Subgroups Of Cancer Survivors Research Articles

High deductible health plans and survival among cancer survivors.

11005 Background: High deductible health plans (HDHP) enable lower premiums at the expense of potentially high out-of-pocket costs. They are associated with more advanced cancer stage diagnoses and delayed or forgone care among cancer survivors. However, it is unknown how HDHPs are associated with survival among cancer survivors. Methods: Individuals ages 18-84 years with non-Medicaid insurance were identified from the 2011-2018 National Health Interview Survey (NHIS) with linked mortality files from the National Death Index. HDHP status was defined by the NHIS as a yearly deductible ≥$1200-1350 for an individual or ≥2400-$2700 for a family (values depend on survey year with increases over time). Cox proportional hazards models using age as the time scale were utilized to determine: 1) association of HDHP status with overall survival (OS) and cancer survival (CS; i.e., freedom from cancer death) among cancer survivors, and 2) how associations differed for survivors compared to those without a cancer history. Models accounted for the NHIS survey design and survey weights and were adjusted for insurance status, marital status, sex, comorbidities, education, income, national region, and cancer site and time since cancer diagnosis (if applicable). Sensitivity analyses adjusting for age at cancer diagnosis were performed using time since diagnosis as the time scale. Results: A total of 147,254 respondents were identified, 5.9% of whom were cancer survivors. 25.6% of survivors and 28.5% of individuals without a cancer history reported being insured by a HDHP at the time of NHIS participation. HDHP status was associated with worse OS (HR: 1.46, 95% CI = 1.19 - 1.79) and CS (HR: 1.34, 95% CI = 1.01 - 1.77) among cancer survivors overall in the adjusted model. HDHP status was additionally associated with worse OS among the following subgroups of cancer survivors: non-Hispanic White (HR: 1.45, 95% CI = 1.16 - 1.82), income > 400% federal poverty level (HR: 1.65, 95% CI = 1.16 - 2.36), college (HR: 1.47, 95% CI = 1.07 – 2.00) or high school (HR: 1.59, 95% CI = 1.19 - 2.12) education, and multiple cancers (HR: 1.58, 95% CI = 1.06 - 2.36), without clear patterns by sex, comorbidities, insurance, and cancer site. Sensitivity analyses provided similar results. In contrast, among adults without a history of cancer at the time of NHIS participation, HDHP status was not significantly associated with OS (HR: 1.08, 0.96 - 1.21; Pinteraction < .01) or CS (HR: 0.90, 95% CI = 0.70 - 1.14; Pinteraction < .01). Conclusions: This nationwide population-based analysis suggests that HDHPs are associated with both worse overall survival and cancer survival among cancer survivors but are not associated with survival in adults without a history of cancer. HDHPs may financially disincentivize cancer survivors from utilizing necessary medical care to optimize survivorship thereby compromising mortality and cure. Policy changes to limit the proliferation of these plans may improve cancer outcomes.

Left Ventricular Strain Analysis During Submaximal Semisupine Bicycle Exercise Stress Echocardiography in Childhood Cancer Survivors

Background Childhood cancer survivors (CCSs) show relevant cardiac morbidity and mortality throughout life. Early detection is key for optimal support of patients at risk. The aim of this study was to evaluate 2-dimensional speckle-tracking echocardiography strain analysis during semisupine exercise stress in CCSs for detection of subclinical left ventricular dysfunction after cancer treatment. Methods and Results Seventy-seven CCSs ≥1-year postchemotherapy were prospectively examined at rest, low, and submaximal stress level and compared with a cohort of healthy adolescents and young adults (n=50). Global longitudinal strain (GLS), short axis circumferential strain, and corresponding strain rates were analyzed using vendor-independent software. CCSs at median 7.8 years postchemotherapy showed comparable left ventricular GLS, circumferential strain, and strain rate values at all stress stages to healthy controls. Yet, prevalence of abnormal GLS (defined as <2 SD of controls reference) in CCSs was 1.3% at rest, 2.7% at low, and 8.6% at submaximal stress. In CCSs, relative change of circumferential strain from rest to submaximal stress was lower than in healthy controls, median 16.9 (interquartile range [IQR], 3.4; 28.8) % versus 23.3 (IQR, 11.3; 33.3) %, P=0.03, most apparent in the subgroups of CCSs after high-dose anthracycline treatment and cancer diagnosis before the age of 5 years. Conclusions In this prospective 2-dimensional speckle tracking echocardiography strain study, prevalence of abnormal left ventricular GLS increased with stress level reflecting impaired cardiac adaptation to exercise stress in some CCSs. However, relatively early after last chemotherapy, this did not result in significant differences of mean GLS-, circumferential strain-, and strain rate values between CCSs and controls at any stress level.

