Gynecologic Cancer Survivors Research Articles

Stakeholder-informed refinement of a behavioral sleep/circadian intervention for gynecologic cancer survivors: an application of the MOST preparation phase.

Sleep disturbance is among the most frequent and distressing symptoms reported by gynecologic cancer survivors. Existing evidence-based behavioral sleep interventions are limited by implementation burden, which can decrease adherence. As part of the preparation phase of the multiphase optimization strategy (MOST), this study solicited stakeholder feedback to maximize adherence in a planned behavioral sleep/circadian intervention optimization trial. Thirteen post-treatment survivors of early-stage gynecologic cancer completed the protocol for the planned optimization trial, including simultaneous receipt of all candidate intervention components. This included six weeks of combined sleep restriction, stimulus control, and systematic exposure to morning bright light. Participants then completed a semi-structured interview to provide feedback on their experience. We used a rapid analytic approach to quickly identify actionable feedback from de-identified transcripts. Participants generally reacted positively to the intervention components. Actionable feedback identified recommended protocol modifications and was categorized into four overarching themes: (i) remove barriers to engagement; (ii) revise for clarity; (iii) augment content; and (iv) consider individual circumstances. Rapid qualitative analysis enabled us to effectively modify our planned study protocol on an expedited timeline. This approach is consistent with the core principles of MOST and can be incorporated into the Preparation phase to enhance optimization efforts.

Lower extremity lymphedema in patients with gynecologic cancer: Validation of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) in German language and investigation of lymphedema real-world treatment

Abstract Purpose The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) is an established patient-reported outcome measure for lower extremity lymphedema (LEL) in gynecologic oncology. We aimed to validate the GCLQ in German language (GCLQ-GER) for lymphedema detection in German-speaking patients and also investigated real-world patterns of lymphedema treatment. Methods The GCLQ was translated from English into German in accordance with the standards of a professional translation process. Subsequently, the questionnaire was administered in a prospective observational study including 102 patients who had undergone lymph node dissection (LND) within gynecologic cancer surgery. Various test quality criteria were calculated for the GCLQ-GER. As gold standard of testing methods, patients were clinically evaluated for LEL, and limb volume measurements were taken. Further data for lymphedema treatment were collected in patients with lymphedema diagnosis. Results Patients with LEL had increased GCLQ-GER total scores (mean 7.27) compared to patients without LEL (mean 1.81), p < 0.001. High diagnostic accuracy was indicated by the large area under the receiver operating characteristics curve (AUC) of 0.874 (95% CI 0.802–0.946). Based on sensitivity and specificity values ≥ 79.0%, the GCLQ total score ≥ 4 was determined as the optimal cut-off value to identify LEL. Excellent internal consistency was demonstrated by Cronbach’s alpha of 0.876. The clinical examination revealed a LEL prevalence of 48.0% (n = 49), and 85.7% (n = 42) of these patients received treatment. Conclusion The GCLQ-GER is a valid and feasible patient-reported outcome measure for lymphedema detection in German-speaking gynecologic cancer survivors. Its clinical introduction could improve secondary prevention of lymphedema and real-world treatment.

FoRSHE-X digital health intervention to improve the quality of life during chemotherapy among gynecological cancer survivors in Indonesia: A protocol for a pilot and feasibility study.

Most Indonesian gynecological cancer survivors have unmet supportive care needs during chemotherapy, which may lower their quality of life and discontinue the treatment. Digital health intervention can address this issue. This pilot investigation aims to (1) examine the feasibility and acceptability of a Fighting on distRess, Self-efficacy, Health Effects, and seXual issues (FoRSHE-X) intervention and (2) evaluate prospectively the impact of the study implementation on the level of distress, self-efficacy, side effects' knowledge and management, and sexual quality of life using the RE-AIM (Reach Effectiveness, Adoption, Implementation, and Maintenance) framework. This is a non-randomized mixed-methods pilot study. We will recruit women diagnosed with gynecological cancer undergoing chemotherapy to participate in the FoRSHE-X intervention consisting of ten weeks of social media-based education and telecoaching. We will evaluate the primary outcomes of study feasibility and acceptability, and the secondary outcomes of study impacts at three time points with quantitative and qualitative inquiries. We anticipate a minimum of 30 participants to enroll in the study and complete the assessment. We will disseminate results through conferences and peer-reviewed scientific journals. This study will imply whether a definitive trial to evaluate the potential benefits of the FoRSHE-X is viable and how it should proceed. The protocol can aid researchers or nurses in implementing this approach in their study or practice. Trial registration: Clinical trial registration number: ISRCTN13311651.

