Survivorship Phase Research Articles

Psychological Aspects of and Support for Survivors Attempting to Conceive During or After Cancer Treatments: A Mixed-Methods Systematic Review.

Advances in medical technology are expected to increase the possibilities for pregnancy for women during and after cancer treatment. We aimed to clarify the psychological dimensions of cancer diagnosis for patients hoping for a pregnancy (their own or their spouse/partner's) during or post-treatment and identify ways to improve support for these survivors and their families. A systematic literature review was conducted in May 2023 using six electronic databases: PubMed, Web of Science, Cochrane Library, PsycINFO, Ichushi-Web, and CINAHL. The search targeted English and Japanese studies with English abstracts published between January 1, 2001, and May 10, 2023. Search terms related to cancer, pregnancy, and psychological aspects were included. The initial search identified 1328 potentially relevant studies after removing duplicates. Subsequently, two reviewers screened article titles and abstracts to exclude studies with no data, those unrelated to pregnancy, and so on, and identified 44 potentially relevant studies. Two reviewers then reviewed the full text of each study, and 20 articles finally met the inclusion criteria. Several studies indicated that trying to conceive negatively impacts survivors' finances, their relationships with their spouses/partners, and their mental health. Although many participants required fertility counseling, few received such opportunities. When cancer survivors try to conceive, they experience physical, psychological, and social burdens; moreover, many report a lack of access to fertility counseling or sufficient information about reproductive health care. Health care professionals should provide patients with updated and more accurate information on reproductive medicine and fertility counseling to enhance pregnancy support during the survivorship phase.

Designing a resilience-based intervention program for children with cancer and their families: a study protocol.

Advances in pediatric oncology have significantly increased survival rates, yet have introduced challenges in managing long-term treatment side effects. This study process introduces an interdisciplinary clinical intervention program rooted in the family resilience framework, aimed at improving well-being across the cancer trajectory for children and their families, especially those in Canadian communities far from specialized oncology centers with limited access to resources. Employing an intervention mapping approach, this program collaboratively involves patients, families, professionals, and researchers. It aims to identify vulnerability factors, establish a logic model of change, and devise comprehensive strategies that include professional interventions alongside self-management tools. These strategies, tailored to address biopsychosocial and spiritual challenges, are adapted to the unique contexts of communities distant from specialized cancer treatment centers. A mixed-methods approach will evaluate program effectiveness. Anticipated outcomes include the empowerment of families with self-management tools and professional support, designed to mitigate biopsychosocial and spiritual complications. By addressing the specific needs and limitations of these communities, the program strives to improve the overall health and well-being of both undergoing treatment and survivorship phases. By focusing on comprehensive care that includes both professional interventions and self-management, this initiative marks a significant shift toward a holistic, family-centered approach in pediatric oncology care for remote communities. It underlines the necessity of accessible interventions that confront immediate and long-term challenges, aiming to elevate the standard of care by emphasizing resilience, professional support, and family empowerment in underserved areas.

Beyond treatment: navigating existential reflections in the cancer survivorship journey

This narrative review explores the intricate intersection of cancer survivorship and existential reflections, acknowledging the profound impact on the overall well-being and quality of life for survivors. As advances in treatment increase survival rates, understanding the psychosocial aspects of survivorship becomes crucial. This review examines how existential concerns evolve through the phases of survivorship, focusing on themes such as fear of recurrence, reassessment of life priorities, and the quest for renewed purpose. It also investigates the influence of social support, cultural and spiritual beliefs, and mental health on these reflections. By evaluating existing support services and interventions, the review highlights successful strategies and identifies areas for improvement. Recommendations are proposed for integrating existential considerations into survivorship care, emphasizing the need for comprehensive, culturally sensitive support to enhance survivors' quality of life and foster resilience and personal growth.

Recommendations on the surveillance and supplementation of vitamins and minerals for upper gastrointestinal cancer survivors: a scoping review.

