Health Of Survivors Research Articles

"I wanna know what to expect" - Care needs regarding sexual and reproductive health after cancer in adolescence and young adulthood (AYA) and recommendations for providers.

To assess care needs related to sexual and reproductive health of patients and survivors diagnosed with cancer during adolescence and young adulthood (AYA). Participants (N=190) were predominantly female (87.4%) and diagnosed with cancer between age 12-39 years. Common diagnoses included breast cancer (37.1%) or leukemia/lymphoma (27.2%). Cancer patients/survivors completed an online survey, which assessed care needs regarding sexual health and fertility/reproductive health. They provided written open answers, which were qualitatively analyzed. Care needs related to sexual health varied and included a need for more information about possible effects on sexual health, which will enable patients/survivors to better anticipate (physical and mental) side effects of cancer on sexual health. AYA patients/survivors need support from providers who normalize the topic of sex, who offer guidance in coping with numerous questions, who provide resources and practical tips and tricks, and who refer to specialists if needed. Participants would like providers to initiate conversations and communicate openly and honestly without taboo, bias, or shame. Care needs regarding reproductive health included needing support in navigating reproduction after cancer, while unmet information needs were central. This included needing information about fertility status and assessment options, reproduction/contraceptives, the safety of pregnancies, and the (im)possibility of alternatives to biological parenthood. Communication is key in informing and supporting AYA cancer patients and survivors regarding their sexual and reproductive health. Providers should assess individual patients'/survivors' needs and tailor information that is tangible accordingly. Additional recommendations for healthcare providers are presented.

“It's the Tide of Your Life”: A Qualitative Study on Survivor Awareness and Understanding of Blood and Marrow Transplantation

This paper describes blood and marrow transplantation (BMT) survivors' and carers' knowledge and understanding of BMT and long-term care requirements. Semistructured, online interviews with 22 BMT survivors and 6 carers were used to collect qualitative data. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Findings indicate the diversity of information and education received by survivors, the importance of timing in the delivery of information, and the need to provide education as an ongoing intervention in the long-term care provided. The health, psychological, and functional status of BMT survivors is significantly improved by the provision of better education, understanding, and decision-making around their long-term care. Many survivors lack a good understanding of the BMT process, the late effects of BMT, and the need for and mechanism of long-term follow-up. As the number of BMT survivors increases over time, improvements in how and where education and support are provided need to be addressed to ensure adherence to recommended long-term follow-up requirements. Nurses who work with BMT survivors should continuously reassess survivors' knowledge and understanding of their condition and provide person-centered education and resources to assist learning and treatment adherence throughout the transplant journey. Further research is necessary to explore the validity and processes of consent for BMT and establish the best model of care for long-term follow-up and education.

Diet quality and cardiometabolic health in breast cancer survivors: the Pathways Study.

Breast cancer (BC) survivors experience higher rates of cardiometabolic conditions, partly due to treatment. While healthy eating decreases the risk of these conditions in the general population, its association in BC survivors is unclear. We included 3415 participants from the Pathways Study, a prospective cohort of women diagnosed with invasive BC between 2005 and 2013 and followed through 2021. Concordance of food intakes from food frequency questionnaires was estimated for five healthy eating patterns at BC diagnosis: Dietary Approaches to Stop Hypertension (DASH), healthy Plant-based Dietary Index (hPDI), 2020 Healthy Eating Index (HEI), American Cancer Society nutrition guidelines (ACS), and the alternate Mediterranean Diet Index (aMED). Incident hypertension, diabetes, and dyslipidemia were identified through electronic health records. Cumulative incidence rates (CIRs) were estimated accounting for the competing risk of death. Covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Fine and Gray regression models, stratified by BC treatment status. Over an average 11.5years (range = 0.3-16.3) of follow-up, 554 (16.2%) participants developed hypertension, 362 (10.6%) developed diabetes, and 652 (19.1%) developed dyslipidemia. CIRs for any cardiometabolic condition 15years after BC diagnosis were 39.2% for women in the highest HEI quartile compared to 49.3% in the lowest. After adjustment, women in the highest HEI quartile had lower risks of any cardiometabolic condition (HR = 0.70, 95% CI 0.54-0.91,Ptrend = 0.006), including hypertension (HR = 0.71, 95% CI 0.54-0.94,Ptrend = 0.007), diabetes (HR = 0.57, 95% CI 0.41-0.79,Ptrend < 0.001), and dyslipidemia (HR = 0.77, 95% CI 0.59-0.99,Ptrend = 0.04). Similar associations were observed for DASH, hPDI, and ACS with diabetes incidence. Healthier diets at BC diagnosis, particularly those aligned with the HEI, were associated with lower cardiometabolic risks.

