Quality Of Life In Cancer Survivors Research Articles

Feasibility and acceptability of an online expressive writing intervention for rural breast cancer survivors: A randomized controlled trial.

Rural breast cancer survivors (BCS) have unique unmet psychosocial needs that affect quality of life (QOL). Expressive writing (EW) has been shown to improve QOL in cancer survivors, however, its applicability is unclear among rural individuals. This pilot study explores the feasibility and acceptability of an online expressive writing (EW) intervention among rural breast cancer survivors (BCS). Participants (N=34) were recruited from a cancer hospital's registry and randomly assigned to either a control group or the EW intervention group to read positive messages and to write about their cancer experience three times, once per week. Health outcomes were assessed at baseline and 1 month after the intervention. Feasibility and acceptability were also assessed. The study yielded a satisfactory response rate, adherence rate, and completion rate. The majority of the participants reported enjoying the study. Preliminary analyses also demonstrated promising efficacy of the intervention, with improvements (medium effect size) observed for QOL (d=0.51) and fatigue (d=-0.64) in the intervention group compared to the control group at 1-month follow-up. The study demonstrates feasibility and acceptability of an online EW intervention among rural BCS. Future research is warranted to examine the efficacy of the intervention in larger samples of rural cancer survivors.

The Effect of Self-efficacy-Enhancing Interventions on Quality of Life of Cancer Survivors: A Systematic Review.

The influence of self-efficacy-enhancing interventions on quality of life (QOL) is not clear with recent randomized controlled trials (RCTs) because current reviews only evaluated self-efficacy as an outcome. We conducted a systematic review to examine the effect of self-efficacy-enhancing interventions on QOL among patients with cancer and to summarize the effective determinants for designing self-efficacy-enhancing interventions. A systematic search was performed on studies published from January 2003 to May 2023 using PubMed, CINAHL, PsycINFO, and Web of Science. Included studies were RCTs, adults diagnosed with cancer, interventions with explicit self-efficacy components, and QOL as the outcome. Nineteen RCTs were included. Risk-of-bias assessment revealed 12 studies with some concerns and 7 with high risk of bias. The mean intervention adherence rate was 88.2%; the most frequently listed reason for dropout was medical conditions and mortality. Self-efficacy interventions were shown to significantly improve at least 1 subscale of QOL in 9 of 19 studies, of which 7 studies used Bandura's 4 sources of self-efficacy. The interventions with between-session intervals shorter than 2 weeks, of 12-week duration, and with an in-person delivery approach were the most effective. Self-efficacy-enhancing interventions show potential beneficial effects on QOL among cancer survivors. Interventions that use Bandura's 4 sources of self-efficacy strategies and have between-session intervals shorter than 2 weeks, an in-person approach, and 12-week intervention duration are recommended. Properly designed self-efficacy-enhancing interventions can facilitate behavioral change and improve QOL in cancer survivors.

Abstract PO3-27-06: Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health Study