Early-stage upper gastrointestinal (UGI) cancer patients, after surgery, have altered gastrointestinal functions, compromising their nutritional status and health outcomes. Nutritional care provision to UGI survivors rarely focuses on long-term survivorship. Here, we explore recommendations for surveillance of micronutrient deficiency and supplementation for UGI cancer survivors after surgery. A scoping review, based on the Joanna Briggs Institute methodology for scoping reviews. Six databases (Medline, Embase, CINAHL, Cochrane, Scopus, and PsycINFO) and 21 cancer-related organisation websites were searched. Publications between 2010 and March 2024 with recommendations aimed at adult UGI cancer (oesophageal, gastric, pancreatic, small bowel, and biliary tract) survivors were included. Twenty-six publications met the selection criteria: 11 reviews (8 narrative reviews, 2 systematic, 1 meta-analysis), 7 expert opinions, 6 guidelines, and 2 consensus papers. Twenty-two publications recommended monitoring of micronutrient deficiencies, and 23 suggested supplementation, with 8 lacking details. Most were targeted at patients with gastric cancer (n = 19), followed by pancreatic cancer (n = 7) and oesophageal cancer (n = 3) with none for biliary tract and small bowel cancers. Vitamin B12 and iron were the most consistently recommended micronutrients across the three tumour groups. Limited publications recommend surveillance of micronutrient status in UGI cancer survivors during the survivorship phase, especially for oesophageal and pancreatic cancer survivors; most were narrative reviews. These recommendations lacked details, and information was inconsistent. Long-term UGI cancer survivors are at risk of micronutrient deficiency after surgery. A standardised approach to prevent, monitor, and treat micronutrient deficiencies is needed.

Associations between Life's Essential 8 and risks of all-cause and cardiovascular mortality in cancer survivors: A prospective cohort study from NHANES

BackgroundLife's Essential 8 (LE8), an indicator of cardiovascular health (CVH), can predict overall and cardiovascular mortality in the general population. Considering that cancer survivors have a higher risk of cardiovascular disease (CVD), our study aimed to investigate the association between LE8 and the prognosis of cancer survivors. MethodsA total of 2191 cancer survivors were included from the National Health and Nutrition Examination Survey (2005–2018). LE8 scores, derived from eight individual metrics, were categorized into three groups: low (0–49), moderate (50–79), and high (80–100). Cox regression analysis, nonlinear analysis, sensitivity analysis, and subgroup analysis were conducted to explore the association between LE8 scores and mortality risks, adjusting for potential confounders. ResultsDuring a median follow-up of six years, 479 deaths were recorded, including 118 CVD events and 156 cancer events. LE8 scores showed an inverse linear relationship with all-cause and cardiovascular mortality. A 10-point increase in LE8 scores was associated with a 25 % reduction in all-cause mortality (hazard ratio [HR], 0.75; 95 % CI, 0.66–0.85) and a 29 % reduction in cardiovascular mortality (HR, 0.71; 95 % CI, 0.57–0.89). Additionally, moderate CVH was linked to a lower risk of all-cause mortality (HR, 0.55; 95 % CI, 0.37–0.81), while high CVH was associated with an even lower risk (HR, 0.35; 95 % CI, 0.19–0.68). Similarly, moderate CVH demonstrated a decreased risk of cardiovascular mortality (HR, 0.31; 95 % CI, 0.15–0.63), with high CVH showing an even lower risk (HR, 0.23; 95 % CI, 0.09–0.58). However, LE8 scores was not associated with cancer-specific mortality. ConclusionsA higher LE8 score was independently associated with a decreased risk of both all-cause and cardiovascular mortality in cancer survivors, underscoring the significance of optimizing CVH during the survivorship phase of cancer care.

Patterns of Survivorship Follow-Up Care Among Patients With Breast Cancer: A Retrospective Population-Based Cohort Study in Ontario, Canada, Between 2006 and 2016.

Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned. We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship. Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care. Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.

Long term sequelae of testicular cancer and treatment: A point prevalence observational study.