Measuring healthy life expectancy and determinants of poor perceived health: A population-based study among a subset of rare and common cancer survivors.

As the survival proportions for rare cancers are on average worse than for common cancers, assessing the expected remaining life years in good health becomes highly relevant. This study aimed to estimate the healthy life expectancy (HLE) of a subset of rare and common cancer survivors, and to assess the determinants of poor perceived health in rare cancer survivors. To calculate HLE, survival data from the population-based Netherlands Cancer Registry of survivors of a rare cancer (i.e., ovarian cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma) (n=21,376) and a common cancer (i.e., colorectal cancer (CRC)) (n=76,949) were combined with quality of life (QoL) data from the PROFILES registry on a random sample of the rare (n=1025) and common cancer (n=2400) survivors. A flexible parametric relative survival model was used to estimate life expectancy (LE) and years of life lost, and multivariate logistic regression was applied to determine factors related to reported poor perceived health. Patients previously diagnosed with a rare cancer had an average LE of 8-36 years and were expected to spend ≥67 % of their remaining life in good health. CRC survivors had an average LE of 10 years with approximately 65 % of their remaining life expected to spend in good health. For all cancer types, those aged ≥65 years or with stage IV had the lowest HLE. Low socioeconomic status, advanced stage, and having received radiotherapy only were important predictors of poor perceived health among rare cancer survivors. HLE can provide meaningful perspective for patients and practitioners for all cancer types, including rare cancers. Yet, data on QoL for rare cancers should be routinely collected, as such will serve as an indicator for monitoring and improving cancer care, and for enabling HLE measurements in cancer survivors.

The long-run and intergenerational impact of early exposure to the Great Chinese Famine of 1959-61 on mental health.

We study the effects of early exposure to the Great Chinese Famine on the mental health and subjective well-being of survivors as well as their offspring using data from the 2010 and 2014 waves of the China Family Panel Studies. Our analysis focuses on K6 scores, severe mental illness, and life dissatisfaction. We find that early exposure to the famine has impaired the mental health outcomes of women, but not men (i.e., the first generation). For the second generation, negative effects only show up among the sons of male famine survivors. Some preliminary evidence suggests that the mechanism for such transmission may have to do with the cultural son preference.

Taking care of women living with female genital mutilation or cutting: Characteristics of the pool of users of two healthcare facilities in Turin, Northern Italy.

Female genital mutilation (FGM) is a form of gender-based violence (GBV) that may lead to adverse consequences on the physical and psychological health of survivors. Patients living with FGM have unique health needs, which have to be addressed from the perspective of human rights and sexual and reproductive health. The aim of this study was to understand the characteristics of the pool of users of two services targeting this population in Turin, given the significance this may have due to the high migratory flows from countries were FGM is performed. A retrospective review of medical records of patients who accessed FGM-C related care in two healthcare facilities in Turin was performed. The most represented type of FGM was IIb. All patients were of African origin. Many presented psychological sequelae, while a smaller group presented uro-gynaecological symptoms. A high number of survivors were subjected to other forms of GBV during their lifetime. These findings highlight the need for an integrated and multidisciplinary service for the management of survivors of FGM.

Effect of Physical Activity on Physical and Mental Health in Young Cancer Patients and Survivors: A Systematic Review of RCTs and CCTs

