Post Cancer Research Articles

Adherence to Cancer Survivorship Care Guidelines and Health Care Utilization Patterns Among Nonmetastatic Breast Cancer Survivors in Singapore.

PURPOSECurrently, limited information is available on care provided to breast cancer survivors in Singapore. This study aims to assess the quality of post-treatment cancer survivorship care among breast cancer survivors on the basis of compliance with international guidelines up to 5 years post-primary treatment.METHODSThis study analyzed a cohort of 189 nonmetastatic breast cancer survivors recruited from the National Cancer Centre Singapore, Changi General Hospital, and KK Women's and Children's Hospital between November 2011 and September 2015. Data were retrieved from electronic medical records in 6-month intervals. Adherence to guidelines was assessed in four areas: (1) recurrent cancer surveillance, (2) monitoring and detecting late effects, (3) health care resource utilization, and (4) preventive care. Descriptive statistics, Kaplan-Meier, and regression analyses were conducted.RESULTSAnnual surveillance mammogram adherence rates were ≥ 83% consistently. The most common new diagnosis was osteoporosis at an incidence rate of 102 (95% CI, 77.6 to 135) cases per 1,000 person-years. Overall, ≤ 10.1% of survivors had an emergency department or hospitalization visit. Oncologist services were overutilized, with a median of 6 (interquartile range: 4-10) visits in the first 6 months before reducing to a median of 2 (interquartile range: 1-3) visits biannually 3 years post-treatment. Bone mineral density test utilization rate adhered to guidelines for 92.2% of aromatase inhibitor recipients but only for 36.4% of premenopausal tamoxifen recipients.CONCLUSIONOverall, adherence rates to surveillance and osteoporosis preventive care were high. Extensive utilization of oncologist services up to 5 years post-primary treatment could be reversed with strategies to engage and coordinate survivorship care with primary care providers, leveraging their strengths to improve adherence to health promotion and chronic disease management.

Cancer-Related Pain: Inside a New Dynamic Personalized Approach. A Narrative Review

Chronic cancer-related pain, according to the latest International Classification of Diseases (ICD-11), is defined as “chronic pain caused by the primary cancer itself or metastases (chronic cancer pain) or its treatment (chronic post-cancer treatment pain)”

Randomized, Controlled Trial of an Intervention Combining Self-Care and Self-Hypnosis on Fatigue, Sleep, and Emotional Distress in Posttreatment Cancer Patients: 1-Year Follow-Up

ABSTRACT Cancer can provoke fatigue, sleep disturbances, and emotional distress. Hypnosis interventions have shown positive short-term effects on these symptoms. However, less is known about their long-term effects. This study assessed the short- and long-term effects of a group intervention combining self-care and self-hypnosis on these symptoms in posttreatment cancer patients. Ninety-five female cancer survivors were randomized to either a hypnosis group intervention or wait-list control. Results showed significant decreases in fatigue, sleep difficulties and emotional distress after intervention for the hypnosis group intervention in comparison to the wait-list control. Most of these positive effects were maintained at 1-year follow-up. Most participants received the hypnosis group intervention approximately 10.65 months after diagnosis, and it is possible that delivering the intervention earlier after diagnosis could have achieved a more robust impact. Further studies are needed to replicate these results in comparison to an active control condition and investigate the best time postdiagnosis for initiating the intervention.

Ustekinumab does not increase risk of new or recurrent cancer in inflammatory bowel disease patients with prior malignancy.