Abstract Background: Black breast cancer survivors (BCS) experience suboptimal quality of life (QoL) compared to White BCS. QoL is a multi-dimensional concept focused on different aspects of wellbeing. Exercise (a subset of physical activity) has been shown to improve QoL in cancer survivors. However, there is limited evidence on the benefits of exercise in relation to QoL among Black BCS and warrants further investigation. Purpose: To examine the association between exercise intensity (e.g., moderate activity) and multiple domains of QoL (e.g., physical wellbeing) among BCS in the Black Women’s Health Study (BWHS). Methods: The BWHS is the largest prospective cohort study following 59,000 Black women in the United States since 1995. Self-reported questionnaires are distributed every two years to obtain current health information, including lifestyle factors and disease occurrence. The 2019 survey data, completed by 3,608 Black BCS, were used to address the primary aim. Of the 3,608 Black BCS, 1,085 females were eligible to participate in this cross-sectional study. The primary predictors were moderate and vigorous exercise intensity. The outcomes (physical, mental, functional, social functioning, and financial wellbeing) were categorized as excellent, very good or good, and fair or poor health. The covariates were marital status, occupation, education, age, body mass index, time since diagnosis, breast cancer stage, and general health. Adjusted multinomial logistic regressions were performed to estimate the odds ratios and 95% confidence intervals for the associations with each predictor. Multiple imputation was used to address missing data. Results: At baseline, the majority of the BCS were 64 years or younger (99%), premenopausal (69%), employed (95%), and had more than a high school degree (86%). About 50% of the participants were married or living as married. There were significant and positive associations between exercise intensity and QoL (p< .05). Compared to BCS who reported little or no exercise (< 60 minutes/week), those who reported at least 60 minutes/week of vigorous exercise had greater odds of experiencing excellent QoL including financial wellbeing (OR=1.70, 95% CI: 1.08-2.67), functional wellbeing (OR=3.64, 95% CI: 1.56-8.49), social functioning (OR=4.56, 95% CI: 2.42-8.60), and physical wellbeing (OR=4.26, 95% CI: 2.12-8.52). Similarly, BCS who engaged in at least 150 minutes of moderate exercise/week had increased odds of reporting excellent social functioning (OR=2.59, 95% CI: 1.41-4.76) and functional wellbeing (OR=4.40, 95% CI: 1.89-10.24) than those who engaged in less than 150 minutes/week of moderate exercise. Conclusions: Black BCS who engage in certain durations (e.g., 150 minutes/week) and exercise intensities (e.g., moderate activity) tend to have better QoL. These findings may help to build upon the relevance of exercise in the context of supportive care for racial and ethnic minority cancer survivors and encourage healthcare professionals to assess the frequency, intensity, time, and type of exercise during routine or follow-up care. Future longitudinal studies are needed to examine the proposed associations among Black BCS and to compare the current study findings. Citation Format: Natasha Burse, Chris Wiesen, Todd Schwartz, Shawn Kneipp, Ashley Leak Bryant. Investigating The Association Between Exercise and Quality of Life Among Breast Cancer Survivors in The Black Women’s Health 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 PO3-27-06.

The influence of trauma insurance on quality of life among cancer survivors

This study investigates Australian cancer survivors' Quality of Life (QOL) concerning whether they own trauma insurance. This research examines (1) whether financial planning mechanisms alleviate financial stress, maintaining the QOL of cancer survivors, (2) how receipt of financial proceeds impacts QOL, and (3) whether emotion affects the financial decisions of cancer patients. Researchers used qualitative research methods to investigate the relationship between trauma insurance ownership and QOL in cancer survivors, considering demographic factors such as gender, age and income, type of cancer, treatment type, the meaning of life, financial planning mechanisms, emotional finance, and risk-shifting behavior. Findings show a general decrease in the QOL of survivors without trauma insurance and less change in the quality of life of survivors with trauma insurance. We attribute this difference to the additional benefits survivors buy with their insurance proceeds. Trauma insurance and other financial mechanisms function to mitigate financial stress.

Study protocol for a pragmatic randomised controlled trial of comparing enhanced acceptance and commitment therapy plus (+) added to usual aftercare versus usual aftercare only, in patients living with or beyond cancer: SUrvivors’ Rehabilitation Evaluation after CANcer (SURECAN) trial