Introduction Young cancer patients (YCP) face high risks of acute and long-term physical and mental health effects resulting from their malignancy and its treatment (Benzing et al., 2022; Siegwart et al., 2020). Physical activity (PA) is increasingly recognized as a strategy to address physical, mental, cognitive, and social challenges faced by YCP and survivors (Braam et al., 2016). This systematic review aimed to summarize findings from randomized controlled trials (RCTs) and clinical control trials (CCTs) evaluating the impact of PA interventions on physical and mental health outcomes in YCP and survivors. Methods A systematic search was conducted in APA PsycINFO, PubMed, SPORTDiscus, Web of Science, Embase, and Scopus. We examined RCTs and CCTs investigating PA interventions in children and adolescents with cancer, during or after treatment, that reported outcomes related to physical or mental health and/or quality of life. Two authors independently screened studies for inclusion, extracted data, and assessed the risk of bias. Results Of 1,164 articles screened, 32 RCTs and CCTs met eligibility criteria, involving 1,315 participants aged 4–19 years. Studies included inpatients (18), survivors (11), or both (2). Chronic PA interventions, such as aerobic, resistance, or combined motor-cognitive training, were implemented. All studies reported physical health outcomes, primarily focusing on cardiorespiratory fitness, muscle strength, and fatigue, while 18 studies assessed psychological outcomes, including depression and quality of life. Four studies objectively evaluated cognitive functions. Benefits were most frequently observed (&gt;50%) for strength, fatigue, and self-efficacy, with no negative effects reported. Discussion/Conclusion Despite variability in session durations and intervention lengths, this review highlights the broad benefits of PA for YCP and survivors, with no indication of negative effects. Most studies have focused on physical and mental health outcomes (Braam et al., 2016), with limited attention to cognitive performance and motor ability, despite the high risk of cognitive late effects in this population (Krull et al., 2018). High-quality RCTs are needed to better understand the role of PA in motor and cognitive development among YCP and survivors. References Benzing, V., Siegwart, V., Spitzhüttl, J., Schmid, J., Grotzer, M., Roebers, C. M., Steinlin, M., Leibundgut, K., Everts, R., &amp; Schmidt, M. (2021). Motor ability, physical self‐concept and health‐related quality of life in pediatric cancer survivors. Cancer Medicine, 10, 1860–1871. https://doi.org/10.1002/cam4.3750 Braam, K. I., van der Torre, P., Takken, T., Veening, M. A., van Dulmen‐den Broeder, E., &amp; Kaspers, G. J. L. (2016). Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews, 3, CD008796. https://doi.org/10.1002/14651858.CD008796.pub3 Krull, K. R., Hardy, K. K., Kahalley, L. S., Schuitema, I., &amp; Kesler, S. R. (2018). Neurocognitive outcomes and interventions in long-term survivors of childhood cancer. Journal of Clinical Oncology, 36(21), 2181-2189. https://doi.org/10.1200/jco.2017.76.4696 Siegwart, V., Benzing, V., Spitzhuettl, J., Schmidt, M., Grotzer, M., Steinlin, M., Leibundgut, K., Roebers, C., &amp; Everts, R. (2020). Cognition, psychosocial functioning, and health-related quality of life among childhood cancer survivors. Neuropsychological Rehabilitation, 32 (6), 922–945. https://doi.org/10.1080/09602011.2020.1844243

The association of perceived health status and presence of chronic conditions with physical activity in childhood cancer survivors.

Childhood cancer survivors (CCS) are at risk for therapy-related late effects. Physical activity (PA)can minimize some late effects risk, but rates of PA are low in CCS. We aimed to determine how perception of survivor health status and presence of chronic conditions are associated with patient- or proxy-reported PA. This cross-sectional, retrospective study of CCS (6-25years; ≥ 1year off-therapy) defined low PA as < 5days per week with ≥ 60minutes/day of patient- or proxy-reported activity. Participants completed PROMIS Global Health questions assessing perceptions of overall, physical, and mental health. Presence of chronic conditions was abstracted from the health record and defined as ≥ 2 late effects. Multivariable logistic regressions were performed to identify associations between physical activity and health status or chronic conditions. Of 284 CCS, 71.8% reported low PA. Negative perceived overall, physical, and mental health status were present in 5.6%, 10.6%, and 15.9% of CCS, respectively, with presence of chronic conditions in 49.7%. Low PA was directly associated with female sex (p = 0.002) and poor physical (p = 0.01) and mental (p = 0.02) health status, and inversely associated with relapsed/refractory disease (p = 0.03). Presence of chronic conditions was not associated with low PA (p = 0.68); however, all CCS with chronic graft-versus-host disease or vision impairment had low PA. Low PA is an issue for CCS, especially females, and is associated with negative perceived physical and mental health. Future PA interventions for CCS should address perceived physical and mental health, and focus on specific at-risk sub-groups.