There is limited data on the rate of new or recurrent cancer in patients with inflammatory bowel disease (IBD) and a history of prior or current malignancy who are initiated on biologic therapies. Furthermore, there is no data on this topic in patients using ustekinumab. The retrospective study included 341 patients with IBD and a history of cancer who were subsequently treated with vedolizumab (VDZ; n=34), ustekinumab (USK; n=27), tumor necrosis factor α antagonists (anti-TNF; n=99), or had no immunosuppressive therapy (control; n=181). Cox proportional hazard models were developed to determine the independent effect of post-cancer immunosuppressive treatment on the occurrence of incident cancer. Over a median of 5.2 person-years of follow up, cancer recurrence occurred in only one patient on anti-TNF, while new cancers developed in one patient on VDZ, three patients on USK, and six patients on anti-TNF, corresponding to cancer rates of 0.4, 1.8, and 0.7 per 100 person-years, respectively. The rate of incident cancer in control patients was 2.4 per 100 person-years and included 18 new and 9 recurrent cancers. Compared with controls, a stepwise Cox proportional hazards model adjusting for significant covariates found no increased risk of incident cancer in patients receiving post-malignancy treatment with USK (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.25-3.03), VDZ (HR 0.18; 95% CI 0.03-1.35), or anti-TNF (HR 0.47; 95% CI 0.20-1.12). Use of biologic therapy in IBD patients with a previous history of malignancy was not associated with an increased risk of new or recurrent cancer.

Computerized Decision Support for Bladder Cancer Treatment Response Assessment in CT Urography: Effect on Diagnostic Accuracy in Multi-Institution Multi-Specialty Study.

This observer study investigates the effect of computerized artificial intelligence (AI)-based decision support system (CDSS-T) on physicians’ diagnostic accuracy in assessing bladder cancer treatment response. The performance of 17 observers was evaluated when assessing bladder cancer treatment response without and with CDSS-T using pre- and post-chemotherapy CTU scans in 123 patients having 157 pre- and post-treatment cancer pairs. The impact of cancer case difficulty, observers’ clinical experience, institution affiliation, specialty, and the assessment times on the observers’ diagnostic performance with and without using CDSS-T were analyzed. It was found that the average performance of the 17 observers was significantly improved (p = 0.002) when aided by the CDSS-T. The cancer case difficulty, institution affiliation, specialty, and the assessment times influenced the observers’ performance without CDSS-T. The AI-based decision support system has the potential to improve the diagnostic accuracy in assessing bladder cancer treatment response and result in more consistent performance among all physicians.

Abstract P2-01-05: Impact of post-treatment ctDNA and residual cancer burden (RCB) on outcomes in patients with triple-negative breast cancer (TNBC) and residual disease