e17015 Background: Testicular cancer (TC) is a highly curable solid organ tumour, which usually occurs in the early years of life. Recent studies have observed an increase in the incidence of TC coupled with improvement in cure rates all around the world, especially in Western Europe and North America. Consequently, we have a growing population living in the survivorship phase. Many researchers have highlighted the late complications in TC survivors, linked with the different treatment modalities used for treatment. In this study, we aim to determine the point prevalence of morbidity and mortality in TC survivors at a tertiary care cancer centre in Ireland. Methods: Participants were assessed in a purpose built survivorship clinic and informed consent was obtained. All participants were 18 years or more of age at the time of assessment with a histologically confirmed diagnosis of testicular cancer over 5 years ago. Assessments included a thorough symptom review, clinical examination, blood tests and other investigations (e.g., X-ray, ECG) if required. Results: A total of 81 patients were recruited in the study from March 2023 to January 2024, with a median follow up of more than a 10 years (129 months). Chemotherapy had been given to 85% of patients and radiotherapy to 5%. All except one patient underwent orchiectomy while RPLND was performed in 17% of patients. There were 3 deaths in the survivorship phase, all related to second malignant neoplasms (SMNs). Hyperlipidaemia was the most common condition found in 55% of TC survivors, followed by raised gonadotropins (47%), low testosterone (34%) and hypertension (40%). Other conditions prevalent in our cohort were hearing impairment (26%), abnormal high glucose (8%) and renal impairment(7%). The majority of these co-morbidities were previously undiagnosed before assessment in our survivorship clinic, including 2 cases of coronary artery disease. Over 70% of hypogonadism, hyperlipidaemia, hypertension, renal impairment and high abnormal glucose were initially diagnosed in our clinic. Conclusions: Results from our study are comparable to the studies conducted in other cancer centres across Europe and the US. Second malignant neoplasms remain the major cause of mortality in this cohort but many modifiable risk factors can be diagnosed early and potentially treated to prevent morbidity. Our data strongly supports the need for specialised survivorship clinics to improve the prognosis and quality of life in TC survivors. [Table: see text]

Risk of significant functional impairment across cancer diagnosis and care continuum.

11100 Background: The purpose of this paper is to examine the extent of unmet need to address physical and functional (PF) impairment among ambulatory cancer patients who were screened at baseline for PF impairment in the NCI Cancer Moonshot study - Northwestern University Improving the Management of Symptoms during and Following Cancer Treatment (NU IMPACT). We hypothesized that PF impairment, measured using the Patient Reported Outcome Measurement Information System – Physical Function (PROMIS-PF), would be common overall, and more prevalent for patients receiving active treatment (intent to cure or palliative) as compared to those in the post-treatment survivorship phase. We also hypothesized that PF impairment would differ across tumor types, independent of cancer continuum phase. Methods: The sample consisted of adults diagnosed with cancer, enrolled and consented in NU IMPACT (n=2,273). We compared PROMIS-PF scores across phases of the cancer continuum. Cancer continuum status was defined by the electronic health record (Epic) Beacon module that classifies patients as receiving active cancer treatment (intent to cure or palliative). Patients not assigned a Beacon status were classified as being in the survivorship group. Tumor type was derived from tumor registry data. A PF score less than or equal to 40 was categorized as moderate-to-severe impairment. We used multivariable logistic regression models to evaluate our hypotheses with a 95% confidence interval. Results: Overall, 40% of patients reported moderate-to-severe PF impairment. Patients diagnosed with melanoma reported the least impairment; those with lung cancer were 6.5 times more likely to have moderate-to-severe PF impairment (95% CI: 2.39 - 17.77). Those in non-curative intent treatment were 1.5 times more likely to have PF impairment (95% CI: 1.05 - 2.15) with lower mean PF scores (mean = 43; p<.001) as compared to those in curative intent (mean=46) and survivorship (mean=48). One-third of those reporting PF impairment also reported moderate-to-severe levels of pain and/or fatigue. Conclusions: PF impairment is present for a large minority of our cohort. Except for patients with lung cancer, PF impairment varied little by tumor type suggesting unmet need across the board. Those in non-curative treatment had more PF impairment than those in post-treatment survivorship providing guidance for targeted and early intervention by cancer rehabilitation. There appears to be a clustering of symptoms that affect human movement. Regular monitoring for PF impairments – in addition to pain and fatigue - may fill a gap in care that should be addressed with appropriate cancer rehabilitation referral and intervention. PROMIS-PF effectively identified variation in physical function. Future studies will explore how timely detection of PF impairment can be used to refer patients for appropriate cancer rehabilitation services and utilization.

International Survey of Psychosocial Care for Cancer Survivors in Low-/Middle- and High-Income Countries: Current Practices, Barriers, and Facilitators to Care.