Reimagining Support After Sexual Violence: Survivors’ Recommendations for Community-Based Support Organizations

Sexual violence (SV) is a public health crisis that disproportionately impacts minoritized communities. SV is prominently associated with post-traumatic stress disorder (PTSD) and related health outcomes. Access to early psychosocial intervention may be effective for reducing the long-term health consequences. Community-based organizations (CBOs) are uniquely positioned to address the immediate health and support needs of survivors of SV. However, significant barriers exist to CBO service engagement. Engaging individuals with lived experience offers unique insight to improving access and experiences with CBOs. In this qualitative descriptive study, semi-structured interviews were conducted with survivors of SV (n = 20) to understand their experiences with CBOs to develop recommendations for improving support services. Interviews were analyzed using reflexive thematic analysis methods. Results fell into three themes encompassing prominent and salient ideas shared across and within interviews: Survivor-Centered Services, emphasizing the importance of centering survivor autonomy in services; Expanded Organizational Outreach, discussing how CBOs may meaningfully increase trust and engagement; and Enhanced Organizational Service Offerings, illustrating needs related to finances and housing, among other social determinants. Findings emphasized the importance of CBOs in promoting the health and wellbeing of SV survivors and highlighted opportunities for improvement related to access to, and quality of, support services offered.

The effects of regular exercise on cognitive and cardiometabolic health in testicular cancer survivors subjected to platinum-based chemotherapy.

Platinum-based chemotherapy provides curative treatment to more than 95% of patients with testicular germ cell tumor but it has negative cardiometabolic and neurological effects. Regular exercise can alleviate late chemotherapy-related toxicities. We examined the impact of a 6-month supervised aerobic-strength training on cognitive and cardiometabolic health and residual level of platinum in cancer survivors. Twenty-eight middle-aged (42.1±7.6 years) testicular germ cell tumor survivors subjected to platinum-based chemotherapy (1-8 cycles, 0-24 years ago) were recruited into exercise (n=20) and control (n=8) groups. Effects of 6-month exercise training on the whole-body and muscle metabolism, cognitive functions, cardiopulmonary fitness, residual plasma platinum, and plasma adiponectin were examined. Exercise intervention improved cardiopulmonary fitness and cognitive functions, reduced residual plasma platinum, visceral adiposity and muscle lipids, improved glucose (glycosylated hemoglobin) and lipid (high-density lipoprotein cholesterol) metabolism, and enhanced dynamics of muscle post-exercise phosphocreatine recovery. Exercise-related decline in plasma platinum was paralleled by decline of muscle glycerophosphocholines and by the enhanced metabolic flexibility during low-intensity exercise, and predicted training-induced increase in cognitive functions. The 6-month exercise intervention resulted in improved cognitive and cardiometabolic health in testicular germ cell tumor survivors, which was paralleled by reduced plasma platinum, providing evidence that structured supervised exercise brings multiple health benefits to testicular germ cell tumor survivors.

Metabolic Sequelae and Quality of Life in Early Post-Treatment Period in Adolescents with Hodgkin Lymphoma.

Background/Objectives: The long-term consequences of intensive treatment for Hodgkin lymphoma (HL), including metabolic syndrome (MetS) and cardiovascular diseases, but also deteriorated quality of life (QoL), are present in many survivors of childhood HL. Methods: Adolescents and young adults diagnosed with HL who continued the follow-up after successful treatment for HL were included. Anthropometric parameters, body composition, laboratory data, blood pressure values, compliance to the Mediterranean diet (MD), QoL and lifestyle habits were evaluated at the follow-up. Available data were also extracted retrospectively at the time of diagnosis. The primary objective was to determine metabolic sequelae in the early post-treatment period in adolescents treated for HL. Additionally, QoL and compliance with MD were explored, and the correlation of MetS with QoL was investigated. Results: Sixty percent of patients had at least one risk factor for metabolic syndrome, with obesity/abdominal obesity, high blood pressure and low HDL being most commonly observed, present in 66.7%, 44.4% and 44.4% of patients, respectively. The number of obese patients increased from 6.3% at the diagnosis to 31.3% at the follow-up. The majority of patients (53.3%) had low adherence to the MD. Participants had comparable quality-of-life domains to those of the healthy population at the follow-up. The physical health domain of QoL was positively correlated with compliance to the MD in young adults (r = 0.8, p = 0.032) and negatively correlated with obesity/overweight in adolescents (r = -0.85, p = 0.008). Conclusions: Healthy lifestyle choices can impact not only the metabolic health of survivors but also their quality of life, and therefore should be encouraged in these patients.

