; (4) manage comorbidities; (5) promote healthy behaviors and wellness; (6) improve health equity; (7) provide clear personalized follow-up; and (8) provide ongoing opportunities for participation in research as the standard of care. Strategies to successfully implement this care are discussed from the perspectives of oncology, primary care, and health care administration.

Fertility and CAR T-cells: Current practice and future directions

Chimeric antigen receptor (CAR) T-cells serve to overcome chemotherapeutic resistance and have been proven to be highly effective in B-cell hematologic malignancies. Although initial use has been in patients with multiply relapsed/refractory disease, as CAR T-cells are used earlier in the treatment paradigm, it will be important to explore implications of this novel therapy on cancer late-effects. We sought to assess the current framework for considerations of fertility surrounding CAR T-cell use and identify opportunities for education and future research. To assess current practice patterns regarding post-CAR T-cell fertility, peri-CAR T-cell fertility guidance, utilization of fertility preservation surrounding CAR T-cell administration and identify future areas of research, a cross-sectional survey assessing practice patterns regarding fertility counseling and outcomes surrounding CAR T-cell therapy was distributed electronically to approximately 300 Center for International Blood and Marrow Transplant Research medical centers treating patients with CAR T-cell therapy in the United States and internationally between October 12 and November 2, 2021. One medical provider was asked to complete the study survey on behalf of their institution. We received 96 survey responses, of which 66 centers utilized CAR T-cells and provided at least partial responses that were used for the primary analysis. Centers were varied in demographics, experience in administering CAR T-cells, and aspects of patients receiving CAR T-cells. Eighteen centers exclusively treated pediatric patients, and patients at these centers were more likely to be treated for B-cell acute lymphoblastic leukemia. Seven pregnancies and 5 live births after CAR T-cells were reported from 6 centers (1 pediatric-only). Most centers had no established guidelines in place regarding fertility preservation in the peri-CAR T-cell period or regarding recommendations for avoiding pregnancy/fathering a child after receiving CAR T-cells. Areas for future research were elicited from responding centers and categorized into 3 broad themes, including: standardized peri-CAR T-cell fertility guidelines; long-term fertility outcomes after CAR T-cell therapy; impact of CAR T-cells on a developing fetus; and determining the relevance of studying fertility in patients who receive CAR T-cells. We identified a high degree of variability in peri-CAR T-cell guidance on avoidance of pregnancy/fathering a child, as well as a wide-range of practices surrounding referral for fertility preservation, the latter of which may be likely due to the fact that patients receiving CAR T-cells in the present era are likely multiply relapsed/refractory. In summary, this is the first report of several live-births following CAR T-cells, which highlights the important need for further research in CAR T-cell therapy and fertility, with a host of novel research questions identified.

QOL-14. Long term neurocognitive and psychosocial outcomes among adolescents and young adults survivors of paediatric brain tumour.

Abstract PURPOSE: The aim of the study was to describe neurocognitive and psychological outcomes among adolescents and young adults (AYA) survivors of paediatric brain tumour (BT). METHODS: neurocognitive and psychological assessment of 45 AYA (M = 30; F = 15), treated for paediatric BT at our institution between 1978 and 2018, were retrospectively collected. Survivors received psychological and neurocognitive assessment at a mean age of 21.4 years (range 15.11-39.4) after a median of 120 months from diagnosis. The assessment was carried out using the following self-report questionnaires: Beck Depression Inventory, State-Trait Anxiety Inventory, Body Uneasiness Test, Multidimensional Fatigue Inventory, European Organization for the Research and Treatment of Cancer Quality of LifeQuestionnaire. Neurocognitive evaluation was carried out using Wechsler Adult Intelligence Scale. RESULTS: 18/45 survivors had received a diagnosis of germ cell tumor, 12 of low grades glioma, 10 of embryonal tumor, 3 of high-grade glioma, 2 of meninges and mesenchymal tumor. Thirty-four patients received neurosurgery, 34 patients chemotherapy, 44 patients cranial radiotherapy. Fatigue was reported in 56% of the patients, 15% of them also showed low level of QoL. The psychological assessment showed clinical levels of anxiety in 56% of AYA, depression in 41% and body image problems in 29%. Neurocognitive assessment showed that 73% has an average tIQ (tIQ ≥ 80). CONCLUSIONS: The psychological evaluation showed that 77% of our cohort had at least one clinically significant distress symptom as fatigue, depressive symptoms, anxiety and body image problems, compared to 23% who did not report any problem. Further analysis is needed to identify any possible psychopathological risk factors. It is essential to provide an accurate and comprehensive assessment and effective psychological support to these patients, to help them better manage the late effects of cancer and therapies at different levels: physical, psychological and neurocognitive.