Eliminating Digestive Irregularities Caused by Late Effects: A Pilot Study of an Innovative Culinary Nutrition Intervention for Reducing Gastrointestinal Toxicity in Gynecologic Cancer Patients Who Have Undergone Pelvic Radiotherapy.

Pelvic radiotherapy (RT) improves survival in gynecologic cancer patients but often results in gastrointestinal (GI) toxicity, affecting quality of life. Standard nutrition guidance lacks specificity for these survivors, complicating dietary choices. To address this gap, the EDIBLE intervention was developed to offer structured dietary self-management skills to alleviate RT-induced GI toxicity. We conducted a single-arm mixed-methods pilot of the EDIBLE intervention among post-treatment gynecologic cancer survivors to assess its feasibility, acceptability, and preliminary effects on GI symptoms, knowledge, and self-efficacy, with measures at baseline (T1), post-intervention (T2), and after 3 months (T3). Qualitative interviews supported strong perceptions of intervention feasibility; however, the recruitment (32%) and retention (72%) rates were modest, indicating that alternate formats for program delivery may be needed to make it more accessible. The acceptability of the EDIBLE intervention garnered especially high ratings on measures of satisfaction and utility, with program improvements largely rallying around a desire for increased in-class sessions and program expansion. Statistically significant improvements were observed at the three-month mark (T3), such as enhanced confidence in culinary practices, increased knowledge and skills with regard to managing GI side effects, and improvements in bowel and GI symptoms. The results suggest EDIBLE is acceptable, improving GI symptoms and self-efficacy; however, moderate recruitment rates indicate refinement is needed. A randomized control trial and cost-effectiveness analysis is needed to confirm effectiveness and scalability.

Barriers to prescription of hormonal contraception and hormone replacement therapy in gynecological cancer survivors: Results of a survey and literature review.

The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions. To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions. A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes. 185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6 %) and 34 oncology gynecologists (18.4 %). Of these, 49.7 % and 55.1 % had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (p < 0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes. The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.

Treatment of Genitourinary Syndrome of Menopause in Breast Cancer and Gynecologic Cancer Survivors: Retrospective Analysis of Efficacy and Safety of Vaginal Estriol, Vaginal Dehydroepiandrosterone and Ospemifene.

To compare the efficacy and safety of three different treatment options (vaginal estriol, vaginal dehydroepiandrosterone (DHEA), and ospemifene) for treating genitourinary syndrome of menopause (GSM) in breast cancer and gynecologic cancer survivors. A retrospective comparative analysis was performed among 185 cancer survivors (including breast, endometrial, ovarian, cervical, and vulvar cancer) affected by GSM. Women were divided into three groups according to the prescribed therapy (vaginal estriol, vaginal DHEA, and ospemifene). Safety and efficacy of therapies were assessed over a 6-month follow-up. Improvement in symptoms was compared using the following questionnaires: Female Sexual Function Index, Female Sexual Distress Scale, Visual Analogue Scale (VAS)-dyspareunia, VAS-vulvar pain, Short Form (36) Health Survey, and Patients' Impression of Global Improvement. Cancer recurrence was evaluated according to oncological protocol. After the 6-month follow-up, no significant endometrial thickening or cancer recurrence was observed in any group. The rate of sexually active women significantly increased in all groups, as well as the frequency of sexual intercourse. Scores on questionnaires assessing women's sexual function significantly improved in all patients. Women also complained of less vulvar pain and dyspareunia. Safety and efficacy of treatment were comparable between the three groups for all items except for dyspareunia. Patients taking ospemifene complained of less dyspareunia than those receiving local hormone treatment. Vaginal estriol, vaginal DHEA, and ospemifene were effective in improving symptoms of GSM in cancer survivors and were not associated with cancer recurrence over the 6-month follow-up. Ospemifene was more effective than local hormones in treating dyspareunia.