Hormonal Implications of SARS-CoV-2: A Review of Endocrine Disruptions.

To improve medical care and rehabilitation algorithms for patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is important to evaluate and summarize the available data on the effect of coronavirus infection (COVID-19) on the endocrine system. The purpose of this review was to study the effect of COVID-19 on the endocrine system. The scientific novelty of this study is the evaluation of the effect of coronavirus infection on the endocrine system and the potential effect of hormones on susceptibility to COVID-19. The results of this review show that the endocrine system is vulnerable to disorders caused by COVID-19, mainly thyroid dysfunction and hyperglycemia. The information in the published literature mentioned here contains some unclear aspects and contradictory data, but much remains to be studied and clarified regarding the impact of COVID-19 on the endocrine system. In particular, this concerns the study of the hyperglycemic status of patients who have had coronavirus infection, which is extremely important for the future metabolic health of COVID-19 survivors. This review contributes to the scientific discourse by systematically synthesizing disparate studies to identify patterns, gaps, and emerging trends in the literature concerning the effects of COVID-19 on the endocrine system. By integrating these findings, this study offers a novel perspective on potential hormonal interactions influencing COVID-19 susceptibility and outcomes, proposing new hypotheses and frameworks for future research.

Analyzing Secondary Cancer Risk: A Machine Learning Approach.

Addressing the rising cancer rates through timely diagnosis and treatment is crucial. Additionally, cancer survivors need to understand the potential risk of developing secondary cancer (SC), which can be influenced by several factors including treatment modalities, lifestyle choices, and habits such as smoking and alcohol consumption. This study aims to establish a novel relationship using linear regression models between dose and the risk of SC, comparing different prediction methods for lung, colon, and breast cancer. Machine learning (ML) models have demonstrated their usefulness in forecasting the likelihood of SC risks based on effective doses in the organ. Linear regression analysis is a widely utilized technique for examining the relationship between predictor variables and continuous responses, particularly in scenarios with limited sample sizes. This study employs linear regression models to analyze the relationship between effective dose and the risk of SC, comparing different prediction methods across lung, colon, and breast cancer. The results indicate that the risk of SC increases with the effective dose in the organ. The linear regression model provides coefficients that mirror the radiation sensitivity of the specific organ, demonstrating the model's effectiveness in predicting SC risk based on dose. The study highlights the significance of using linear regression models to predict the risk of SC based on effective doses in the organ. The findings underscore the importance of considering the radiation sensitivity of specific organs in SC risk prediction, which can aid in better understanding and managing the long-term health of cancer survivors.

Trajectories and Influencing Factors of Post-Traumatic Stress in Disaster-Affected People According to Their Income Level: A Longitudinal Study in South Korea.

Disasters often have long-lasting effects on the mental health of people affected by them. This study aimed to examine the trajectories and predictors of mental health in people affected by disasters according to their income level. This study used data from the "Long-Term Survey on the Change of Life of Disaster Victim" conducted by the National Disaster Management Research Institute. Latent growth curve modeling and multigroup analysis were employed on 699 participants. Individuals in the low-income class had a higher post-traumatic stress (PTS) intercept than those in the middle-high-income class. The PTS intercept was increased by unmet health care needs and financial hardship caused by disasters and was decreased by health care support. Social support, which was low in the low-income class, did not affect their PTS level; however, it lowered the PTS intercept in the middle-high-income class. These results suggest that it is important to address the mental health of disaster survivors by providing sufficient disaster relief services and compensation to ensure that disasters do not further exacerbate social inequalities. It is also crucial to provide emotional, informational, and material support using local community resources for those who have less or no access to in-person social networks.

Frailty in Long-Term Prostate Cancer Survivors and Its Association With Quality of Life and Emotional Health.