The disclosure dilemma: requesting accommodations for chronic pain in job interviews.

This study explores the job interview process for those who need disability-related accommodations on the job (in particular an "invisible" disability such as many of the long-term and late effects of cancer and its treatment (e.g., pain, fatigue, cognitive problems)), and explores whether the communication channel or the timing of the disclosure has implications on the perceived employability of applicants, with the aim of helping to close the employment gap for this marginalized population. Using 1917 participants in a partially crossed 2 × 3 × 2 experimental design, we explored disclosing the need for accommodations using each video or audio-only channels, by varying the timing of the disclosure within the interview (early, late, or not at all), and by varying the negotiation strategy used (modest or significant increase over proposed salary). Participants rated the candidate's employability at two different points in time. Early and late disclosures of the need for accommodations were both associated with poorer ratings of employability. Disclosure via audio was singularly damaging as compared to video disclosure, whether it occurred early or late. Finally, asking for a significant increase in salary resulted in lower ratings of employability, especially if the disclosure of the disability happened late in the process (and proximally to the salary request itself). Holding off on the request for accommodations until after the job has been offered may be advisable. Similarly, disability disclosures and requests for accommodation are better received using richer communication channels (video as opposed to audio). Salary requests are also sensitive topics and can be affected by ill-timed disclosures. If accommodations are needed on the job (based on chronic pain), waiting until later in the process to discuss this topic (using video and not the phone) and ensuring distance in time from making a salary request are apparently the better choices.

Late effects of cancer in children, teenagers and young adults: Population-based study on the burden of 183 conditions, in-patient and critical care admissions and years of life lost.

SummaryBackgroundChildren, teenagers and young adults who survived cancer are prone to developing late effects. The burden of late effects across a large number of conditions, in-patient hospitalisation and critical care admissions have not been described using a population-based dataset. We aim to systematically quantify the cumulative burden of late effects across all cancer subtypes, treatment modalities and chemotherapy drug classes.MethodsWe employed primary care records linked to hospitals, the death registry and cancer registry from 1998–2020. CTYA survivors were 25 years or younger at the time of cancer diagnosis had survived ≥5 years post-diagnosis. Year-of-birth and sex-matched community controls were used for comparison. We considered nine treatment types, nine chemotherapy classes and 183 physical and mental health late effects. Cumulative burden was estimated using mean cumulative count, which considers recurring events. Multivariable logistic regression was used to investigate the association between treatment exposures and late effects. Excess years of life lost (YLL) attributable to late effects were estimated.FindingsAmong 4,063 patients diagnosed with cancer, 3,466 survived ≥ 5 years (85%); 13,517 matched controls were identified. The cumulative burden of late effects at age 35 was the highest in survivors of leukaemia (23.52 per individual [95% CI:19.85–29.33]) and lowest in survivors of germ cell tumours (CI:6.04 [5.32–6.91]). In controls, the cumulative burden was 3.99 (CI:3.93–4.08) at age 35 years. When survivors reach age 45, the cumulative burden for immunological conditions and infections was the highest (3.27 [CI:3.01–3.58]), followed by cardiovascular conditions (3.08 [CI:1.98–3.29]). Survivors who received chemotherapy and radiotherapy had the highest disease burden compared to those who received surgery only. These patients also had the highest burden of hospitalisation (by age 45: 10.43 [CI:8.27–11.95]). Survivors who received antimetabolite chemotherapy had the highest disease and hospitalisation burden, while the lowest burden is observed in those receiving antitumour antibiotics. Regression analyses revealed that survivors who received only surgery had lower odds of developing cardiovascular (adjusted odds ratio 0.73 [CI:0.56–0.94]), haematological (aOR 0.51 [CI:0.37–0.70]), immunology and infection (aOR 0.84 [CI:0.71–0.99]) and renal (aOR 0.51 [CI:0.39–0.66]) late effects. By contrast, the opposite trend was observed in survivors who received chemo-radiotherapy. High antimetabolite chemotherapy cumulative dose was associated with increased risks of subsequent cancer (aOR 2.32 [CI:1.06–4.84]), metastatic cancer (aOR 4.44 [CI:1.29–11.66]) and renal (aOR 3.48 [CI:1.36–7.86]) conditions. Patients who received radiation dose of ≥50 Gy experienced higher risks of developing metastatic cancer (aOR 5.51 [CI:2.21–11.86]), cancer (aOR 3.77 [CI:2.22–6.34]), haematological (aOR 3.43 [CI:1.54–6.83]) and neurological (aOR 3.24 [CI:1.78–5.66]) conditions. Similar trends were observed in survivors who received more than three teletherapy fields. Cumulative burden analyses on 183 conditions separately revealed varying dominance of different late effects across cancer types, socioeconomic deprivation and treatment modalities. Late effects are associated with excess YLL (i.e., the difference in YLL between survivors with or without late effects), which was the most pronounced among survivors with haematological comorbidities.InterpretationTo our knowledge, this is the first study to dissect and quantify the importance of late morbidities on subsequent survival using linked electronic health records from multiple settings. The burden of late effects is heterogeneous, as is the risk of premature mortality associated with late effects. We provide an extensive knowledgebase to help inform treatment decisions at the point of diagnosis, future interventional trials and late-effects screening centred on the holistic needs of this vulnerable population.