Effects of a DVD-delivered randomized controlled physical activity intervention on functional health in cancer survivors

BackgroundSupervised physical activity interventions improve functional health during cancer survivorship, but remain costly and inaccessible for many. We previously reported on the benefits of a DVD-delivered physical activity program (FlexToBa™) in older adults. This is a secondary analysis of the intervention effects among cancer survivors in the original sample.MethodsLow active, older adults who self-reported a history of cancer (N = 46; M time since diagnosis = 10.7 ± 9.4 years) participated in a 6-month, home-based physical activity intervention. Participants were randomized to either the DVD-delivered physical activity program focused on flexibility, toning, and balance (FlexToBa™; n = 22) or an attentional control condition (n = 24). Physical function was assessed by the Short Physical Performance Battery (SPPB) at baseline, end of intervention, and at 12 and 24 months after baseline.ResultsRepeated measures linear mixed models indicated a significant group*time interaction for the SPPB total score (β = − 1.14, p = 0.048), driven by improved function from baseline to six months in the FlexToBa™ group. The intervention group also had improved balance (β = − 0.56, p = 0.041) compared with controls. Similar trends emerged for the SPPB total score during follow-up; the group*time interaction from 0 to 12 months approached significance (β = − 0.97, p = 0.089) and was significant from 0 to 24 months (β = − 1.84, p = 0.012). No significant interactions emerged for other outcomes (ps > 0.11).ConclusionsA DVD-delivered physical activity intervention designed for cancer-free older adults was capable of eliciting and maintaining clinically meaningful functional improvements in a subgroup of cancer survivors, with similar effects to the original full sample. These findings inform the dissemination of evidence-based physical activity programs during survivorship.Trial registrationClinicalTrials.govNCT01030419. Registered 11 December 2009

The eHealth self-management application ‘Oncokompas’ that supports cancer survivors to improve health-related quality of life and reduce symptoms: which groups benefit most?

Background Oncokompas is a web-based self-management application that supports cancer survivors to monitor their health-related quality of life (HRQOL) and symptoms, and to obtain personalised feedback and tailored options for supportive care. In a large randomised controlled trial among survivors of head and neck cancer, colorectal cancer, and breast cancer and (non-)Hodgkin lymphoma, Oncokompas proved to improve HRQOL, and to reduce several tumour-specific symptoms. Effect sizes were however small, and no effect was observed on the primary outcome patient activation. Therefore, this study aims to explore which subgroups of cancer survivors may especially benefit from Oncokompas. Materials and methods Cancer survivors (n = 625) were randomly assigned to the intervention group (access to Oncokompas, n = 320) or control group (6 months waiting list, n = 305). Outcome measures were HRQOL, tumour-specific symptoms, and patient activation. Potential moderators included socio-demographic (sex, age, marital status, education, employment), clinical (tumour type, stage, time since diagnosis, treatment modality, comorbidities), and personal factors (self-efficacy, personal control, health literacy, Internet use), and patient activation, mental adjustment to cancer, HRQOL, symptoms, and need for supportive care, measured at baseline. Linear mixed models were performed to investigate potential moderators. Results The intervention effect on HRQOL was the largest among cancer survivors with low to moderate self-efficacy, and among those with high personal control and those with high health literacy scores. Cancer survivors with higher baseline symptom scores benefitted more on head and neck (pain in the mouth, social eating, swallowing, coughing, trismus), and colorectal cancer (weight) specific symptoms. Discussion Oncokompas seems most effective in reducing symptoms in head and neck cancer and colorectal cancer survivors who report a higher burden of tumour-specific symptoms. Oncokompas seems most effective in improving HRQOL in cancer survivors with lower self-efficacy, and in cancer survivors with higher personal control, and higher health literacy.