Frailty is emerging as an important determinant for quality of life (QoL) and emotional health in older patients with cancer, and specifically in long-term prostate cancer survivors, but quantitative studies are lacking. The current study assesses the prevalence of frailty and its association with QoL and emotional health in long-term prostate cancer survivors after radical prostatectomy. A total of 2,979 prostate cancer survivors from the multicenter German Familial Prostate Cancer cohort completed questionnaires on frailty (Groningen Frailty Indicator [GFI]), QoL (EORTC QoL Questionnaire-Core 30), and emotional health (anxiety/depression symptoms via the Patient Health Questionnaire-4). Modified Poisson regression analysis was used to assess factors associated with frailty. Average patient age was 79.4 years [SD, 6.4 years] and average time since radical prostatectomy was 17.4 years [SD, 3.8 years]. Among the cohort, 33.1% (n=985) of patients were classified as frail (GFI ≥4). Frail patients reported worse emotional health than nonfrail patients (depression symptoms: 24.0% vs 4.0%; anxiety symptoms: 20.6% vs 2.0%; both P<.001) and lower QoL (mean [SD], 53.4 [19.2] vs 72.7 [16.0]); P<.001). Higher age (relative risk [RR], 1.02; 95% CI, 1.01-1.03) and worse depressive (RR, 1.18; 95% CI, 1.12-1.24) and anxiety symptoms (RR, 1.17; 95% CI, 1.11-1.23) were associated with frailty. Living in a partnership (RR, 0.76; 95% CI, 0.67-0.86) and a higher QoL (RR, 0.86 for a 10-point increase; 95% CI, 0.84-0.89) were associated with nonfrailty. In a large German cohort, every third long-term prostate cancer survivor after radical prostatectomy was frail. The association of frailty with lower QoL and poorer mental health indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes targeted to frail patients.

The genomic and clinical consequences of replacing procarbazine with dacarbazine in escalated BEACOPP for Hodgkin lymphoma: a retrospective, observational study.

Procarbazine-containing chemotherapy regimens are associated with cytopenias and infertility, suggesting stem-cell toxicity. When treating Hodgkin lymphoma, procarbazine in escalated-dose bleomycin-etoposide-doxorubicin-cyclophosphamide-vincristine-procarbazine-prednisolone (eBEACOPP) is increasingly replaced with dacarbazine (eBEACOPDac) to reduce toxicity. We aimed to investigate the impact of this drug substitution on the mutation burden in stem cells, patient survival, and toxicity. In this two-part retrospective, observational study, we first compared mutational landscapes in haematopoietic stem and progenitor cells (HSPCs) from patients with advanced-stage Hodgkin lymphoma in remission for at least 6 months who had been treated with eBEACOPDac (eBEACOPDac cohort), eBEACOPP (real-world eBEACOPP cohort), or doxorubicin-bleomycin-vinblastine-dacarbazine (ABVD); in buccal DNA from five children of a female patient with classical Hodgkin lymphoma treated with eBEACOPP before conceiving the third child; in sperm DNA from a patient with mild oligospermia treated with eBEACOPP; and in caecal adenocarcinoma and healthy colon tissue from a survivor of Hodgkin lymphoma treated with chlorambucil-vinblastine-procarbazine-prednisolone. For the second part, we analysed efficacy and toxicity data from adult patients (aged >16 years) treated with first-line eBEACOPDac (eBEACOPDac cohort) at 25 centres across UK, Ireland, and France; efficacy was compared with the German HD18 eBEACOPP trial data and toxicity with a UK real-world dataset. Participants in the German HD18 and UK real-world datasets were adults (aged >16 years) with previously untreated Hodgkin lymphoma, treated with first-line eBEACOPP. We had two co-primary objectives: to define the comparative stem-cell mutation burden and mutational signatures after treatment with or without procarbazine-containing chemotherapy (first study part); and to determine progression-free survival of patients with Hodgkin lymphoma treated with eBEACOPP or eBEACOPDac (second study part). Secondary objectives included overall survival and explored differences in specific toxicity outcomes, including transfusion requirements and measures of reproductive health (second study part). In the first part of the study (mutational analysis), patients treated with eBEACOPP (n=5) exhibited a higher burden of point mutations in HSPCs compared with those treated with eBEACOPDac (n=4) or ABVD (n=3; excess mutations 1150 [95% CI 934-1366] vs 290 [241-339] vs 186 [116-254]). Two novel mutational signatures, SBSA (SBS25-like) and SBSB, were identified in HSPCs and in a single neoplastic and healthy colon sample from patients who received procarbazine-containing chemotherapy. SBSB was also identified in germline DNA of three children conceived after eBEACOPP and in sperm of a male patient treated with eBEACOPP. SBSC was detected in patients treated with either ABVD or eBEACOPDac. In the second part of the study (efficacy and toxicity analysis), dacarbazine substitution did not appear to compromise efficacy or safety. 312 patients treated with eBEACOPDac (eBEACOPDac cohort; treated 2017-22, 186 [60%] male, median follow-up 36·0 months [IQR 25·2-50·1]) had a 3-year progression-free survival of 93·3% (95% CI 90·3-96·4), which was similar to the 93·3% [95% CI 92·1-94·4]) progression-free survival seen in 1945 patients in the German HD18 eBEACOPP trial (treated 2008-14, 1183 [61%] male, median follow-up 57·0 months [35·4-64·7]). Patients treated with eBEACOPDac required fewer blood transfusions (mean 1·70 units [SD 2·77] vs 3·69 units [3·89]; p<0·0001), demonstrated higher post-chemotherapy sperm concentrations (median 23·4 million per mL [IQR 11·0-632·3] vs 0·0 million per mL [0·0-0·001]; p=0·0040), and had earlier resumption of menstrual periods (mean 5·04 months [SD 3·07] vs 8·77 months [5·57]; p=0·0036) compared with 73 patients treated with eBEACOPP in the UK real-world dataset. Procarbazine induces a higher mutation burden and novel mutational signatures in patients with Hodgkin lymphoma treated with eBEACOPP and their germline DNA, raising concerns for the genomic health of survivors of Hodgkin lymphoma and hereditary consequences for their offspring. However, replacing procarbazine with dacarbazine appears to mitigate gonadal and stem-cell toxicity while maintaining similar clinical efficacy. Addenbrooke's Charitable Trust and Wellcome Trust.