Tai Chi for cancer survivors: A systematic review toward consensus‐based guidelines

To manage acute, long‐term, and late effects of cancer, current guidelines recommend moderate‐to‐vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment‐free, multicomponent mind–body exercise performed at light‐to‐moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient‐reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty‐six reports from 14 trials (one non‐randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low‐level evidence emerged to support the benefits of 40–60 min of thrice‐weekly supervised Tai Chi for 8–12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling‐up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer‐related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre‐treatment and end of life phases.

1669O Late effects, long-term problems, and unmet needs of cancer survivors

Great efforts and impressive progresses are being made in tumor treatment. Research and care concerning long-term problems and late effects of cancer in disease survivors is, however, still insufficient.

Linfoma di Burkitt in età pediatrica

Sporadic Burkitt lymphoma (BL) accounts for about 80% of non-Hodgkin lymphomas in childhood and adolescence, with an incidence of 3-5 cases per million in developed countries. The hallmark of LB is the deregulation of MYC oncogene, usually caused by the [t(8;14)(q24;q32)] translocation, involving the gene of immunoglobulin heavy chain. BL is a very aggressive neoplasm, with a doubling time of 12-24 hours and its diagnosis and therapy are a true haematologic emergency. Abdomen, head and neck are the most frequent sites of presentation and the involvement of ileo-caecal area can cause an intussusception as first manifestation of the disease. <br> BL and mature B-cell acute leukaemia (the leukaemic manifestation of BL) share the same therapeutic approach, intensive short courses with multiple alternating chemotherapy agents, the use of high dose-methotrexate and intrathecal CNS prophylaxis. The outcomes are satisfactory: in Italy during the period 1997-2014 the children with BL were treated according to the AIEOP LNH-97 protocol, achieving more than 90% of 5 year-survival. <br> In the last decades, the prognosis for children and adolescents with cancer has dramatically improved and the increasing number of long-term survivors has focused the attention of clinicians on the late effects of cancer and its therapy. A multidisciplinary follow up and a correct transition from the paediatrician to the primary care doctor plays a central role not only in the early detection and therapy of late effects of cancer but also in supporting the patient to realize their physical, mental and social well-being as much as possible.

Late effects of cancer (treatment) and work ability: guidance by managers and professionals

BackgroundThe prevalence of the group of workers that had a cancer diagnosis in the past is growing. These workers may still be confronted with late effects of cancer (treatment) possibly affecting their work ability. As little is known about the guidance of this group, the aim of this study was to explore the experiences and ideas of managers and professionals about the guidance of these workers in the case of late effects of cancer (treatment). Given the positive associations with work ability of the job resources autonomy, social support by colleagues and an open organisational culture found in several quantitative studies, these job resources were also discussed. Further ideas about the influences of other factors and points of attention in the guidance of this group of workers were explored.MethodsSemi-structured interviews were conducted with managers (n = 11) and professionals (n = 47). Data-collection was from November 2019 to June 2020. The data were coded and analysed using directed content analyses.ResultsThe late effects of cancer or cancer treatment discussed were physical problems, fatigue, cognitive problems, anxiety for cancer recurrence, and a different view of life. The self-employed have less options for guidance but may struggle with late effects affecting work ability in the same way as the salaried. Late effects may affect work ability and various approaches have been described. Autonomy, social support of colleagues and an open organisational culture were regarded as beneficial. It was indicated that interventions need to be tailor-made and created in dialogue with the worker.ConclusionsEspecially with respect to cognitive problems and fatigue, guidance sometimes turned out to be complicated. In general, the importance of psychological safety to be open about late effects that affect work ability was emphasized. Moreover, it is important to take the perspective of the worker as the starting point and explore the possibilities together with the worker. Autonomy is an important factor in general, and a factor that must always be monitored when adjustments in work are considered. There is a lot of experience, but there are still gaps in knowledge and opportunities for more knowledge sharing.