The number of cancer survivors living with and beyond cancer treatment is rising globally. It is fundamental to understand the extent and type of psychosocial care services offered worldwide. We evaluated models of cancer survivorship care, psychosocial care practices in the post-treatment survivorship phase, and barriers/facilitators to delivery of psychosocial care services, including in low- and middle-income countries (LMICs). The International Psycho-Oncology Society (IPOS) Survivorship Special Interest Group led a cross-sectional online survey between March and November 2022. Health care professionals and researchers in psycho-oncology were invited through the IPOS global membership, social media, and snowballing. The survey was administered to individuals but included questions related to practices in their country at a national level. Two hundred eighty-three respondents from 37 countries participated (40% from LMICs), with a median of 12 years of experience (IQR, 6-20) in the psycho-oncology field. Participants reported that the most common elements of routine survivorship care were related to the prevention/management of recurrences/new cancers (74%), physical late effects (59%), and chronic medical conditions (53%), whereas surveillance/management of psychosocial late effects (27%) and psychosocial/supportive care (25%) were least common. Service availability was more commonly reported in high-income countries (HICs) than LMICs related to reproductive health (29% v 17%), genetic counseling/support (40% v 20%), and identifying/managing distress (39% v 26%) and pain (66% v 48%). Key barriers included providers focusing on treatment not survivorship (57%), medical not psychosocial care (60%), and a lack of allied health providers to deliver psychosocial care (59%). The psychosocial needs of people living with cancer are not adequately available and/or provided in post-treatment survivorship even in HICs, because of barriers at patient, provider, and system levels.

Investigating psychological mechanisms linking pain severity to depression symptoms in women cancer survivors at a cancer center with a rural catchment area

PurposeWomen cancer survivors, especially those in rural areas, with high levels of depression may be acutely susceptible to pain due to the ways they think, feel, and behave. The current study seeks to elucidate the relationship between symptoms of depression and pain severity in women cancer survivors, by examining the putative mediators involved in this relationship, specifically their self-efficacy for managing their health, how overwhelmed they were from life’s responsibilities, and relational burden.MethodsSelf-report data were collected from 183 cancer survivors of breast, cervical, ovarian, or endometrial/uterine cancer, who were between 6 months and 3 years post-active therapy.ResultsWomen cancer survivors with higher (vs. lower) symptoms of depression had more severe pain. Individual mediation analyses revealed that survivors with higher levels of depression felt more overwhelmed by life’s responsibilities and had lower self-efficacy about managing their health, which was associated with greater pain severity. When all mediators were simultaneously entered into the same model, feeling overwhelmed by life’s responsibilities significantly mediated the link between survivors’ symptoms of depression and their pain severity.ConclusionsThe relationship between symptoms of depression and pain severity in women cancer survivors may be attributed in part to their self-efficacy and feeling overwhelmed by life’s responsibilities. Early and frequent assessment of psychosocial factors involved in pain severity for women cancer survivors may be important for managing their pain throughout the phases of cancer survivorship.

Searching for the "Holy Grail" of breast cancer recurrence risk: a narrative review of the hunt for a better biomarker and the promise of circulating tumor DNA (ctDNA).

This paper is a narrative review of a major clinical challenge at the heart of breast cancer care: determining which patients are at risk of recurrence, which require systemic therapy, and which remain at risk in the survivorship phase of care despite initial therapy. We review the literature on prognostic and predictive biomarkers in breast cancer with a focus on detection of minimal residual disease. While we have many tools to estimate and refine risk that are used to individualize local and systemic therapy, we know that we continue to over treat many patients and undertreat others. Many patients also experience what is, at least in hindsight, needless fear of recurrence. In this review, we frame this dilemma for the practicing breast oncologist and discuss the search for what we term the "holy grail" of breast cancer evaluation: the ideal biomarker of residual distant disease. We review the history of attempts to address this problem and the up-to-date science on biomarkers, circulating tumor cells and circulating tumor DNA (ctDNA). This review suggests that the emerging promise of ctDNA may help resolve a crticical dilemma at the heart of breast cancer care, and improve prognostication, treatment selection, and outcomes for patients with breast cancer.

Exercise Across the Phases of Cancer Survivorship: A Narrative Review.