Physical Activity and Quality of Life After Distal Femur Tumor Resection and Limb Salvage.

Background/Objectives: Distal femur tumor resection with limb salvage is a demanding procedure that offers hope for patients by preserving the limb rather than opting for amputation. While limb salvage can improve both physical function and psychological well-being, there's limited knowledge on how active patients remain afterward and how their Quality of Life (QoL) is affected, especially regarding physical activities and sports. This study investigates the quality of life of the patients through the development of motor activity, focusing on both physical and sporting activity of the above-mentioned individuals and their physical abilities to participate in activities of daily and sporting life after surgery. Methods: This study involved 16 patients aged 19-47 years who had undergone surgical resection and replacement of the distal femur for the treatment of sarcoma and were selected by random sampling from a total of 72 patients who had undergone a similar procedure. To explore the topic in depth, the researchers followed the triangulation method. From July 2023 to February 2024, we used surveys and interviews to explore their physical activity (PA) levels, sports participation, and QoL. This study included the International Physical Activity (PA) Questionnaire (IPAQ), the University of California and Los Angeles (UCLA) Activity Score, and semi-structured interviews. The data were analyzed using the statistical software packages SPSS 25 and Excel. Results: Most participants reported moderate to high levels of PA, according to IPAQ, and continued engaging in sports, with swimming, walking, and stair climbing being the most common activities. No significant relationship was found between their PA levels and factors such as age, BMI, or the side of the affected limb. Interviews showed that patients' motivation and their surgeon's guidance played key roles in their return to regular activities, though many exercised less frequently or intensely than recommended. Conclusions: Patients who undergo limb salvage surgery following distal femur tumor removal generally maintain a good level of physical activity, which supports their QoL. Encouraging these patients to stay active and even engage in sports appears feasible, especially when guided by medical professionals. These findings highlight the potential benefits of tailored rehab programs to improve long-term health and QoL in sarcoma survivors, although larger studies are needed for more comprehensive insights.