BackgroundTwo million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence, and concerns about returning to work. We aimed to develop and evaluate an intervention based on acceptance and commitment therapy (ACT), suited to address the concerns of cancer survivors and in improving their QoL. We also recognise the importance of exercise and vocational activity on QoL and therefore will integrate options for physical activity and return to work/vocational support, thus ACT Plus (+).MethodsWe will conduct a multi-centre, pragmatic, theory driven, randomised controlled trial. We will assess whether ACT+ including usual aftercare (intervention) is more effective and cost-effective than usual aftercare alone (control). The primary outcome is QoL of participants living with or beyond cancer measured using the Functional Assessment of Cancer Therapy: General scale (FACT-G) at 52 weeks. We will recruit 344 participants identified from secondary care sites who have completed hospital-based treatment for cancer with curative intent, with low QoL (determined by the FACT-G) and randomise with an allocation ratio of 1:1 to the intervention or control. The intervention (ACT+) will be delivered by NHS Talking Therapies, specialist services, and cancer charities. The intervention consists of up to eight sessions at weekly or fortnightly intervals using different modalities of delivery to suit individual needs, i.e. face-to-face sessions, over the phone or skype.DiscussionTo date, there have been no robust trials reporting both clinical and cost-effectiveness of an ACT based intervention for people with low QoL after curative cancer treatment in the UK. We will provide high quality evidence of the effectiveness and cost-effectiveness of adding ACT+ to usual aftercare provided by the NHS. If shown to be effective and cost-effective then commissioners, providers and cancer charities will know how to improve QoL in cancer survivors and their families.Trial registrationISRCTN: ISRCTN67900293. Registered on 09 December 2019.All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1.

Systematic literature review of quality-of-life questionnaires in Waldenström macroglobulinaemia-need for a disease-specific tool.

Systematic literature review of quality-of-life questionnaires in Waldenström macroglobulinaemia-need for a disease-specific tool.

Factors influencing quality of life among cancer survivors in Kenya.

The number of cancer survivors is growing continuously due to advances in treatment of cancer patients. In developed countries, numerous studies on quality of life (QoL) of cancer survivors have been conducted. Little is known regarding the QoL of cancer survivors in Kenya. Therefore, the aim of this study was to explore the factors that contribute to QoL of cancer survivors in Kenya. A descriptive cross-sectional design was used for the study. Participants were 108 adult cancer survivors. Self and interviewer administered QoL Patient/Cancer Survivor Questionnaire was used. Findings indicate a statistically significant relationship between QoL and age (rs =-.055 p<.05), marital status (rs=.490 p<.01), income (rs =.228 p<.05), stage of cancer diagnosis (rs =-.269. p<.01), year of cancer diagnosis (rs =-.295 p<.01), religious affiliation (rs =-.279, p<.01) and the religion one belonged to (rs =-.198 p<.05). Regression analysis showed that age, stage of cancer diagnosis, time off treatment, educational level, and religious affiliation are significant predictors of QoL in cancer survivors. The findings highlight the importance of key factors associated to QoL in cancer survivors in Kenya. Interventions aimed at early cancer detection, treatment, and spiritual support among cancer survivors will improve QoL.

Significance of active screening for detection of health problems in childhood cancer survivors.

BackgroundChildhood cancer survivors (CCSs) have a lifelong increased risk of chronic health problems, most of which are associated with the curative therapies. Recent studies have suggested that prospective active screening using comprehensive assessments for CCSs is superior in identifying undiagnosed chronic health problems.MethodsTo assess the significance of active screening using comprehensive medical examinations for detecting chronic health problems in multiple organ systems in CCSs, we retrospectively compared the frequency and severity of health problems between two different cohorts of CCSs in a single institution: 110 CCSs who visited the outpatient clinic for regular follow-ups between December 2010 and December 2015 (regular follow-up group) vs. 58 CCSs who underwent comprehensive medical examinations between February 2016 and September 2019 (active screening group). CCSs were defined as patients aged ≥ 18 years who had been diagnosed as having childhood cancer ≥ 10 years before and had survived without cancer for ≥ 5 years.ResultsPatient characteristics were similar between the two groups except for primary diagnosis (more brain tumors and embryonal tumors in the active screening group) and treatment history (more alkylating agents used and surgical interventions performed in the active screening group). The prevalence and the median number of health problems were significantly higher in the active screening group than in the regular follow-up group: 93% vs. 67% and 1.0 [0.0–8.0] vs. 2.0 [0.0–7.0] respectively. In term of organ-specific health problems, pulmonary dysfunction, neurocognitive impairment, ocular abnormalities, and dental abnormalities were identified more in the active screening group, partly because these problems had not been assessed in the regular follow-up group. Nevertheless, the prevalence of grade 3–5 health problems was similar between the two groups, except for pulmonary dysfunction.ConclusionActive screening using comprehensive medical examinations was effective for identifying health problems in CCSs. Although the prevalence of severe problems identified by both approaches was similar, comprehensive medical examinations could detect overlooked problems such as severe pulmonary dysfunction, dental maldevelopment, and borderline intellectual functioning, which might have an impact on quality of life in CCSs.