Scanxiety and Fear of Recurrence in Young Adult Female Breast and Gynaecological Cancer Survivors: Investigating Shared Mechanisms.

Adolescent and young adult (AYA) females are vulnerable to psychological sequelae following cancer diagnosis and treatment. Fear of cancer recurrence (FCR) is well-documented in cancer survivors, however AYA survivors of breast and gynaecological cancers are less well-studied. Moreover, little is known about scan-related fears and anxiety ('scanxiety') in survivors of any agegroup. This study aimed to assess demographic, medical, and quality-of-life correlates of FCR and scanxiety in AYA female breast and gynaecological cancer survivors post-treatment. Additionally, we explored potential shared mechanisms of FCR and scanxiety, including intolerance of uncertainty, bodily threat monitoring, and perceived stress. AYA breast and gynaecological cancer survivors (N=115) completed measures of FCR, scanxiety, intolerance of uncertainty, bodily threat monitoring, perceived stress, and quality of life. Bivariate associations and a structural equation model explored relationships between these variables. Both FCR and scanxiety were prevalent, with 84% reporting clinically meaningful FCR and 38% reporting severe FCR. Higher FCR and scanxiety were both associated with poorer quality of life. FCR and scanxiety were moderately associated but not entirely overlapping. Intolerance of uncertainty, bodily threat monitoring, and perceived stress were significantly correlated with both FCR and scanxiety. The structural equation model indicated that bodily threat monitoring is a plausible intermediate variable linking intolerance of uncertainty and FCR, but not scanxiety. FCR and scanxiety are common in AYA survivors of breast and gynaecological cancers, with potentially distinct underlying mechanisms. Interventions targeting intolerance of uncertainty and bodily threat monitoring may reduce FCR, while further research is needed to identify therapeutic targets for scanxiety.

A physical therapy program to treat late-effect vaginal stenosis in gynecological cancer survivors: An interventional study.

To evaluate the effect of a physical therapy program on vaginal length and diameter, pelvic floor strength, and quality of life among gynecological cancer survivors suffering from late-effect vaginal stenosis. Thirty-four women who were previously diagnosed with gynecological cancer and experiencing vaginal stenosis, at least 12months post-oncological treatment, were enrolled. The intervention program consisted of ten weeks of individualized weekly sessions, each lasting 50min, involving perineal massage, progressive vaginal dilation, and pelvic floor exercises. Pre- and post-treatment evaluations included assessments of pelvic floor muscle strength through digital palpation, measurements of vaginal length and diameter using a silicone vaginal dilator, and classification of stenosis according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Health-related quality of life was assessed using the FACT-G and FACT-Cx questionnaires. Twenty-one women completed the physical therapy program. There was a significant increase in vaginal length (p < 0.001), vaginal diameter (p < 0.001) and improvement in pelvic floor muscle strength (p < 0.001), with a large effect size (r = 0.81), a medium effect size (r = -0.77) and a medium effect size (r = -0.78), respectively. This resulted in resolution of vaginal stenosis in 14 participants (66.7%) following intervention. Mean scores for FACT-Cx and FACIT-G, encompassing total scores and physical, social, and functional well-being domains, increased significantly after the treatment. The proposed physical therapy program demonstrated positive effects on vaginal stenosis, pelvic floor muscle strength and health-related quality of life in gynecological cancer survivors.

Expectations and needs of gynecological cancer survivors at the end of primary cancer treatment: A convergent mixed methods study.