Use of eHealth to Facilitate Diet and Exercise Tracking and Discussions Between Cancer Survivors and Clinicians

Abstract Objectives Cancer-specific diet and exercise recommendations are not often discussed during oncology visits due to limited time and resources. eHealth [i.e., apps, activity trackers, electronic medical records (EMR)] could facilitate patient-clinician communication about health behaviors, but it is unknown how cancer survivors use eHealth and how engaged they are with digital technologies. We investigated cancer survivors’ eHealth practices and whether their engagement differs from those without a cancer history. Methods Cycle 1 and 2 data from the National Cancer Institute Health Information National Trends Survey 5 were used for this study. Of the 6751 adults included in our analysis, 1097 had a cancer history; the remainder served as the comparison group. We examined participants’ engagement with tablets and/or smartphone apps and the EMR. Adjusted polytomous logistic regression models were performed to estimate associations between cancer history and eHealth engagement. Descriptive results were weighted, and the jackknife replication method was used to account for the complex sampling design. Significance threshold was set at p &amp;lt; 0.05. Results Cancer survivors had a mean age of 64.2 ± 0.8 years and a mean BMI of 28.2 ± 0.3 kg/m2. Approximately one-third of cancer survivors used an app to track progress toward health goals and a tablet to facilitate health discussions with a clinician; 20% of cancer survivors shared data from a tracker and/or smartphone with a clinician. Further, 43% of cancer survivors accessed their EMR ≥ 1 time in the past year and 22% downloaded EMR data to their own devices. Cancer survivors were more likely to access the EMR ≥ 10 times in the past year than the comparison group, after adjusting for age, race, gender, education, income, and BMI [OR = 1.93 (95% CI: 1.12, 3.34), p = 0.02]. No other differences in eHealth engagement were observed between those with and without a cancer history. Conclusions Our results demonstrate that cancer survivors are beginning to engage with eHealth to manage their health and communicate with clinicians. Both health apps and the EMR appear to be underutilized yet promising ways to deliver health recommendations for cancer survivors. Future research should investigate patterns of eHealth use among different subgroups of cancer survivors. Funding Sources The first author is supported by the National Cancer Institute.

Panel-based methodology for assessing the impact of public policies on cancer patients and survivors.

12059 Background: Cancer interventions are subject to a range of regulations, but data from large, nationally representative surveys are not always available in time to inform the policy process and do not always address issues specific to cancer patients and survivors. Understanding their experiences is critical to achieving policy solutions to issues such as access to effective pain relief, reducing unexpected medical bills, and reducing the impact of high prescription drug costs on treatment for lower income cancer patients. This research intended to better understand patient experiences and opinions in a statistically valid manner specifically targeted to the policy process. Methods: 3057 panelists were identified from ACS contacts, health systems, and social media advertising through ACS/ACS CAN pages and paid Facebook ads, to participate in a series of surveys across a year. The panel included diverse survivors across age, gender, race, ethnicity, economic status, and cancer type. Online surveys deployed semi-monthly on cancer survivorship topics impacted by current policy, including access to/affordability of care, pain treatment, and prescription drug costs. Responses were analyzed for the entire population and across subgroups of cancer survivors. Results: Each survey achieved a response rate between 35% and 50% of all panel members, resulting in a margin of error +/- 3% and 95% confidence level. Insights from cancer patient and survivor experiences helped support public policies through findings such as (but not limited to): 41% of those prescribed opioids had trouble getting their medicine, creating difficulty participating in work, family, or social events; extra trips to the doctor or pharmacy; negative impact on treatment, and trips to the Emergency Room due to uncontrolled pain; 24% received a surprise medical bill, increasing their anxiety, reducing likelihood to see a specialist, and reducing likelihood to seek emergency care during a serious health issue; and 31% of those with household income less than $30,000 report trouble affording prescription drugs and 17% have delayed or not filled a prescription due to cost. Findings supported the policy process by helping craft policy positions aligned with cancer patient preferences, raising public awareness, and communicating to policymakers the impact of policies on cancer. Conclusions: The panel methodology illustrates the impact of policy decisions on cancer patients and survivors. Findings provide an unprecedented level of input to the policy process for cancer patients and survivors.

Examining the Impact of a Personalized Self-Management Lifestyle Program Using Mobile Technology on the Health and Well-Being of Cancer Survivors: Protocol and Rationale for a Randomized Controlled Trial (The Moving On Study).

BackgroundCancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors are overweight. This has negative implications for long-term health outcomes, including increased risk of subsequent and secondary cancers. There is a need to identify interventions, which can improve physical and psychological outcomes that are practical in modern oncology care. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology to improve health outcomes in cancer survivors.ObjectiveThis study aims to investigate whether a personalized mHealth self-management lifestyle program is acceptable to participants and can improve physical and psychological outcomes of a subgroup of cancer survivors with increased health risks related to lifestyle behaviors.MethodsA sample of 123 cancer survivors (body mass index >25 kg/m2) was randomly assigned to the control (n=61) or intervention (n=62) group. The intervention group attended a 4-hour tailored lifestyle information session with a physiotherapist, dietician, and clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through short message service text messaging contact). Objective measures of health behavior (ie, physical activity) were collected using Fitbit (Fitbit, Inc). Data on anthropometric, physiological, dietary behavior, and psychological measures were collected at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Semistructured interviews were conducted to explore the retrospective acceptability of the Moving On program from the perspective of the recipients.ResultsThis paper details the protocol for the Moving On study. The project was funded in August 2017. Enrolment started in December 2017. Data collection completed in September 2018. Data analysis is underway, and results are expected in winter 2019.ConclusionsThe results of this study will determine the efficacy and acceptability of an mHealth intervention using behavior change techniques to promote health behaviors that support physical health and well-being in cancer survivors and will therefore have implications for health care providers, patients, health psychologists, and technologists.International Registered Report Identifier (IRRID)DERR1-10.2196/13214

Medical Conditions Among Survivors of Adolescent and Young Adult Non-Hodgkin Lymphoma (NHL), Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML)

Introduction: Adolescent and young adult (AYA) cancer survivors are at an increased risk of developing subsequent medical problems, including asthma/chronic obstructive pulmonary disorder, cardiovascular disease, diabetes and second cancers. However, few population-based studies have focused on these risks in AYAs with NHL, ALL or AML or considered whether the occurrence of these and other medical conditions differ by sociodemographic factors.Methods: Data for patients aged 15-39 when diagnosed with NHL (n=4,459), ALL (n=1,100) and AML (n=1,107) during 1996-2012 and surviving a minimum of 2 years were obtained from the California Cancer Registry and followed in California hospital discharge databases. Discharge diagnoses were used to classify medical conditions as cardiac (hypertensive disease, ischemic heart disease, other heart disease), neurologic (stroke, seizure), endocrine (hypothyroidism, diabetes, ovarian/testicular dysfunction, other metabolic diseases), respiratory (asthma, chronic obstructive pulmonary disease), renal (chronic kidney disease, hemodialysis, kidney transplant), liver (chronic liver disease, pancreatitis, cirrhosis, liver transplant), and avascular necrosis. Second cancers were obtained from the cancer registry. We estimated the cumulative incidence (CMI) of developing each condition 10-years after diagnosis, accounting for death as a competing risk. We determined the impact of race/ethnicity, neighborhood socioeconomic status (SES), health insurance status and stem cell transplant (SCT) on the occurrence of each medical condition after adjusting for other demographic and clinical factors using multivariable Cox proportional hazards regression.Results: The most common medical conditions among AYA survivors at 10-years were cardiac (CMI NHL: 11.6%; ALL= 20.5%; AML= 18.2%), endocrine (CMI NHL: 18.6%; ALL= 33.0%; AML= 25.9%) and respiratory (CMI NHL: 5.1%; ALL= 7.7%; AML= 6.8%) diseases. Avascular necrosis had the highest CMI in ALL patients (CMI NHL: 1.2%; ALL= 8.7%; AML= 2.5%). Neurologic (CMI NHL: 2.1%; ALL= 4.5%; AML= 4.9%) and liver (CMI NHL: 2.0%; ALL= 5.6%; AML= 4.4%) were more common in survivors of ALL and AML than NHL. Second cancers (2.3-2.5%) and renal diseases (2.2-3.5%) were less common at 10-years. NHL survivors with advanced stage disease had a higher incidence of all medical conditions, except second cancers. Chemotherapy was associated with a higher CMI of cardiac and endocrine conditions among NHL survivors; these associations could not be assessed in ALL and AML patients as nearly all patients received chemotherapy. Initial radiation therapy was not associated with a higher CMI of medical conditions in NHL or ALL survivors, but was associated with a higher CMI of respiratory, renal and endocrine diseases in AML survivors. In multivariable models, public or no insurance (vs private) was associated with a higher risk of most medical conditions in NHL and ALL survivors, but not AML survivors (Table). The risk of developing medical conditions varied by race/ethnicity, with Hispanics ALL survivors (vs non-Hispanic whites) at a higher risk of cardiac, renal, liver, endocrine, second cancers and neurologic diseases and black AML survivors at a higher risk of all medical conditions, except endocrine diseases. AYAs with NHL who resided in lower SES neighborhoods were at a higher risk for developing cardiac, respiratory and endocrine diseases; AML survivors in lower SES neighborhoods had a higher risk of respiratory diseases. Across all cancers, AYAs undergoing a SCT were at a higher risk of most medical conditions.Conclusion: This study found that sociodemographic factors were associated with the risk of developing medical conditions in AYA NHL, ALL and AML survivors. As expected, the risk of medical conditions varied by cancer type and treatment, with those undergoing SCT having a higher risk of medical conditions regardless of cancer type. NHL and ALL survivors who were uninsured or publicly insured were at a consistently higher risk of developing medical conditions, as were Hispanic ALL survivors and Black AML survivors. Our findings highlight the higher burden of medical conditions in subgroups of cancer survivors that may relate to reduced access to preventive care, early detection/intervention and long-term surveillance. DisclosuresMuffly:Shire Pharmaceuticals: Research Funding; Adaptive Biotechnologies: Research Funding.