Reallocating Time Between Sleep, Sedentary Time, And Physical Activity On Quality Of Life In Cancer Survivors

PURPOSE: Increasing time in moderate-vigorous physical activity (MVPA) and reducing time in sedentary behaviors (SB) can improve quality of life (QOL) in cancer survivors (CS). However, these behaviors only account for a small portion of the day, neglecting other important health behaviors like sleep and light PA. When examining the effects of these behaviors on QOL, it is important to account for their interdependent nature within the confines of the 24-hour day (i.e., you must decrease time in one activity to increase time in another). This study examined the effect of reallocating time between sleep, SB, light PA and MVPA on QOL in a mixed sample of CS. METHODS: A cross-sectional evaluation of adult CS within five-years of completing active cancer treatment(s). Participants concurrently wore the activPAL™ accelerometer to measure SB, light PA and MVPA, and the Actiwatch-2 to measure sleep duration for 7-days, 24-hours per day. QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). FACT-G scores range from 0-108, a difference of 4 points is considered clinically meaningful, and higher scores indicate better QOL. Isotemporal substitution methods in linear regression models were used to examine the effect of 30-minute time reallocations on total QOL. RESULTS: Participants (N=73) were M=53±13 years old, mostly female (75.7%), and diagnosed with colorectal (33.8%) breast (29.7%), leukemia/lymphoma (9.5%), or other (27.0%) cancer. Average QOL score was 87.0±15.3 (range = 41-107). No time reallocations were statistically significant, however, clinically meaningful associations (i.e., lower QOL) were observed for reallocating 30 minutes from MVPA to sleep (-4.42), SB (-4.32), or light PA (-5.06). CONCLUSION: Findings suggest that moving time away from MVPA may negatively impact QOL but did not reach statistical significance. These findings are congruent with previous literature which has established the important role of MVPA for QOL in CS. Future studies should evaluate reallocating time among a sample of survivors presenting with poor versus good QOL to guide intervention development.

Abstract P4-11-28: Collecting quality of life information in a cohort of breast cancer survivors- Integrating electronic data collection into clinical practice