Cancer Survivors: What are Their Concerns and Quality of Life Across the Survivorship Trajectory?

Purpose: Survivors of cancer deal with a myriad of acute, chronic, and late effects of cancer and its treatment which can linger on for decades and inadvertently affect their quality of life (QOL). The aim of this study is to determine the main concerns of survivors at various stages of the cancer survivorship, and to assess whether these concerns have any effect on their QOL. Methods: A cross-sectional survey was conducted on cancer survivors diagnosed with colorectal, breast, lung, gynaecological, prostate or liver cancers (top 6 cancers in Singapore) who were seen at the National Cancer Centre Singapore between 11 April and 12 July 2017. Eligible study participants self-completed a questionnaire adapted from the Mayo Clinic Cancer Centre’s Cancer Survivors Survey of Needs. QOL was rated by participants on a scale of 0-10, with higher ratings denoting higher level of QOL. Results: A total of 1107 cancer survivors filled in the questionnaire. The top 5 concerns among all survivors were cancer treatment and recurrence risk (51%), followed by long-term treatment effects (49%), fear of recurrence (47%), financial concerns (37%) and fatigue (37%). Cancer treatment and recurrence risk, long-term treatment effects and fear of recurrence were amongst the top concerns across the survivorship trajectory. Mean QOL was 7.3 on a scale of 0-10. Completed treatment patients had higher QOL score than the newly diagnosed and on treatment patients and the patients dealing with recurrence or second cancer patients. Predictors for QOL included the economic status and housing type of patients and whether patients were concerned with pain and fatigue. Conclusion: This study reveals that cancer survivors in Singapore face multiple challenges and had various concerns at various stages of cancer survivorship, some of which negatively affect their QOL. It is critical to design patient care delivery systems that appropriately address their key concerns at different stages of their cancer trajectory so as to enhance their coping skills throughout their cancer journey.

What are the holistic experiences of adults living long-term with the consequences of cancer and its treatment? A qualitative evidence synthesis.

The number of people living with and beyond cancer is increasing; a significant number of these people will experience the long-term and late effects of cancer and its treatment. Research into this group has been identified as a priority to better understand healthcare needs. This review identified and synthesised qualitative research data relating to the lived experience of the consequences of cancer and its treatment. A systematic search via electronic databases was conducted in July 2019. Literature was identified that explored the experience of adults living beyond cancer from their own perspective. Thematic synthesis was used to extract and analyse data. Six articles were reviewed. Three main themes were identified with four subthemes:1. Living with an altered sense of self; 2. Things are never going to be quite the same again (2.1. The unexpected. 2.2 The uncertain.); 3. Ways of coping with the unexpected and the uncertain. (3.1. Drawing on internal resilience. 3.2. The influence and impact of external relationships.). The findings showed that the participants' world-view changed after cancer and this affected everyday lives both positively and negatively. The experience of having had cancer remains significant long after diagnosis and treatment, yet effective preparation and ongoing support for living beyond cancer is lacking. The experience of living long-term after cancer is characterised by an altered sense of self and has implications for long-term wellbeing. Further research should explore healthcare needs and services required to adequately meet the needs of this growing group of people.

Prevalence and temporal trends of prescription drug use in cancer survivors: A population study, 2001 to 2016.