Exercise has long been recognized as an important component of treatment for various diseases. However, the benefits and risks of exercise interventions must be carefully evaluated to ensure the former outweighs the latter. As cancer patients undergo diverse treatment modalities with distinct objectives, a systematic approach partitioning the cancer journey into distinct phases is necessary to inform tailored exercise prescriptions. This narrative review summarizes exercise benefits and mechanisms for cancer patients and survivors across four distinct survivorship periods-before surgery, after surgery and before adjuvant treatment, during nonsurgical treatment (adjuvant and neoadjuvant), and during extended survival. In summary, exercise reduces the risks of complications and declines in physical functioning while improving fatigue, quality of life, and the ability to manage treatment effects. Although additional research is warranted, existing evidence is sufficient to integrate exercise into clinical oncology practice and cancer survivorship programs.

Abstract B013: Unsilenced strength: Survivorship perspectives from Black prostate cancer survivors

Abstract Introduction: The relentless surge of prostate cancer rates is rapidly alarming public health officials, leaving a trail of shattered hopes among Black men in the United States. This toll reduces mortality for this population, the urgent need for effective solutions becomes more apparent. Survivorship care plans (SCPs) emerge as a beacon of hope, holding the potential to transform the provision of care. Within this tool lies the encapsulation of vital cancer-related information, passed from the oncology team to the resilient survivor and their primary care physician. However, despite the unwavering support of national governing bodies, a disheartening reality persists for Black male survivors, who never access these life-saving plans. The study purpose was to identify receipt of SCPs and the preferred communication delivery of health information among Black prostate cancer survivors. Methods: Utilizing a grounded theory approach, our study delved into the experiences of a convenience sample of seven Black male prostate cancer survivors. In-person and telephone-based semi-structured interviews we sought to unravel unique narratives. The research inquiries used open-ended questions (1) knowledge, awareness, and understanding of SCPs; (2) interactions with medical professionals; and (3) preferred methods of communication of healthcare information. Employing a line-by-line descriptive force coding method, we extracted pertinent statements by open and axial coding to generate specific codes to encapsulate information collected from an underserved population. Results: Thorough analysis revealed several distinct themes pertaining to survivorship care plans and preferred communication styles. The relevant findings were a lack of SCPs knowledge, an absence of post-treatment care, the profound influence of faith and family support, and the value of group settings. Despite receiving education on treatment, survivors expressed a sense of being left adrift, as if their medical professional team had failed to provide them with a clear roadmap for their survivorship journey. In the absence of proper guidance, survivors resorted to considering pre-treatment risk assessments as a makeshift substitute for a comprehensive survivorship care plan. Conclusion: The impact of our study’s findings resonates deeply, revealing a startling reality: Black male survivors in our sample possessed a distressing lack of knowledge about the post-treatment phase of survivorship. Instead, they relied on the support of their spouses or fellow survivors with whom they connected during treatment sessions. The removal of government mandates aimed at promoting SCPs likely contributes toward a disheartening knowledge disparities among many Black men, leaving them without clear guidance regarding the crucial phase of aftercare. Armed with this data, we have the opportunity to drive change and enhance the development of culturally tailored, interactive care plans specifically designed to support Black male survivors after they conquer prostate cancer treatment. Citation Format: Dottington Fullwood, Charles Waldon, Carol Thomas, Mary Ellen Young, Shannon Pressey, Folakemi T. Odedina, Brandon Snipe, Isela Villasenor. Unsilenced strength: Survivorship perspectives from Black prostate cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B013.

OGC P51 Development of a symptom response questionnaire following therapeutic interventions for patients recovering from oesophagogastric cancer resection