Abstract Background: With the increase of the cancer survivor population, the Quality of Life (QoL) of these patients has become a topic of interest. Breast cancer survivors often suffer physical, emotional, and social consequences due to cancer diagnosis and treatment that impact their overall QoL. However, physicians still have the challenge of collecting reliable data directly from patients with a method that is time- and resource-saving. The Horizon2020 European project “Artificial Intelligence to Support CAncer Patients across Europe (ASCAPE)” aims to use artificial intelligence to help doctors improve the QoL of cancer survivors. Under the context of this project, the purpose was to study the prevalence of chronic side effects in breast cancer survivors collected through two electronic platforms as well as the adherence of patients to these platforms. Methods: The study involved breast cancer survivors where initial treatment, such as surgery, chemotherapy or radiotherapy concluded at least 1 year prior to inclusion. Participants are asked to complete the EORTC QLQ-C30, BR23 and the HADS questionnaires as well as standalone questions using a Likert-scale approach. The symptoms of interest in this study are shown in Table 1. Participants are followed for 1 year, in which the initial contact and data collection is done face-to-face, and patients receive questionnaires through email to be completed remotely every 3 months. The two electronic platforms used to collect QoL data from patients are: 1) OntoCR, an electronic database based in ontologies that is connected to the electronic health records and is also used to collect data directly from patients, and 2) the Xemio app, a smartphone application that allows patients to register their symptoms and then they are automatically sent to OntoCR. Approximately half of the patients have access to the Xemio app on their phone and can use it. Results: As of now, fifty eight breast cancer survivors have been included in this study cohort. The mean age of the participants is 55.7 years (SD: 8.9 years) and the mean time since initial diagnosis is 3.7 years (SD: 2.3 years). 62% of the participants have undergone chemotherapy and 93% are undergoing endocrine therapy at the time of enrollment. Table 1 shows the proportion of participants with the symptoms of interest at baseline. Of the 24 participants with the Xemio app in their smartphone, 63% have reported symptoms through the app. The symptom most reported through the app is joint pain, which has been reported by 8 participants. Regarding adherence to the data collection methodology, 20/24 (83%) of participants have answered the questionnaires electronically at 3 months and 6/7 (86%) also did it at 6 months. Some participants have not responded to questionnaires (3 at 3 months and 3 at 6 months). Recruitment to the study is ongoing and more complete data will be presented at the conference. Conclusion: The prevalence of long-term side effects in our study cohort of breast cancer survivors is high but there are no clear remedial tracks from oncology departments from which patients can try to solve these symptoms. Electronic platforms can be a helpful tool to capture the QoL and side effects of breast cancer survivors facilitating the long-term follow-up of this population. These platforms can be time-effective for healthcare professionals once they are integrated into their working system. Citation Format: Clara Amat, Ángeles Fuentes, Imma Grau, Raimundo Lozano-Rubí, Olga Martinez-Sáez, Nuria Chic, Barbara Adamo, Maria Vidal, Irene Fernandez, Antonis Valachis, Thanos Kosmidis, Miltiadis Kokkonidis, Montserrat Muñoz. Collecting quality of life information in a cohort of breast cancer survivors- Integrating electronic data collection into clinical practice [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 P4-11-28.

Functional outcomes of cancer patients in an acute inpatient setting at King Fahad Medical City.

[Purpose] Cancer survivors have functional impairments that adversely affect patients’ quality of life (QoL). Acute rehabilitation helps to reduce disability and improves QoL in cancer survivors. This study investigated the potential improvement in mobility levels and QoL of cancer patients during acute inpatient physical therapy (PT) from admission to discharge. [Participants and Methods] This was a cross-sectional study conducted at King Fahad Medical City, Riyadh. Acute inpatient cancer survivors (n=99) were assessed at their admission and discharge. The primary outcome measure was the AM-PAC “6-Clicks” Basic Mobility, Functional Assessment of Cancer Therapy-General (FACT-G7) and the Karnofsky Performance Scale (KPS). [Results] Overall, 82.8% of cancer patients were discharged home. There were significant improvements in all the three outcome measures for all the patients from admission to discharge. Patients who were discharged home exhibited significantly better improvement in all the scales. Factors that predicted discharge mobility and quality of life were discharge destination, number of PT sessions, and baseline admission scores. [Conclusion] The study found that acute inpatient cancer rehabilitation helps to improve mobility and QoL. Rehabilitation programs available in Saudi Arabia are limited, and it is important to integrate the cancer rehabilitation model into the oncology services.

Factors affecting the quality of life of gastric cancer survivors

BackgroundThe number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention.MethodsData were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson’s correlation coefficient, and multiple regression analysis.ResultsA total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = − .39, p < .001) and gastric cancer-specific symptoms (r = − .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (β = − .397, p < .001), religious belief (β = .299, p < .001), functional status (β = .251, p = .003), and self-efficacy (β = .191, p = .004).ConclusionThis study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.

Relationship between balance function and QOL in cancer survivors and healthy subjects.