The role of psychosocial resources for long-term breast, colorectal, and prostate cancer survivors: prevalence and associations with health-related quality of life.

Many long-term cancer survivors still have to adjust to possible adverse consequences of the illness or treatment. Resources can play an important role in this adjustment process, but research on this topic is limited, especially for very long-term survivors. This study explores, which resources are most frequently indicated by different subgroups of cancer survivors, and what role resources play for functioning and health-related quality of life (HRQL) in cancer survivors with and without recurrence. The sample of 6030 breast, colorectal, and prostate cancer survivors (5-16years post-diagnosis) was recruited in a German multi-regional population-based study. Personal resources were assessed by a 27-item checklist; HRQL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). General linear models were used to analyze associations of resources with HRQL. Participants indicated on average 11.4 (SD 5.1) resources as helpful. Family, activities with others, and partnership were indicated most commonly overall, but frequencies varied according to age, sex, and tumor site. Physical activity, health, professional help, calmness, hope, optimism, and hobbies were most important in explaining HRQL variance. Cancer survivors with recurrence and many resources were found to report similar HRQL as survivors without recurrence and only few resources. The study underlines the importance and situational variability of personal and social resources for cancer survivors' HRQL, even years post-diagnosis. Not only the availability, but also the individual perception and significance of resources should be considered in follow-up cancer care.

Fertility treatments among female cancer survivors giving birth – a Finnish register-based study

Background: Long-term survival rates for most types of childhood cancers have improved dramatically over the past decades. However, because of advances in multimodality treatments, cancer survivors nowadays more often face long-term complications, including diminished gonadal and reproductive function. The aim of this study was to identify whether the use of fertility treatments among early onset (0–34 years) cancer survivors giving birth differed from that among siblings giving birth and to identify the subgroups of cancer survivors that were most likely to require fertility treatments.Material and methods: Nationwide cancer and birth registries were merged to identify 1974 post-diagnosis deliveries of cancer survivors and 6107 deliveries of female siblings in 2004–2013. Unconditional multivariate logistic regression models were used to estimate the risk for different fertility treatments namely assisted reproductive technology, intrauterine insemination and ovulation induction. We adjusted for maternal age, year of delivery, parity and smoking.Results: We found overall significantly increased odds for use of any fertility treatments in survivors compared to siblings (OR 1.84, 95% CI 1.18–2.86). As time from cancer treatment increased, the odds for need of fertility treatments increased, being highest at 11 to 15 years post cancer treatment (OR 2.88, 95% CI 1.13–7.30). Survivors diagnosed at ages 25–34 years had the highest odds for use of fertility treatments compared to siblings (OR 2.31, 95% CI 1.01–5.32).Conclusions: Our study supports previous findings indicating that cancer survivors have an increased risk for subfertility. Survivors diagnosed in their childhood had the lowest risk for fertility treatment and seemed to get pregnant with less extensive fertility treatments than survivors diagnosed as adults. Time elapsed from cancer treatment played a central role, increasing the need for fertility treatments compared to siblings, suggesting that cancer therapies might lead to diminished ovarian reserve.