Abstract Background Patients frequently experience symptoms after major oesophagogastric (OG) cancer resection which can delay quality of life resolution. Multiple symptoms can arise simultaneously making diagnosis of the underlying problem(s) and subsequent treatment complex. While diagnostic tests can offer valuable insight, some conditions are treated empirically and a positive response to therapy can go some way to confirming the diagnosis. Whilst numerous baseline symptom questionnaires exist, there is currently no established questionnaire to assess treatment response to an intervention following OG cancer surgery. Methods A survey of 362 OG cancer patients in survivorship phase identified their most important symptoms after surgery. A questionnaire based on validated EORTC symptom questionnaires including those derived from EORTC QLQ- CR 29, Bil 21, C30, ST022, OES 18 and OG25 has been developed to assess intervention impact on symptoms. For each reported symptom the patient is asked to grade the degree to which the symptom affected them before and after the intervention on a Likert scale.This study reports the development of the questionnaire and patient feedback following pyloric dilatation for delayed gastric emptying at 2 and 4 weeks post-procedure. Results The development of the questionnaire incorporated the use of previously validated EORTC questions and two measures that compared the patient’s symptoms before and after therapeutic intervention. All 12 patients involved in the initial development and first-stage review of the questionnaire rated it as easy or very easy to complete. A subsequent consecutive validation cohort of 27 patients undergoing pyloric dilatation for delayed gastric emptying also described the questionnaire as easy or very easy in 100% of cases. Conclusions Symptom response to an intervention is not routinely collected in a prospective setting despite potentially offering important clues as to accuracy of underlying diagnosis and documenting efficacy of the treatment. Patient recall of response to treatment retrospectively may be inaccurate and susceptible to bias. To best of our knowledge, this is the first questionnaire to detail symptomatic responses to therapeutic interventions in patients after OG cancer surgery. The questionnaire appears to be acceptable to patients and easy to complete. Further validation is needed before the questionnaire can be widely used, including testing with various interventions and on a digital platform.

Abstract 14262: Cancer - A Driver of Heart Failure in People With Diabetes

Introduction: Despite the risk of heart failure (HF) in the survivorship phase of some cancers, the risk is not high enough to justify HF screening. However, people with diabetes mellitus (DM) have an increased risk of both HF and cancer. Examining this at-risk population may allow for better understanding of the effect cancer has on the development of HF. Hypothesis: Among people with DM, HF is more common in those with than without prior cancer. Methods: Data from the Australian National Diabetes Services Scheme (NDSS; 1,114,356 DM, types 1 and 2) from 2010 to 2019, was linked with public hospital data, the National Death Index and national Pharmaceutical Benefits Scheme (PBS) database. People with cancer were identified by the prescription of chemotherapy agents on the PBS dataset or a hospital admission with cancer. Incident HF was detected via first hospitalisation with HF as the primary diagnosis or death due to HF. The model was adjusted for age and sex. Results: Of the total cohort (1,114,356 people with DM), 48,014 experienced HF during 6,663,046 person-years of follow up from 2010-2019. Specifically, of 175,656 people with DM and cancer, 8,464 experienced HF during 644,620 person-years of follow up. The HF incidence rate ratio (IRR) of people with DM and cancer was 1.63 (95%CI: 1.59-1.67), compared to people with DM but no cancer. Cancer admission alone had an IRR of 1.97 (1.90-2.05), with an IRR of 1.50 (1.46-1.54) in DM treated with chemotherapy with or without admission. Conclusion: Cancer diagnosis is associated with an increased incidence of HF among people with DM. The higher IRR of people with cancer admission alone supports the association of cancer with HF irrespective of chemotherapy. Further studies controlling for confounders of cardiovascular risk and refinements by age are required to justify grounds for HF screening.

Psychosocial care for cancer survivors: A global review of national cancer control plans.

National Cancer Control Plans (NCCPs) are high-level policy documents that prioritise actions to be taken to improve cancer control activities. As the number of cancer survivors grows globally, there is an urgent need to assess whether and how psychosocial care across the cancer care continuum is included in NCCPs. This review aimed to ascertain the extent to which NCCPs referenced psycho-oncology care for cancer survivors in the post-treatment phase. NCCPs were obtained from the International Cancer Control Partnership (ICCP) portal (in November 2021) and reviewed in two phases. In Phase 1, all available NCCPs were screened to determine whether they mentioned psycho-oncology or survivorship. In Phase 2, reviewers extracted data from the NCCPs identified in Phase 1 on the degree that each plan articulated objectives/goals to improve psychosocial care in the post-treatment survivorship phase. We screened 237 NCCPs. Of these, initial potential reference to psycho-oncology and survivorship content were identified in 97 plans (41%). In Phase 1, 57/97 (59%) had reference to psycho-oncology or survivorship content within defined criteria. In Phase 2, 27/97 (28%) had little mention of psycho-oncology specifically in survivorship, 47/97 (48%) had some (general or brief) mention, and the remaining 23/97 (24%) had substantial content/specific sections and clearly articulated goals and/or objectives. Common goals for improving psychosocial care in the post-treatment period included building capacity of healthcare professionals, implementing rehabilitation models, and increasing the utilisation of community services. Most NCCPs did not reference psycho-oncology and only one-quarter contained clear objectives specifically in the post-treatment survivorship phase.