Gynecological cancer (GC) survivors desire holistic, person-centred, supportive care interventions to address their unmet needs after treatment. The development of such interventions requires an understanding of both the expectations and needs of GC survivors. The purpose of this study was to understand GC survivors' expectations and needs for post treatment, and to consider how their expectations and needs converge and diverge to inform care. A convergent mixed-methods design (QUAL+quant) was used. Qualitative data were collected via 1:1 telephone interviews. Quantitative data were collected using the Cancer Survivors' Unmet Needs measure. Twenty-four individuals participated. Survivors' expectations for interventions after treatment included the implementation and outcomes of interventions and were grouped into two themes: Wrestling the unknown and Trusted information strengthens capacity. The most common unmet needs were related to existential survivorship. However, mixed-methods analysis revealed participants primarily expected to have their informational needs met in post-treatment interventions. Study findings illuminate GC survivors' expectations and needs after treatment, and the importance of analyzing both when planning and providing care. Clinicians may use these findings to develop and refine interventions to address unmet needs of GC survivors.

Patterns of patient-reported outcomes (PROs) in a diverse group of gynecologic cancer survivors

ObjectivesRacial and ethnic disparities in patient-reported outcomes (PROs) among gynecologic cancer survivors are not well studied. We evaluated whether individual-level characteristics were associated with PROs in diverse gynecologic cancer survivors.MethodsGynecologic cancer patients in an ambulatory oncology clinic completed a psychosocial and practical needs assessment before their appointments through the electronic medical record (EMR) patient portal. Assessments were available in English and Spanish. Fatigue, pain, physical function, depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS®) computer adaptive tests, and health-related quality of life was assessed by FACT-G7. PROs were dichotomized based on severity (normal/mild vs moderate/severe). Demographic and clinical information was collected. Analyses were performed using Chi-square, t-tests, and Kruskal–Wallis tests.ResultsA total of 582 women completed the assessment; 20% (n = 116) were racial minorities, and 54.5% (n = 310) were Hispanic. A total of 192 (32.8%) completed the assessments in Spanish. Hispanic patients had lower mean fatigue scores (49.31 vs 51.74, p = 0.01), and patients whose preferred language was Spanish had lower mean depression (47.63 vs 48.97, p = 0.05) and fatigue scores (48.27 vs 51.27, p < 0.01). There were no significant differences in the severity of PROs by race, ethnicity, or preferred language. QOL scores were worse in patients with high symptom severity for anxiety (p = 0.04) and physical functioning (p < 0.01). Current smokers had worse physical functioning (13.4% vs 6.5%, p = 0.03).ConclusionsWe found no significant differences in severity of PROs by race, ethnicity, or preferred language. Quality of life scores were worse for patients with high symptom severity for physical functioning and anxiety.

Age, comorbid conditions, and cancer: Their associations with memory impairment in postmenopausal gynecologic cancer survivors in the Women's Health Initiative

Age, comorbid conditions, and cancer: Their associations with memory impairment in postmenopausal gynecologic cancer survivors in the Women's Health Initiative

Group Appointments for Cancer Survivorship Equity (GRACE): Evaluating the use of group medical visits in rural and underserved gynecologic cancer survivors

Group Appointments for Cancer Survivorship Equity (GRACE): Evaluating the use of group medical visits in rural and underserved gynecologic cancer survivors

Expectations and needs of gynecological cancer survivors at the end of primary cancer treatment: A convergent mixed methods study