Abstract Introduction: Residual disease (RD) after neoadjuvant chemotherapy (NACT) is associated with high risk of recurrence in TNBC. RCB classification is prognostic in patients with RD. Recent studies show that post-NACT circulating cell-free tumor DNA (ctDNA) also provides prognostic information in patients with RD. Most TNBC patients with RD receive adjuvant therapy after surgery (chemotherapy and/or radiation), thus ctDNA status at completion of all adjuvant therapy (end of treatment, EOT) may be a better indicator of long-term prognosis. Furthermore, the impact of EOT ctDNA status on prognosis in context of RCB is of interest. Utilizing data from a prospective registry, the objective of this study was to investigate the impact of EOT ctDNA status and RCB class on outcomes in TNBC patients with RD. We hypothesized that RCB and EOT ctDNA status may provide complementary prognostic information. Methods: Study population included TNBC patients with RD post-NACT and available EOT plasma samples who were enrolled in an IRB-approved multisite prospective registry between 2011 and 2018. EOT samples were collected after completion (1-6 months) of all curative treatment (local and systemic). ctDNA was isolated and subjected to next generation sequencing (QIAseq 275-gene Human Comprehensive Cancer Panel on an Illumina NextSeq 550). Samples demonstrating pathogenic/likely pathogenic variant(s) with 3-40% allelic frequencies were considered ctDNA positive. Variants with allelic frequencies ≥40% were included in ctDNA positive status only if not present in ClinVar8/dbSNP9 as a known germline variant. The impact of EOT ctDNA status and RCB on event-free survival (EFS) and overall survival (OS) were estimated according to the Kaplan-Meier method and compared among groups by log-rank test, followed by Cox regression analysis. Results: For 47 TNBC patients with RD and available EOT plasma sample, the median age was 47 years, and 43% had node-positive disease at diagnosis. RCB class distribution was as follows: RCB I=28%, RCB II=49%, RCB III=15%, RCB unknown=8%. 45% of patients received adjuvant chemotherapy (59% with RCB II-III received adjuvant chemotherapy), and 68% received adjuvant radiation. EOT ctDNA was positive in 34% (16/47) of patients and was associated with higher T stage (p=0.012), TNM stage (p=0.033) and trend toward higher RCB class (p=0.078). ctDNA positivity rates in RCB I, II and III classes were 23%, 30% and 71%, respectively. Among all patients, 3-year EFS and OS were 71% and 73%, respectively. Table 1 provides 3-year EFS and OS by ctDNA status in all patients and by RCB class. ctDNA positive status was associated with inferior EFS and OS. Conclusion: EOT ctDNA positivity was noted in one-third of TNBC patients with residual disease and was highly prognostic, with almost half of patients with ctDNA positivity suffering an EFS event by 3 years. Patients with RCB III had very poor outcome (3-year EFS ≤20%) regardless of ctDNA status. However, in RCB classes I/II, ctDNA provided further prognostic utility, as ctDNA negative patients with RCB I/II had excellent outcomes (3-year EFS >90%). These findings should be confirmed in other studies and provide insights into the role of ctDNA for patient stratification/selection in residual disease adjuvant therapy intensification trials for TNBC. 3-year EFS3-year OSAll patients: ctDNA positive vs ctDNA negative56% vs 78%, HR 3.02 (95% CI: 1.01-9.01), p=0.03856% vs 82%, HR 3.05 (95% CI: 1.02-9.13), p=0.037RCB I/II: ctDNA positive vs ctDNA negative73% vs 92%, HR 4.38, p=0.07873% vs 92%, HR 3.03, p=0.159RCB III: ctDNA positive vs ctDNA negative0% vs 20%, HR 1.67, p=0.5610% vs 20%, HR 1.30, p=0.765 Citation Format: Priyanka Sharma, Shane R Stecklein, Bruce F Kimler, Rachel Yoder, Kelsey Schwensen, Joshua M Staley, Qamar J Khan, Anne P O'Dea, Lauren E Nye, Manana Elia, Jaimie Heldstab, Trisha Home, Stephen Hyter, Kamilla Isakova, Harsh B Pathak, Andrew K Godwin. Impact of post-treatment ctDNA and residual cancer burden (RCB) on outcomes in patients with triple-negative breast cancer (TNBC) and residual disease [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-01-05.

Nutrition Practices among Adult Cancer Survivors Living on the Island of Ireland: A Cross-Sectional Study.

The purpose of this research was to explore the nutrition practices among post-treatment cancer survivors across Ireland. Cancer survivors aged 18+ years living across Ireland, who were not palliative and had completed active cancer treatment at least six months previous, were recruited to complete an online survey assessing dietary quality, food choice and satisfaction with food-related life as well as clinical and nutrition status. It was circulated by cancer support networks and on social media. Descriptive statistics are presented. The cohort (n = 170) was predominantly female (85.9%) and had breast cancer (64.7%). Mean age was 51.5 ± 10.9 years and 42.7% of the cohort were >five years post-treatment. Only 20% and 12% of the cohort had been assessed by a dietitian during and post-treatment, respectively. The mean dietary quality score was 10.3 ± 1.7, which was measured by the Leeds short-form food frequency questionnaire (SFFFQ). Using a 5-point Likert scale, the median satisfaction with food-related life score was 19 (3.3), which evaluates cognitive judgements on the person’s food-related life. The food choice questionnaire (FCQ) assesses the relative importance of a range of factors related to dietary choice to individuals. The primary determinant of food choice in this cohort was the natural content (31.7%) followed by health (24.7%). Vitamin and mineral supplement use was reported by 69.8% of the cohort; the most consumed was Vitamin D. Four themes emerged from an optional open-ended question: awareness of nutritional importance; desire for specific nutritional advice and dietetic referral; cancer and treatment nutrition impacts were highlighted; as well as struggles with weight gain. This research provides useful insight into the nutrition practices of Irish cancer survivors. A desire and need for individualised and specific advice are evident.