Factors influencing resilience among breast cancer survivors: Implications for evidence-based practice.

Breast cancer survivors are increasing in South Korea, and resilience has become very important in their life. This study aimed to examine the relationships among anxiety, depression, family support, problem-focused coping, emotion-focused coping, self-efficacy, and resilience, and the factors influencing the resilience of breast cancer survivors. A cross-sectional descriptive design was employed. Participants were 153 breast cancer survivors after completion of treatment who were 5 years or less after diagnosis in South Korea. Measures were the general characteristics list, Korean version of Connor-Davidson Resilience Scale, Korean version of Hospital Anxiety and Depression Scale, family support scale, Korean version of Ways of Coping Checklist, and Self-Efficacy Scale. The strongest predictor that influenced resilience was depression (β = -0.32), followed by family support (β = 0.23) and problem-focused coping (β = 0.15). Resilience levels in breast cancer survivors after completion of treatment were relatively low. Interventions using problem-focused coping, including family members, could increase resilience, thus, moving away from focusing solely on the perspectives of cancer survivors when developing and implementing support interventions. Nurses should pay attention to influencing factors to help improve the resilience of breast cancer survivors during the extended survivorship phase.

The association of cancer-related fatigue on the social, vocational and healthcare-related dimensions of cancer survivorship.

Cancer-related fatigue (CRF) is well documented in cancer survivors, but little is known about the personal and societal impact of CRF. This study aimed to examine the impact of CRF in relation to social and vocational functioning and health care utilization in a large sample of post-treatment cancer survivors. We conducted a cross-sectional descriptive study of early stage breast and colorectal cancer survivors (n = 454) who were within 5 years from treatment completion. Social difficulties (SDI-21), work status, absenteeism and presenteeism (WHO-HPQ) and healthcare utilization (HSUQ) were compared in those with (CFR +) and without (CRF -) clinically significant fatigue (FACT-F ≤ 34). A total of 32% met the cut-off criteria for CRF (≤ 34). Participants with CRF + had significantly higher scores on the SDI-21 across all domains and 55% of CRF + vs. 11% in CRF - was above the SDI cut-off (> 10) for significant social difficulties. Participants with CRF + were 2.74 times more likely to be unemployed or on leave (95% CI 1.62, 4.61, p < 0.001). In the subgroup of participants who were currently working (n = 249), those with CRF + reported working on average 27.4 fewer hours in the previous 4 weeks compared to CRF - (p = 0.05), and absolute presenteeism was on average 13% lower in the CRF + group (95% CI 8.0, 18.2, p < 0.001). Finally, individuals with CRF + reported significantly more physician (p < 0.001), other health care professional (p = 0.03) and psychosocial visits (p = 0.002) in the past month. CRF is associated with substantial disruption in social and work role functioning in the early transitional phase of cancer survivorship. Better management of persistent CRF and funding for the implementation of existing guidelines and recommended evidence-based interventions are urgently needed.

Adherence to lifestyle recommendations among Norwegian cancer survivors and the impact of traditional and complementary medicine use: the Tromsø Study 2015–2016