Moderators of acupuncture effectiveness in breast cancer survivors: Randomized clinical trial (RCT).

162 Background: The popularity of acupuncture among cancer patients highlights the need for studying its effectiveness for mitigating side effects of cancer treatments. Insomnia is prevalent among cancer patients and is associated with fatigue and reduced quality of life (QOL). It is also closely linked with depression, sleep apnea, and circadian disruption. Using data form an RCT of acupuncture for insomnia among breast cancer survivors, we examined depression, apnea and circadian factors as moderators of acupuncture effectiveness. Methods: 68 breast cancer survivors (54 years, SD = 9) experiencing insomnia symptoms were randomized to receive 12 sessions of acupuncture (N = 34) or sham (N = 34; using placebo needles). Measures included the Insomnia Severity Index, Brief Fatigue Inventory, and FACT—G, obtained at baseline, mid-treatment (3 weeks), end of treatment (6 weeks), and follow-up (10 weeks). Results: Although acupuncture produced significant improvements from baseline to follow-up in insomnia symptoms, fatigue, and QOL, these improvements did not differ from sham. Compared to sham, the acupuncture produced significantly greater improvements in: 1) insomnia severity (p = 0.03) and QOL (p = 0.02) among those with greater tendency for morning chronotype; 2) fatigue (p = 0.01) among those with lower apnea risk; and 3) QOL (p &lt; 0.001) among those with lower depression scores at baseline. Conclusions: These findings suggest that acupuncture might be more effective among certain subgroups of patients. Moderators of insomnia, fatigue, and QOL include morningness tendency, lower risk for sleep apnea and lower depression scores, respectively. Our findings on depression are in line with prior research that has found that patients with less severe depression may have a greater capacity for acupuncture response perhaps due to higher availability of serotonin. Additional research is needed to test whether acupuncture is a viable treatment option for subgroups of cancer survivors with insomnia. Clinical trial information: NCT01162018.

Characteristcs associated with complementary and alternative medicine use among racially and ethnically diverse long-term cancer survivors.

e20532 Background: To identify the prevalence and predisposing, enabling and need for care characteristics of long-term adult cancer survivors who use complementary and alternative medicine (CAM) modalities. Methods: We analyzed data from the Follow-up Care Use among Survivors (FOCUS) Survey, a cross-sectional population-based investigation of the follow-up care experiences among racially and ethnically diverse long-term (i.e., five years or more post-diagnosis) cancer survivors recruited from California NCI SEER registries. Ever and last year use of CAM modalities, as well as reasons for use, were assessed. Multivariable logistic regression models were applied to identify if predisposing, enabling and need for care characteristics described in the CAM Healthcare Model were associated with CAM use in the past year. Results: Long-term cancer survivors in the study (N=1,666) were predominately female (62%) and older (mean age=69.5), with breast (24%), prostate 26(%), colorectal (25%), ovarian (13%) and endometrial cancers (12%). Forty-two percent of survivors used CAM in the past year to relieve stress (28%), treat or prevent cancer from coming back (22%), relieve cancer-related symptoms (18%) and help deal with another medical condition (18%). Certain predisposing (i.e., female gender, higher optimism) and need for care factors (i.e., experienced cancer-related symptoms in the past two years, ever had depression/anxiety) were significantly associated with CAM use (p-values&lt;0.05). Insurance coverage, financial resources, and receipt of cancer-related follow-up care were not associated with CAM use. Conclusions: Cancer survivors report a high prevalence of CAM use even years after their initial diagnosis. It is important for healthcare providers to be aware of the higher prevalence of CAM use among subgroups of cancer survivors (i.e., female, high in optimism, have experienced cancer-related symptoms, have a history of anxiety/depression) in order to communicate effectively about these modalities with their patients.

Prospective assessment of symptom burden among cancer survivors with common solid tumors: Results from ECOG trial E2Z02.