The development and implementation of the After Cancer Treatment Transition (ACTT) Program for survivors of cancer.

The After Cancer Treatment Transition (ACTT) program at Women's College Hospital (Toronto) is a transitional follow-up program for patients, their families, and healthcare providers to address the broad range of post-cancer treatment and survivorship needs. This publication describes the systematic development and implementation of the ACTT program, with a focus on the advanced practice nursing (APN) role. ACTT development required the collaboration of an APN, a general practitioner in oncology (GPO), and an inter-professional team. ACTT developers proposed a clinic structure in an ambulatory setting, linking healthcare professionals to provide post-treatment follow-up and ongoing survivorship care. Post-treatment guidelines were developed based on expert oncologist consensus, cancer site group input, and evidence-informed guidelines or best practice recommendations. Initial challenges and concerns were rooted in the requirements that post-cancer treatment care was maintained and survivor needs were addressed. Cancer site groups and the inter-professional teams provided continuous feedback on processes and protocols. ACTT established a standard approach to transition patients safely and effectively out of tertiary care and, ultimately, to primary care. ACTT delivers comprehensive posttreatment and survivorship care through close collaboration between the GPO and APN. Both roles specialize in managing late or persistent effects, cancer surveillance and prevention, and addressing psychosocial needs prior to discharge to primary care. The survivorship care plan provided by ACTT is an informative tool for both patient and primary care provider to continue post-treatment follow-ups. Next steps for ACTT include expanding to other cancer specialties, exploring new ways to deliver care, optimizing the transition of care, and conducting comprehensive evaluations of patient reported outcomes.

Workplace health surveillance and COVID-19: algorithmic health discrimination and cancer survivors.

PurposeThis article examines ways COVID-19 health surveillance and algorithmic decision-making (“ADM”) are creating and exacerbating workplace inequalities that impact post-treatment cancer survivors. Cancer survivors’ ability to exercise their right to work often is limited by prejudice and health concerns. While cancer survivors can ostensibly elect not to disclose to their employers when they are receiving treatments or if they have a history of treatment, the use of ADM increases the chances that employers will learn of their situation regardless of their preferences. Moreover, absent significant change, inequalities may persist or even expand.MethodsWe analyze how COVID-19 health surveillance is creating an unprecedented amount of health data on all people. These data are increasingly collected and used by employers as part of COVID-19 regulatory interventions.ResultsThe increase in data, combined with the health and economic crisis, means algorithm-driven health inequalities will be experienced by a larger percentage of the population. Post-treatment cancer survivors, as for people with disabilities generally, are at greater risk of experiencing negative outcomes from algorithmic health discrimination.ConclusionsUpdated and revised workplace policy and practice requirements, as well as collaboration across impacted groups, are critical in helping to control the inequalities that flow from the interaction between COVID-19, ADM, and the experience of cancer survivorship in the workplace.Implications for Cancer SurvivorsThe interaction among COVID-19, health surveillance, and ADM increases exposure to algorithmic health discrimination in the workplace.