IntroductionAdherence to healthy lifestyle recommendations has positive effects on cancer outcomes yet adherence is low among cancer survivors. Differences in adherence between women and men, phase of survivorship, and other factors that might increase adherence, like the use of traditional and complementary medicine (T&CM), need to be explored. We aimed to study the adherence to national recommendations for a healthy diet (daily intake of ≥ 5 portions of fruit/vegetables), physical activity (150 min of moderate-intensity or 75 min of high-intensity/week), normal body mass index (BMI) (18.5–24.9 kg/m2), non-smoking, and low-risk alcohol consumption (women ≤ 10 g/day, men ≤ 20 g/day) among Norwegian cancer survivors and their associations with sex, the use of T&CM, and survivorship phase.MethodsWe used logistic regression, independent sample t-test, and chi-square test to study self-reported (diet, physical activity, smoking, alcohol consumption) and measured (BMI) adherence in 1530 cancer survivors (40 years and above, participating in the population-based Tromsø Study conducted in 2015–2016 (65% attendance). We dichotomized all assessed lifestyle recommendations (adherence = 1 point, non-adherence = 0 points), and created a score for every recommendation (0–5 points). Adherence to individual lifestyle recommendations and the use of T&CM as well as the phase of survivorship was adjusted for sex, age, income, and living with a partner.ResultsAdherence to recommendations was 7.5% for diet, 85.3% for physical activity, 30.5% for BMI, 89.3% for non-smoking, and 87.6% for alcohol consumption. In total 2.3% adhered to all five recommendations concurrently (mean score 2.96 [SD = 0.86]). Women adhered to more recommendations concurrently compared to men (3.03 [SD = 0.90] vs. 2.89 [SD = 0.80] points respectively, [p = .012]). In total, 31% reported the use of T&CM and there were no differences in adherence to individual lifestyle recommendations or concurrent adherence in overall T&CM use compared to non-use. Users of self-help techniques were more likely to adhere to the recommendations of diet (aOR 2.69, 95% CI 1.45–4.98) and physical activity (aOR 6.26, 95% CI 1.51–25.92). Users of traditional healers and users of more than one T&CM modality were less likely to adhere to the low-risk alcohol consumption recommendation, (aOR 0.32, 95% CI 0.13–0.77, and aOR 0.53, 95% CI 1.08–2.17, respectively) compared to T&CM non-users. Survivors with cancer previously (1162) had higher odds of adhering to the recommendation of diet (aOR 2.66, 95% CI 1.36–5.19) than survivors with cancer presently (n = 368), but not to other recommendations.ConclusionThe health of cancer survivors can be improved through adherence to lifestyle recommendations, yet our study found partial adherence among survivors in Norway, in accordance with findings from other countries. Although overall T&CM use was not associated with higher adherence to lifestyle recommendations, differences in adherence were seen among individual modalities like the use of self-help techniques and traditional healers. Our results suggest the need for intensified follow-up of lifestyle with attention to male survivors and diet among all survivors throughout the cancer survivorship continuum.

The association between cardiovascular disease and breast and gynecologic cancers among black female patients

IntroductionLittle is known about whether a breast or gynecologic cancer diagnosis increases long-term cardiovascular disease (CVD) risk among Black females. The purpose of this study was to determine whether a breast or gynecologic cancer diagnosis is associated with CVD risk and identify determinants of subsequent CVD risk among Black females with an incident breast or gynecologic cancer diagnosis. MethodsUsing the Southern Community Cohort Study data from 2002–2016, this study was designed to analyze CVD incidence among Black females without cancer or CVD at enrollment. Cox proportional hazards regression models with or without covariates were used to explore the relationship between a breast or gynecologic cancer diagnosis and CVD risk among women without cancer as well as without CVD at enrollment (N=11,486). In addition, Cox proportional hazards regression models, excluding those who developed CVD before breast and gynecologic cancer diagnosis and those with other types of cancers, were used to assess determinants of CVD risk among breast and gynecologic cancer survivors. ResultsOf 11,486 Black females, 531 developed a breast or gynecological cancer (4.6%) over a median follow-up of 140 months (interquartile range: 123-159 months). Compared to women without cancer, women with a breast or gynecological cancers had greater than 20% higher risk of incident CVD during the follow-up period. Without adjusting for covariates, positive association between CVD risk and breast cancer was observed (hazard ratio (HR) = 1.24; 95% confidence interval (CI) = 1.11 - 1.39; p < 0.001); as well as between CVD risk and a gynecological cancer (HR = 1.23; 95% CI = 1.03 - 1.46; p = 0.021). Yet, after adjusting for covariates, CVD risk was only significantly associated with breast cancer (p = 0.001) but not gynecologic cancer. In cancer case-only analyses, CVD risk was significantly increasing with age (p < 0.05). ConclusionsLike study populations of predominantly White females, our results suggest that, adjusting for covariates, Black females possess a higher risk of CVD following a breast cancer diagnosis compared to women who did not develop breast cancer. Our results suggest a need for active CVD surveillance in the cancer survivorship phase.