BIOMARKERS OF HEALTH AND AGING IN A COHORT OF VIETNAMESE ADULTS AGED 60 AND OLDER

Abstract War and traumatic events have negative health impacts across the life course, and most wars are situated in lower- and middle-income countries, where many survivors are now or will soon be entering old age. To date, however, most aging research has focused on health effects in high-income countries, neglecting the burdens of war exposure for the broader global population. The Vietnam Health and Aging Study (VHAS), a longitudinal study of 2,447 individuals aged 60+, investigates how stress and trauma experienced during the American War impacts health and aging of Vietnamese survivors. Using biomarker and anthropometric data collected in 2021-2022, we examined associations of recruitment characteristics (age, sex, district, military participation) with select cardiometabolic and inflammatory biomarkers (e.g., C-reactive protein [CRP], Interleukin-6 [IL-6]). Preliminary analyses revealed variation in associations of key demographic and outcome measures. Hypertensive risks were significantly higher for males, and overweight/obesity (OW/OB) risk significantly higher for females, whereas age was positively associated with hypertensive risk and inversely associated with OW/OB risk. Hypertensive risk was lower for those with formal military experience, while proinflammatory markers (i.e., CRP, IL-6) increased with age but did not vary by sex or military participation. District residence, which reflects differences in bombing intensity during the war, showed varied associations with inflammatory and cardiometabolic biomarkers. These findings suggest inflammatory and cardiometabolic risks are not uniformly coupled across participants in this study, underscoring the complexities of how prior war trauma interacts with other factors to influence health and well-being during aging.

Economic Impacts of Technology-Facilitated Abuse Among U.S. Young Adults.

Technology-facilitated abuse (TFA) can result in long-term financial and mental health impacts on survivors. However, little research has been published to date about the types of costs and the economic burden that survivors of TFA experience. This study presents results from a U.S. nationally representative sample of young adults aged 18 to 35 on financial cost experienced as a result of TFA, including findings of healthcare utilization and associated healthcare costs. Respondents who reported experiencing one or more forms of TFA were asked about the lifetime health and economic impacts of the TFA. Nearly one in five TFA survivors (18.2%) reported experiencing an economic cost from the TFA, with a median total cost of $900 USD. There was a significant difference in the likelihood of reporting a financial cost among TFA survivors by race/ethnicity, TFA exposure, average use of online sites/apps, and the number of sites/apps used. Financial fraud, technology, and housing costs were the most common types of cost reported. More than 1 in 10 survivors (11.3%) reported receiving mental health counseling related to the TFA, with a per-person total cost estimate of $6,228 USD from mental health counseling. A similar proportion (11.6%) of TFA survivors reported taking one or more prescribed medications to manage the impact of the TFA, with an average duration of 37.4 weeks of use. Older age, identifying as non-Hispanic Black/African American or Hispanic/Latino/a/x, identifying as a sexual or gender minority, and greater TFA severity were associated with higher financial cost reported. Findings present novel information on the economic and psychological harms associated with TFA and indicate the importance of access to mental health and financial support services for TFA survivors.

Systematic Review and Meta-Analysis of Female Reproductive Health Following Ebola Virus Disease.

The viral hemorrhagic fevers Lassa fever (LF) and Ebola virus disease (EVD) have been documented to cause long-term health problems in survivors. Limited studies have noted the presence of adverse reproductive health outcomes, including menstrual irregularities and pregnancy loss, after recovery from infection. The objective of this systematic review and meta-analysis is to summarize existing knowledge surrounding reproductive health in female survivors of LF and EVD. Literature was gathered from PubMed, Embase, Ovid Medline, Cumulative Index of Nursing and Allied Health (CINAHL) Complete, Web of Science, and Global Health databases and subsequently reviewed in Covidence. Included studies described at least one reproductive health outcome in women after recovery from EVD or LF. Thirteen studies were identified in the systematic review, all of which only discussed reproductive health in EVD survivors. No studies of reproductive health among survivors of LF were identified. The included studies were conducted in Guinea, Sierra Leone, and Liberia, and they reported irregular menstruation, pregnancy loss, decreased libido, pelvic inflammatory disease, sexual dysfunction, female reproductive odor, and genital problems/infections among survivors. In a meta-analysis of nine studies, 14.0% of female EVD survivors experienced any adverse reproductive health outcome. However, there was significant heterogeneity among the included studies. This study highlights the health problems faced by female EVD survivors and underscores the need for more research surrounding the effects of viral hemorrhagic fevers on women's health.