9137 Background: The expansion of the cancer survivor population in the U.S. mandates better understanding of survivors’ symptoms. Methods: A sample of 3106 ambulatory patients diagnosed with invasive cancer of the breast, prostate, colon/rectum or lung were recruited from six academic medical centers and 32 community sites at any point in their disease trajectory. A subgroup of cancer survivors (n = 248, 8%) defined as having non-advanced cancer, not currently receiving treatment, and diagnosed at least 3 years prior to study registration were identified. Participants rated symptom severity on a 0-10 scale for 25 common cancer-related symptoms at study enrollment and 4-5 weeks later. Symptom burden was compared to remaining patients in the sample (n = 2,858). Results: Survivors (n=248) had a median age of 64 years and were predominantly White (76%) and female (75%). Primary cancer site included breast (63%), colorectal (19%), prostate (9%) and lung (8%). Most of the sample had a performance status of 0 (...

Lifestyle behaviors in Massachusetts adult cancer survivors

Adoption of healthy lifestyles in cancer survivors has potential to reduce subsequent adverse health. We sought to determine the prevalence of tobacco use, alcohol use, and physical inactivity among cancer survivors overall and site-specific survivors. We performed a cross-sectional analysis of the Massachusetts Behavioral Risk Factor Surveillance System, 2006-2008, and identified 1,670 survivors and 18,197 controls. Specific cancer sites included prostate, colorectal, female breast, and gynecologic (cervical, ovarian, uterine). Covariates included age, gender, race/ethnicity, education, income, marital status, health insurance, and physical and mental health. Gender stratified logistic regression models associated survivorship with each health behavior. 4.9% of men and 7.7% of women reported a cancer history. In adjusted regression models, male survivors were similar to gender matched controls, while female survivors had comparable tobacco and alcohol use but had more physical inactivity than controls (OR 1.5; 95% CI, 1.2-1.8). By site, breast cancer survivors were more likely to be physically inactive (OR 1.5; 95% CI, 1.1-2.0) and gynecologic cancer survivors were more likely to report current tobacco use (OR 1.8; 95% CI, 1.2-2.8). Specific subgroups of cancer survivors are more likely to engage in unhealthy behaviors. Accurate assessment of who may derive the most benefit will aid public health programs to effectively target limited resources.

Marriage, employment, and health insurance in adult survivors of childhood cancer

Adult survivors of childhood cancer are at risk for disease- and therapy-related morbidity, which can adversely impact marriage and employment status, the ability to obtain health insurance, and access to health care. Our aim was to identify factors associated with survivors' attainment of these outcomes. We surveyed 1,437 childhood cancer survivors who were >18 years old and >10 years past diagnosis. We compared our cohort's data to normative data in the Medical Expenditure Panel Survey and the U.S. Census Bureau's Current Population Surveys. Respondents were stratified by hematologic malignancies, central nervous system tumors, or other solid tumors and by whether they had received radiation therapy. Most respondents were survivors of hematologic malignancies (71%), white (91%), and working full-time (62%); 43% were married. Compared with age- and sex-adjusted national averages, only survivors of hematologic malignancies who received radiation were significantly less likely to be married (44 vs. 52%). Full-time employment among survivors was lower than national norms, except among survivors of hematologic malignancies who had not received radiation therapy. The rates of coverage of health insurance, especially public insurance, were higher in all diagnostic groups than in the general population. While difficulty obtaining health care was rarely reported, current unemployment and a lack of insurance were associated with difficulty in obtaining health care (P < 0.05 and P < 0.001, respectively). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS: Subgroups of cancer survivors do experience long-term differences in functional outcomes that should be addressed early. Survivors who are unmarried, unemployed, and uninsured experience difficulty accessing health care needed to address long-term health concerns.

Breast Cancer Chemotherapy-Related Cognitive Dysfunction

Cognitive side effects of systemic chemotherapy have become an increasing concern among breast cancer survivors, their families, and health care professionals. A growing body of research supports the hypothesis that chemotherapy can produce long-term cognitive changes in at least a subgroup of cancer survivors. We review evidence implicating systemic chemotherapy as the cause of cognitive changes; describe the limitations due to lack of longitudinal studies and gaps in knowledge (ie, no clear mechanism by which chemotherapy can produce cognitive changes has been proposed); discuss possible factors like age, intelligence quotient/education, and psychological, genetic, and hormonal factors that might increase risk for chemotherapy-induced cognitive changes; and outline future directions for research. Such future research includes large-scale, longitudinal studies of pretreatment neuropsychological assessments, use of imaging techniques and the development of animal models to study the mechanisms of chemotherapy-induced changes in cognitive functioning, and the development of interventions to prevent or reduce the negative cognitive effects of chemotherapy.