Objectif : Les survivantes d’un cancer gynécologique souhaitent bénéficier d’interventions de soutien holistiques et axées sur la personne pour répondre aux besoins non satisfaits après le traitement. L’élaboration de ce genre d’interventions nécessite de comprendre à la fois les attentes et les besoins des survivantes de cancer gynécologique. L’objectif de la présente étude était de comprendre les attentes et les besoins des survivantes de cancer gynécologique après le traitement, et d’examiner comment ces attentes et ces besoins convergent et divergent afin d’orienter les soins. Méthodologie : L’étude faisait appel à un devis convergent à méthodes mixtes (qualitative+quantitative) parallèles. Les données qualitatives ont été recueillies lors d’entrevues téléphoniques individuelles. Les données quantitatives ont été recueillies à l’aide du questionnaire sur les besoins non satisfaits des survivants au cancer (Cancer Survivors’ Unmet Needs). Résultats : En tout, 24 personnes ont participé à l’étude. Les attentes des survivantes par rapport à la période post-traitement comprenaient deux catégories d’interventions (tant pour la mise en œuvre que pour les résultats) : la lutte contre l’inconnu et l’information fiable pour renforcer les capacités. Les besoins non satisfaits les plus courants touchaient l’aspect existentiel de la survivance; toutefois, l’analyse à méthodes mixtes a révélé que les participantes s’attendaient surtout à ce que les interventions post-traitement comblent leurs besoins informationnels. Conclusion : Les conclusions mettent en lumière les attentes et les besoins des survivantes de cancer gynécologique après le traitement, de même que l’importance d’analyser le moment où il convient de planifier les soins et de les dispenser. Les cliniciens pourront utiliser ces conclusions pour concevoir et raffiner les interventions visant à répondre aux besoins non satisfaits des survivantes de cancer gynécologique.

A look into the cancer continuum for the development of a physical activity intervention: qualitative investigation of the physical activity experiences and preferences of female cancer survivors.

Clinical guidelines recommend cancer survivors (i.e., people with a cancer diagnosis) engage in regular physical activity (PA) during and post treatment, yet most do not. Additionally, PA promotion for cancer survivors has primarily focused on post treatment, calling for an understanding of PA promotion during treatment. This study explores the PA experiences and preferences of both in-treatment and post-treatment breast and gynecologic cancer survivors (BGCS) to inform the design of a PA intervention. Semi-structured interviews were conducted with postmenopausal women aged ≥ 50years, diagnosed with breast or gynecological cancer (stages 1-3), who were undergoing, or recently completed (12 to 24months) chemotherapy and/or primary treatment. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to explore themes. Participants (N = 26; Mage: 63.9years) had a breast (92.3%) and gynecologic (7.7%) cancer diagnosis and 46.2% (n = 12) were in treatment whereas 53.8% (n = 14) were post treatment. BGCS experienced several side effects of cancer treatment and both groups felt PA was an important goal. In-treatment BGCS focused on managing side effects (e.g., fatigue) and recognized energy fluctuated around treatments, making those periods less ideal for PA. In-treatment BGCS strongly endorsed a flexible, at-home intervention. Post-treatment BGCS emphasized recovery and relapse prevention, also favoring at-home, flexible interventions but showing greater interest towards support groups to aid with their recovery journey. Preferred activities included walking, dancing, and muscle-strengthening. Findings highlight the unique challenges postmenopausal BGCS face in participating in PA, especially in-treatment, emphasizing the importance of a tailored PA intervention.

Nutritional assessment of Chinese gynecologic cancer survivors with post-surgical lower limb lymphedema: a cross-sectional study.

This study aims to evaluate the nutritional status of Chinese gynecologic cancer survivors with post-surgical lower limb lymphedema (LLL) by analyzing serum albumin levels and the prognostic nutritional index (PNI). A retrospective cross-sectional study was conducted at two Chinese medical centers. The cohort comprised 155 gynecologic cancer survivors who developed symptomatic unilateral LLL post-surgery, during the period from September 2021 to June 2024. Nutritional status was assessed by measuring serum albumin and PNI. Statistical analysis was performed using univariate and multivariate logistic regression models to identify factors associated with low serum albumin and PNI. The mean age of the cohort was 55.47 ± 10.56 years, and the median total survival time was 72.0 months (36.5, 111.5 months). The prevalence of low serum albumin (< 40 g/L) was 40.0%, and low PNI (< 45) was 80.6%. Significant associations were found between low hemoglobin levels and both low serum albumin (OR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and low PNI (OR = 1.09, 95% CI: 1.04-1.13, p < 0.001). Advanced International Society of Lymphology stage 3 was also associated with low albumin (OR = 0.18, 95% CI: 0.03-0.99, p < 0.05). The study highlights a significant prevalence of high risk of malnutrition among Chinese gynecologic cancer survivors with LLL, underscoring the need for regular nutritional assessments and interventions.