A previous study reported that cancer survivors exhibit decreased postural stability compared to age-matched controls. Another study showed that cancer survivors have a lower quality of life (QOL) compared to healthy subjects, and there was a significant relationship between muscle strength and QOL in cancer survivors. We aimed to investigate differences in the associations between balance function and QOL in cancer survivors and healthy subjects.Forty-one cancer survivors and 33 healthy subjects were included. Balance function was evaluated using the timed up and go test, and body sway was tested using a force platform. QOL was assessed using the medical outcome study 36-item short-form health survey.Cancer survivors exhibited significantly higher timed up and go and lower QOL than that of healthy subjects (P < .05). There was a significant association between body sway and QOL (P < .05) among cancer survivors. However, healthy subjects had subscales for QOL related to the body sway test parameters more frequently than cancer survivors (P < .05).Cancer survivors’ balance function may have little effect on QOL, unlike in healthy subjects.

Cancer Survivors with Low Hand Grip Strength Have Decreased Quality of Life Compared with Healthy Controls: The Korea National Health and Nutrition Examination Survey 2014-2017.

BackgroundCancer survivors experience decreased physical function and reduced muscle strength, which leads to lower quality of life (QOL). The hand grip strength (HGS) can be a predictor of poor health-related QOL as a parameter of sarcopenia. The purpose of this study was to investigate the relationship between low HGS and QOL in cancer survivors and healthy controls.MethodsWe analyzed 392 cancer survivors and 1,176 healthy controls from the Korea National Health and Nutrition Examination Survey, 2014–2017. We defined low HGS as 2 standard deviation values for healthy young Korean adults from a previous study. QOL was evaluated using the European Quality of Life Scale-Five Dimensions. A complex sample logistic regression model was used to assess the relationship between each dimension of low HGS and QOL.ResultsThe odds ratios (ORs) for decreased QOL were significantly higher in male cancer survivors with low HGS on self-care (OR, 8.51; 95% confidence interval [CI], 1.69–42.83) and usual activities (OR, 6.63; 95% CI, 1.22–36.03). The ORs for problems in mobility (OR, 5.87; 95% CI, 2.04–16.91), usual activities (OR, 14.46; 95% CI, 3.84–54.44), pain/discomfort (OR, 4.90; 95% CI, 2.00–12.01), and anxiety/depression (OR, 6.43; 95% CI, 2.16–19.12) were significantly high in female cancer survivors with low HGS. However, healthy controls showed no significant relationship between low HGS and QOL.ConclusionFor cancer survivors, low HGS was associated with poor QOL in some domains. Strategies to increase muscle strength must be considered to improve the QOL of cancer survivors.

Moderate to vigorous physical activity participation associated with better quality of life among breast and colorectal cancer survivors in Korea

BackgroundTo investigate the association between physical activity (PA) and quality of life (QoL) among breast and colorectal cancer survivors in Korea.MethodsA total of 224 cancer survivors (151 breast and 73 colorectal cancers) who completed treatments were recruited. We measured PA level with Godin Leisure-Time Exercise Questionnaire and QoL with European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30.ResultsModerate to vigorous PA was significantly correlated with global QoL (r = .311, p < 0.01), physical functioning (r = .231, p < 0.01), fatigue (r = −.176, p < 0.05), pain (r = −.154, p < 0.05), and dyspnea (r = −.221, p < 0.01) while no correlation was found between light PA and QoL after controlling for potential confounders. When we further divided our participants into four groups by total PA level, we found a strong linear dose-response relationship between higher total PA and better QoL outcomes (p < .001). Compared with participants in the lowest quartile, those in the highest quartile had significantly better score in global QoL (65.8 ± 2.7 vs. 77.6 ± 2.8, p = 0.003), physical functioning (67.2 ± 2.3 vs. 85.3 ± 2.4, p = 0.007), fatigue (35.9 ± 3.2 vs. 23.6 ± 3.2, p = 0.008), pain (22.7 ± 3.3 vs. 13.0 ± 3.4, p = 0.046), and dyspnea (13.7 ± 2.5 vs. 5.9 ± 2.6, p = 0.034).ConclusionsHigher PA level was associated with better QoL among breast and colorectal cancer survivors in Korea. Increasing PA levels should be included as one of important strategies to improve QoL in cancer survivors.