Synthesis and evaluation of electrospun PCL-plasmid DNA nanofibers for post cancer treatments

Poly-ε-caprolactone (PCL) incorporated with plasmid DNA was electrospun, and the resultant nanofibers were used to observe DNA release from the nanofibers. The plasmid DNA enhanced green fluorescent protein (EGFP) with cytomegalovirus (CMV) promoter (PCMVb-GFP) was amplified with E. coli. PCL was chosen because it is biodegradable aliphatic polyester, which plays a critical role in tissue engineering, such as scaffolding, drug, DNA, gene and protein delivery vehicles. Some of the physical and biological properties of the nanofibers were determined using different methods. Scanning electron microscopy (SEM) micrographs showed that nanofibers have an average diameter of about 100 nm. Cytotoxicity tests showed that cell viability for 1 day, 4 days, and 7 days of the tests were above 80 %. These data demonstrated that PCL-plasmid DNA nanofibers have no cytotoxicity and showed benign biocompatibility for biomedical applications. PCMVb-GFP plasmid-linked electrospun nanofibers continuously released double-stranded DNA for at least seven days. For the first 15 min, there was a burst release of about 1.8 ng/ml. For the following hours and days, the release was about to be the same (release of 0.575 ng/ml). Therefore, PCL nanofibers may be an ideal candidate for various biomedical applications such as cancer treatment, scaffolding, tissue engineering, and protein delivery vehicles.

Case reports of new-onset eating disorders in older adult cancer survivors

BackgroundIt is unusual for a de novo eating disorder to emerge in late adulthood. Across a number of years, a number of patients were identified who experienced severe and unexpected weight loss post curative management of an upper abdominal cancer (i.e., cancer survivors). Each of the patients was readmitted to the tertiary surgical hospital due to complications of severe malnutrition. Each presentation was initially considered to have a major physical health problem (such as cancer recurrence). Each required extensive investigations and multidisciplinary team involvement and were later conceptualised as a new-onset (in later adulthood) eating disorder that emerged post curative cancer treatment. The team wished to better understand this group and/or characterise and/or inform the scientific community of this phenomena if not already well described.Literature reviewThe review identified that the re-emergence of pre-existing eating disorders at the time of cancer treatment was described; however, there was no identification of similar new-onset in later adulthood cases of eating disorders in cancer survivors in the medical literature.Review of the casesOnce ethics and consent was obtained, then the clinical course of four complex individuals were reviewed, including the use of a multidisciplinary Delphi review process, to understand commonalities and then plot a common care pathway with potential intervention points.Case presentationsCommon factors identified among the four patients included the lack of a physical health (organic) cause to the weight loss and ongoing weight loss despite intense multidisciplinary care. All had abnormal attitudes and behaviours relating to food, nutritional rehabilitation and/or recovery. None returned to a healthy weight and/or healthy eating despite extensive team input. The presentations were ultimately conceptualised as having severe disordered eating behaviours and in at least three cases met criteria for a formal eating disorder. The cohort had similar psychosocial characteristics including low socioeconomic status and complex family dynamics. None had prior formal psychiatric care. The outcomes were poor; one patient died, another required admission to a specialist eating disorder admission with a subsequent relapsing remitting course, and the remaining two had complicated chronic courses.ConclusionSimilar cases may be underreported. If identified earlier, there may be a role for intervention to prevent high morbidity and mortality and to support clinical teams managing similar complex patients.

Hypermethylation involved in DNA profiles of lung cancer specific tumour suppressor genes and epigenetic modification caused by an ultra-highly diluted homeopathic drug, Condurango 30C, in vitro and in vivo

Background and objectives: DNA hyper-methylation is an important aspect involved in carcinogenesis and cancer progression, which affects mainly CpG islands of DNA and causes inactivation of tumour suppressor genes. Therefore DNA hypermethylation status of the genomic DNA in both the transformed cancerous cell lines and in carcinogen-induced lung cancer was ascertained by analysis of expressions of certain major lung cancer specific tumour suppressor genes. The other objective was to examine if ultra highly diluted homeopathic drug, Condurango 30C, had ability to modulate DNA methylation. Methods: DNA methylation activity, if any, has been ascertained in H460-NSCLC cells in vitro and in BaP-induced lung cancer of rats in vivo, in respect of tumour suppressor genes like p15, p16, p18 and p53 by using PCR-SSCP analyses. The ability of modulation of DNA methylation, if any, by Condurango 30C was also verified against placebo control in a blinded manner. Results: Condurango 30C-treated DNA showed significant decrease in band-intensity of p15 and p53 genes especially in methylated condition, in vitro, at the IC50 dose (2.43µl/100µl). SSCP analysis of p15 and p53 genes in Condurango 30C-treated DNA also supported ability of Condurango 30C to modulate methylation state, in vitro. Inhibition of p15 hypermethylation was observed after post cancer treatment of rat with Condurango 30C. SSCP results gave a better indication of differences in band-position and single strand separation of p15 and p53 in Condurango 30C treated samples. Conclusion: Condurango 30C could trigger epigenetic modification in lung cancer via modulation of DNA hypermethylation but placebos could not.

Possible substantive improvements in the structure of the Quality of Life in Adult Cancer Survivors (QLACS) scale? A study based on its Spanish version.

Quality of Life in Adult Cancer Survivors (QLACS) scale is one of the most commonly used and validated measures to assess the Health-Related Quality of Life (HRQoL) in this population. However, there are some aspects related to its structure that still deserve consideration. The aim of this study was to test the substantive improvement over the original QLACS structure resulting from several proposals reflected in the literature. Using a cross-sectional design and Confirmatory Factorial Analysis, we explored those proposals. Reliability, convergent validity, and factor invariance across three cancer survivorships phases (re-entry, early, and long term) were also analyzed. 1.862 post-treatment survivors of diverse cancer types completed the Spanish versions of QLACS, Brief Symptom Inventory-18 (BSI-18), and Subjective Happiness Scale (SHS). The original model with twelve domains, grouped (with the exception of benefits) into a single total score, versus two subtotal (Generic and Cancer-specific) obtained a good fit. The values of Cronbach's alpha, Composite reliability, Average Variance Extracted indexes, and Pearson correlations supported the internal consistency and temporal stability (interval of 2-3weeks) of the QLACS. Results also showed its adequate convergent validity and an invariant factor structure across survival periods (re-entry survivorship, early survivorship, long-term survivorship). In its original structure, albeit the replacement of the scores on the two subscales by a total score, our results support QLACS as a valid and useful tool for the assessment of HRQoL in post-treatment cancer survivors throughout the different survival phases.

Effectiveness and implementation of models of cancer survivorship care: an overview of systematic reviews.

PurposeTo critically assess the effectiveness and implementation of different models of post-treatment cancer survivorship care compared to specialist-led models of survivorship care assessed in published systematic reviews.MethodsMEDLINE, CINAHL, Embase, and Cochrane CENTRAL databases were searched from January 2005 to May 2021. Systematic reviews that compared at least two models of cancer survivorship care were included. Article selection, data extraction, and critical appraisal were conducted independently by two authors. The models were evaluated according to cancer survivorship care domains, patient and caregiver experience, communication and decision-making, care coordination, quality of life, healthcare utilization, costs, and mortality. Barriers and facilitators to implementation were also synthesized.ResultsTwelve systematic reviews were included, capturing 53 primary studies. Effectiveness for managing survivors’ physical and psychosocial outcomes was found to be no different across models. Nurse-led and primary care provider-led models may produce cost savings to cancer survivors and healthcare systems. Barriers to the implementation of different models of care included limited resources, communication, and care coordination, while facilitators included survivor engagement, planning, and flexible services.ConclusionsDespite evidence regarding the equivalent effectiveness of nurse-led, primary care-led, or shared care models, these models are not widely adopted, and evidence-based recommendations to guide implementation are required. Further research is needed to address effectiveness in understudied domains of care and outcomes and across different population groups.Implications for Cancer SurvivorsRather than aiming for an optimal “one-size fits all” model of survivorship care, applying the most appropriate model in distinct contexts can improve outcomes and healthcare efficiency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01128-1.