Randomized pilot trial of an unconditional cash transfer intervention to address food insecurity in oncology.

Screening for food insecurity and other social determinants of health is being integrated into oncology practice. We performed a pilot randomized trial to investigate whether an unconditional cash transfer (UCT) could be used to address food insecurity among female breast and gynecological cancer survivors. Food-insecure cancer survivors completed a baseline survey and were randomly assigned to receive $100/month for 3 months (UCT) or usual care (UC). Participants (n = 14) completed a follow-up survey after 3 months, and we compared changes in health-related quality of life, indicators of food insecurity, diet quality, and whether a participant had to forgo, delay, or make changes to medical care because of cost. The UCT was associated with higher physical health scores, fewer indicators of food insecurity, better diet quality, and a lower likelihood of forgoing medical care than those who received UC. Our results suggest that UCTs can improve outcomes for food-insecure cancer survivors.

Feasibility and pilot study of Indonesia's first telehealth support program for gynecological cancer survivors undergoing chemotherapy.

Most Indonesian gynecological cancer survivors experience chemotherapy side effects on their physical and mental health as they face unmet needs of supportive care, which increases the likelihood of discontinuing treatment. Interventions in telehealth assist survivors in resolving these issues. The aim of this pilot study was to determine the feasibility of fighting distress, self-efficacy, health effects, and sexual (FoRSHE-X) interventions and evaluate their potential impact on distress level, side effects knowledge and management, self-efficacy, and sexual quality of life. The study involved gynecological cancer survivors who underwent chemotherapy and participated in ten weeks of individual social media-based education, tele-coaching, and teleconsultations, from September 2023 to June 2024. The study feasibility and pilot outcomes were evaluated using descriptive statistics and qualitative thematic analysis. Of the twelve women recruited, six (50%) completed the study, filled out pre- and post-intervention questionnaires, and participated in interviews. Fifty-four virtual education, coaching, and consultation sessions were performed individually. The statistical results indicated that participants were highly satisfied with the telehealth program, which significantly increased their knowledge (p = 0.02), health practices (p = 0.04), and self-efficacy (p = 0.01). The qualitative analysis highlighted participants' and coaches' perspectives on the study's acceptance, barriers, and recommendations. In conclusion, this pilot study suggests that a definitive trial to assess the FoRSHE-X interventions is feasible, acceptable, and can be applied not only to gynecological cancer survivors but also to other types of cancer, thereby broadening the potential impact of the study.

Examining the feasibility of a dietetic intervention on body composition in irish breast and gynaecological cancer survivors: The LYSA trial

Examining the feasibility of a dietetic intervention on body composition in irish breast and gynaecological cancer survivors: The LYSA trial

23 - Pelvic rehabilitation for gynecological cancer survivors with vaginal stenosis

23 - Pelvic rehabilitation for gynecological cancer survivors with vaginal stenosis

From Treatment to Recovery: Gynecological Survivors' and Caregivers' Perspectives About the Usability of an Educational Resource.

The objective of this study was to understand gynecological cancer (GC) survivors' and their informal caregivers' perceptions about the usability of an educational resource to support their transition from primary cancer treatment into surveillance and/or recovery. After developing an empirical- and experiential-informed educational resource, we used a semi-structured questioning process to understand GC survivors and their caregivers' perceptions about its usability. Data were collected via online focus groups or 1:1 interviews that were audio recorded and transcribed. We used thematic analysis to analyze the data. Ten participants who were survivors or informal caregivers of cervical, ovarian, or uterine/endometrial cancer participated in two rounds of data collection. We grouped qualitative data into two themes: (1) reputable, relevant, and accessible education reduces uncertainty and promotes connection, and (2) individualized delivery of education provided by trusted cancer clinicians. The transition from treatment to surveillance is a challenging time for which reputable, relevant, and accessible educational resources are useful to facilitate an understanding about and self-management of survivorship-related concerns. Survivors and caregivers look to clinicians to provide reputable education to address their needs. This education should be diverse in content and referred to repeatedly throughout the cancer trajectory.