Management of gastrointestinal perforation related to radiation.

Perforation of gastrointestinal (GI) tract is a rare, but serious complication of abdominopelvic irradiation, and it can even occur several years after radiotherapy. As one of the symptoms of radiation enteropathy, it shares common features with other chronic complications and has its own characteristic at the same time. It has been reported that some systematic therapies, such as sorafeniband bevacizumab, could add the risk of radiation-induced GI perforation. The potential mechanisms of aggravated GI injury may be exacerbation of epithelial cell damage, microvascular damage or subsequent inflammatory response. The complicated situation makes it almost impossible to set uniform dose constraints for GI perforation prevention. The majority of cancer patients with GI perforation require emergency surgery, and there is no high quality evidence for supporting the use of any prevention measures. In this review, we summarize the clinical manifestation, risk factors, mechanism, and therapy of radiation-induced GI perforation. A comprehensive treatment plan is crucial to improve the quality of life forcancer survivors.

Are Accelerometer-based Functional Outcome Assessments Feasible and Valid After Treatment for Lower Extremity Sarcomas?

Aspects of physical functioning, including balance and gait, are affected after surgery for lower limb musculoskeletal tumors. These are not routinely measured but likely are related to how well patients function after resection or amputation for a bone or soft tissue sarcoma. Small, inexpensive portable accelerometers are available that might be clinically useful to assess balance and gait in these patients, but they have not been well studied. In patients treated for lower extremity musculoskeletal tumors, we asked: (1) Are accelerometer-based body-worn monitor assessments of balance, gait, and timed up-and-go tests (TUG) feasible and acceptable? (2) Do these accelerometer-based body-worn monitor assessments produce clinically useful data (face validity), distinguish between patients and controls (discriminant validity), reflect findings obtained using existing clinical measures (convergent validity) and standard manual techniques in clinic (concurrent validity)? This was a prospective cross-sectional study. Out of 97 patients approached, 34 adult patients treated for tumors in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) were included in this study. Twenty-seven had limb-sparing surgery and seven underwent amputation. Patients performed standard activities while wearing a body-worn monitor on the lower back, including standing, walking, and TUG tests. Summary measures of balance (area [ellipsis], magnitude [root mean square {RMS}], jerkiness [jerk], frequency of postural sway below which 95% of power of acceleration power spectrum is observed [f95 of postural sway]), gait [temporal outcomes, step length and velocity], and TUG time were derived. Body-worn monitor assessments were evaluated for feasibility by investigating data loss and patient-reported acceptability and comfort. In addition, outcomes in patients were compared with datasets of healthy participants collected in parallel studies using identical methods as in this study to assess discriminant validity. Body-worn monitor assessments were also investigated for their relationships with routine clinical scales (the Musculoskeletal Tumour Society Scoring system [MSTS], the Toronto Extremity Salvage Score [TESS], and the Quality of life-Cancer survivors [QoL-CS)] to assess convergent validity and their agreement with standard manual techniques (video and stopwatch) to assess concurrent validity. Although this was a small patient group, there were initial indications that body-worn monitor assessments were well-tolerated, feasible to perform, acceptable to patients who responded (95% [19 of 20] of patients found the body-worn monitor acceptable and comfortable and 85% [17 of 20] found it user-friendly), and produced clinically useful data comparable with the evidence. Balance and gait measures distinguished patients and controls (discriminant validity), for instance balance outcome (ellipsis) in patients (0.0475 m/s [95% confidence interval 0.0251 to 0.0810]) was affected compared with controls (0.0007 m/s [95% CI 0.0003 to 0.0502]; p = 0.001). Similarly gait outcome (step time) was affected in patients (0.483 seconds [95% CI 0.451 to 0.512]) compared with controls (0.541 seconds [95% CI 0.496 to 0.573]; p < 0.001). Moreover, body-worn monitor assessments showed relationships with existing clinical scales (convergent validity), for instance ellipsis with MSTS (r = -0.393; p = 0.024). Similarly, manual techniques showed excellent agreement with body-worn monitor assessments (concurrent validity), for instance stopwatch time 22.28 +/- 6.93 seconds with iTUG time 21.18 +/- 6.23 seconds (intraclass correlation coefficient agreement = 0.933; p < 0.001). P < 0.05 was considered statistically significant. Although we had a small, heterogeneous patient population, this pilot study suggests that body-worn monitors might be useful clinically to quantify physical functioning in patients treated for lower extremity tumors. Balance and gait relate to disability and quality of life. These measurements could provide clinicians with useful novel information on balance and gait, which in turn could guide rehabilitation strategies. Level III, diagnostic study.