Hypothalamic obesity post cancer treatment - optimising outcomes

Hypothalamic obesity post cancer treatment - optimising outcomes

Diabetes Life After Cancer Treatment

Research shows that clients can stop insulin therapy post bariatric surgery and post-treatment clearance of hepatitis C virus. However, no study was performed on patients post cancer treatment. This case will examine a 67-year-old male, with a 17-year history of type 2 diabetes. He was on 64 units of basal insulin and 15 units of rapid insulin, including correction factor. HbA1c results have been maintained between 6.5%-7.5%.

Effect of Tai Chi Chuan practice on immune system and pro-metastasis markers in early post-treatment breast cancer survivors

Purpose: To investigate the effect of Tai Chi Chuan (TCC) to improve immune system and decrease pro-metastasis markers in early post-treatment breast cancer survivors. Methods: 130 post-treatment breast cancer survivors were recruited and randomized 1:1 into TCC group and wait-list (control) group. The TCC group practiced for a 60-minutes session once per week, for a total of 52 weeks. 115 forms of Yang-style TCC were taught by a Tai Chi master. Blood samples were taken from each subject and complete blood count was performed. The expressions of NKG2D protein, P-selectin, and vascular endothelial growth factor (VEGF) in plasma were measured. Lymphocyte activity was measured by cell proliferation reagent and ATP assay. Images of lymphocyte colony formation were taken with an inverted microscope. Results: At 52 weeks, TCC group demonstrated a significantly higher WBC (p=0.001) , a significantly higher NKG2D value (p=0.001) and a significantly lower VEGF value (p=0.005) when compared to the wait-list group. However, there was a small, non-significant change for P-selectin values between the breast cancer survivor groups. After 72h incubation, TCC group had a significant increase in lymphocyte proliferation (p=0.001) and greater area of lymphocyte clusters or colonies (p=0.001). Conclusion: The practice of TCC could stimulate tumor immunosurveillance via NKG2D and activate the immune response. VEGF, a marker playing an important role in breast cancer and its metastases, was also reduced in those who practiced TCC. As an alternative for conventional exercise, post-treatment breast cancer survivors may select TCC in their rehabilitation program.

Housing environmental and design attributes and psychoneuroimmunology profiles – a systematic review

BackgroundPsychoneuroimmunology (PNI) indicators, with the central role in low-grade systemic inflammation, are associated with major psychiatric disorders and late effects post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on the behaviour and mental disorders. Therefore, our primary objective is to evaluate whether the exposure to household environmental attributes can trigger PNI biomarker level changes, and to what extent a set of architecture parameters influence on the spatial dynamics of environmental variables.MethodsA restricted systematic review is employed to generate knowledge synthesis about housing and mental recovery for the COVID-19 context in a resource-efficient manner. This review is conducted in accordance with the Cochrane Handbook guideline and PRISMA statement. We searched in Medline, EMBASE, Web of Science, Scopus, the Cochrane Library and Google Scholar. Included studies need to be peer-reviewed, written in English and meet pre-defined eligibility criteria. Observational or intervention studies investigating the effects of either environmental determinants within home environments -air pollution, thermal comfort, lighting, electromagnetic fields, noise and nature- using objective metrics or housing design, or combination with a set of circulating biomarkers in PNI and correlate gut microbiome composition are included. Quantitative measures of mental morbidities common in the cancer survivorship are included as secondary outcomes. Study eligibility and quality assessments are carried out by one team member and verified by a second reviewer. A descriptive analysis is conducted.To the best of our knowledge, this review is the first to systematically explore and integrate the evidence available on the association multifactorial and dynamic of housing environmental and design attributes with immune and microbiome mechanisms.Key messages Disease surrogate markers based on systems biology and PNI approaches may help understand multi-level and multi-directional interactions among neuroimmune-microbiota function and housing exposure.This timely study contributes to understand if household environmental and architecture parameters might facilitate cancer rehabilitation via home design, restoring mental-physiological functions.

Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group.

Simple SummaryAdolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context.

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators—with the central role in low-grade systemic inflammation—are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.