12023 Background: The burden of prescription drug use is higher in cancer survivors than the general population. We examined the prevalence and temporal trends of prescription drug use among cancer survivors, with an emphasis on central nervous system (CNS) active medications used to manage long-term cancer sequelae. Methods: Adult respondents with (n=3207) and without (n=40,440) a prior cancer diagnosis from 8 cycles (2001-2016) of the National Health and Nutritional Examinational Survey (NHANES) were evaluated for prescription drug usage. Cross-sectional analyses and temporal trends across cycles were evaluated and weighted to represent the US adult population. Results: Cancer survivors report higher rates of prescription drug usage (85.1% vs 54.3%, p<0.001, and 75.8%, p<0.001) and polypharmacy (27.8% vs 10.7%, p<0.001, and 22.7%, p<0.001) than both unadjusted and age-adjusted controls. Younger survivors report greater usage of CNS (36.8% vs 13.1%, p<0.001), psychotherapeutic (18.4% vs 7.7%, p<0.001), hormonal agents (19.1% vs 10.1%, p=0.003), and gastrointestinal (10.7% vs 4.7%, p=0.02) than controls, while differences are attenuated in older cohorts. Among broad drug categories, the usage of cardiovascular (p-trend<0.001), metabolic (p-trend<0.001), and immunologic agents (p-trend=0.01) has increased. Among CNS active subclasses, the usage of anticonvulsants (p-trend<0.001), anxiolytics (p-trend =0.02), narcotics (p-trend=0.02) and GABA analogs (p-trend<0.001) has increased. When comparing respondents with and without a history of cancer, the increased usage of anti-depressant prescription medications (18.3% vs 1.5% p<0.001), including SSRIs (11.2% vs 1.0%, p<0.001), SSNRIs (3.5% vs 0.3%, p<0.001), tricyclics (2.8% vs 0.1%, p<0.001), among cancer survivors was disproportionate compared to the increased proportion of positive depression screens (9.2% vs 7.0%, p=0.006). Conclusions: Cancer survivors report higher prescription drug use for both chronic conditions and late effects of cancer. The usage of CNS active medications, many of which are used on and off label for their pain management properties, has increased. The higher rates of pharmaceutical use may result in unanticipated long-term toxicities and financial burdens.

Early and Often: The Need for Comprehensive Discussion of Treatment-Induced Cancer Late Effects.

Imagine your worst fear realized as an oncologist confirms that your child has cancer. During the initial clinic visit, you will be informed of your child’s diagnosis and his or her prognosis1 contingent on the best available treatment protocol, usually based on years of comprehensive clinical research. In the uncommon case that no best-practice protocol is available for your child, treatment options will be presented for you to help choose a course of action. Ideally, that discussion will include the pros and cons of each choice, including prognostic estimates, acute toxicities, and potential long-term effects on your child’s health and psychosocial well-being as they may evolve over the life course. From knowledge gained through clinical research and observational follow-up studies of cancer cohorts,2 the unambiguous association between therapeutic exposures and specific acute and long-term effects in childhood cancer has led to a focus in treatment protocols on maintaining high survival probability while minimizing serious late effects and optimizing quality of life. For example, efforts to reduce late effects have included omission or reduction of … Address correspondence to James G. Gurney, PhD, School of Public Health, 236 Robison Hall, University of Memphis, Memphis, TN 38152. E-mail: jggurney{at}memphis.edu

Challenges to Family Management for Caregivers of Adolescent and Young Adult Survivors of Childhood Brain Tumors [Formula: see text

Due to the complexity of cancer late effects, the education required to provide anticipatory guidance and support to the caregivers of adolescent and young adult (AYA) survivors of childhood brain tumors can be difficult. Therefore, identifying challenges to family management (FM) could be helpful in anticipating complications with the integration of tumor and treatment late effects into family life. Building on previous research that described FM for children with chronic conditions, children who survived cancer, and the Family Management Styles Framework, the purpose of this study was to identify FM challenges for caregivers of AYA survivors of childhood brain tumors to guide clinical practice and research. Directed content analysis was used to identify FM challenges in data from semistructured interviews with 45 maternal caregivers for AYA survivors of childhood brain tumors living with them. Caregivers were largely White (89%) with an average age of 52 years, educated beyond the high school level (67%), and were partnered or married (53%). On average, caregivers had been caring for the AYA for 21 years since diagnosis, and 56% of their survivors had moderate functional restrictions. A primary and a secondary analyst were assigned to the data for each interview and completed a single summary matrix. A list of challenges was created by the research team based on Family Management Styles Framework, the literature, and clinical expertise. Seven core challenges to FM were identified: ensuring survivor well-being, supporting survivor independence, encouraging sibling well-being, planning family activities, sustaining parents as caregivers, attending to survivor late effects, and providing support and advocacy.