Physical Wellbeing in Cervical and Breast Cancer Survivors: A Cross-sectional Study in Surabaya, Indonesia

Background: Cervical and breast cancer are the two top leading cases of female cancer worldwide. Both cases share some similar clinical manifestations as specific symptoms of cancer. Physical wellbeing often decreased as frequent symptoms appear. This study aimed to compare and analyze the physical wellbeing among cervical cancer and breast cancer survivors (CCS and BCS).Methods: This cross-sectional study involved 47 CCS and 58 BCS in the district of Rangkah, Gading, and Pacarkeling, Surabaya, Indonesia. Instrument of Quality of Life – Cancer Survivors (QOL-CS) was used for data collection. Independent sample T test and Mann-Whitney U test were used in data analysis (α&lt; .05). Results: More severe fatigue, appetite changes, pain, sleep disturbance, constipation, nausea-vomiting, and menstrual changes were found in CCS. More poor perceived health status and optimal physical wellbeing were found in BCS. Overall, most sufficient physical wellbeing was found in both groups. There were significant differences of fatigue, pain, sleep disturbance, appetite changes, constipation, health status (p&lt;.001 for each), nausea-vomiting (p= .004), and menstrual changes (p= .001) were found between groups. Overall, physical wellbeing was significantly different between groups (p&lt; .001). Sleep disturbance (84.7% of influence) and appetite changes (75.7% of influence) were the best predictors for determining physical wellbeing in CCS and BCS respectively.Conclusion: More severe cancer symptoms were found in CCS, but more poor perceived health status was found in BCS. There was a significant difference of physical wellbeing found between CCS and BCS.

Quality of Life in Pre- and Post-Treatment among Head and Neck Cancer Survivors at A Tertiary Centre, Malaysia

Background : Treatment for head and neck cancer (HNC) may result in a variety of long term consequences that impair their health and quality of life (QoL). HNC patients often are prone to have a poor health related QoL due to significant changes in vital functions. Despite researches being done in the area cancer survivors' QoL internationally, those done locally were relatively scares and not clear. The study aim to determine and compares the pre and post treatments QoL in HNC patients. Methods : A cohort study was carried out to recruit 81 newly diagnosed HNC patients purposively; pre and six months post treatment using QoL Cancer Survivor and Questionnaire-Head &Neck 35 questionnaires. .Data was analyzed for descriptive and inferential analysis. Results : A total of 40 (50%) patients participated and the result shows that QoL of HNC patients were at medium level (6.22 ± 1.8) pre-treatment, and however reduced (4.84 ± 1.16) at 6 months post treatment), despite the symptoms or problems that occur reduced post treatment compared (1.58 ± 1.25). The Pearson coefficient correlation test result shows that QoL of HNC patients pre and post treatment were strong but negatively correlated ( r = -0.447, p = 0.002). Conclusion: Understanding of QoL and affecting factors in HNC patients' QoL is very crucial as it may potentially assist in designing interventions that lessen the adverse impact of this disease process and more accurately support those in active treatment, survivors, and caregivers.

Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects.

We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p<.05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p<.05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p<.05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors.