Change in health-related quality of life of newly diagnosed cancer patients, cancer survivors, and controls

Changes in quality of life over time in patients diagnosed with oral leukoplakia: A prospective longitudinal study

BACKGROUND

Oral leukoplakia (OL) is one of the most prevalent oral potentially malignant disorders (OPMD). Although there is emerging evidence that quality of life (QoL) is impaired in subjects with OL; studies to date are based on single and heterogenous point-in-time assessments. The aim of this study was to ascertain if QoL scores change over time in individuals diagnosed with OL.

METHODS

Forty-one individuals with OL were administered the Short Generic Health Questionnaire (SF-12) and the discipline-specific Oral Potentially Malignant Disorder Questionnaire (OPMDQ) at four points in time: at the time of clinical diagnosis, at the post-biopsy review (confirmed diagnosis), and at 3- and 6-month follow-up appointments. Responses were compared between the four time points.

RESULTS

No significant differences were observed in the SF-12 questionnaire scores over time. However, a general improvement in the participants' life quality was evident over the 6-month period under investigation in the domains of psychological and social well-being (p = 0.0027) and effect of treatment on daily life (p = 0.0317) as well as in the total score (p = 0.0005) of the OPMDQ. Age, gender, medical status, tobacco/alcohol use, lesion site, size, the presence of dysplasia and treatment did not impact QoL scores over time.

CONCLUSIONS

QoL scores of OL subjects may improve with time. Our results suggest that studies examining QoL in individuals with OL should be controlled for time at which the participants are surveyed.

Association of dietary risks, behavioural and lifestyle factors, and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study

BACKGROUND

Cancer patients are confronted with a variety of other health-related issues, including physical disability, poor quality of life, and psychological challenges. This study aims to quantify the association of dietary, behavioural and lifestyle risk factors and comorbidities on the magnitude and distribution of disability burden among cancer patients in Australia.

METHODS

This study comprised a sample of 2283 cancer patients drawn from the latest nationwide Australian National Health Survey conducted in 2017-18. Negative binomial regression models were used to estimate the incidence rate ratio (IRR) of the number of disabilities and its associations.

RESULTS

Forty-five percent of cancer patients experienced at least one disability. The magnitude of disability was significantly associated with sugar-sweetened drink consumption ≥ 3 days per week (IRR= 1.12, 95% CI: 1.02-1.26), a lack of physical activity (IRR = 1.69, 1.38-2.07), frequent or regular alcohol consumption (IRR = 1.95, 1.84-2.08), poor health status (IRR = 1.99, 1.78-2.24) and the presence of five or more chronic comorbid conditions (IRR = 3.59, 2.90-4.46). Cancer patients who consumed vegetables at least two or more times per day had a 10% lower risk of disability burden (IRR = 0.90, 0.82-0.99).

CONCLUSIONS

This study shows the association of diet, behavioural, and lifestyle risk factors on the degree of disability burden among cancer patients, highlighting the need for bold and effective policies. The findings will inform the implementation of evidence-based lifestyle interventions and offer a foundation for evaluating their influence on cancer survivors' health.

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016

PURPOSE

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history.

METHODS

Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted.

RESULTS

Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI 0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50 years) reported poorer MCS-12 than the older population (age 50 years and above).

CONCLUSION

Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer

BACKGROUND

Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type.

METHODS

Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes-severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)-in participants with versus without cancer, for 13 cancer types.

RESULTS

Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25-1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02-1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24-1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56-3.77; distress 1.53, 1.20-1.96; poor/fair QoL 2.40, 1.87-3.07), lung cancer (disability 2.81, 2.50-3.15; distress 1.67, 1.46-1.92; poor/fair QoL 2.53, 2.21-2.91) and non-Hodgkin's lymphoma (disability 1.56, 1.37-1.78; distress 1.20, 1.05-1.36; poor/fair QoL 1.66, 1.44-1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16-1.32; distress 0.95, 0.90-1.01; poor/fair QoL 1.15, 1.05-1.25), prostate cancer (disability 1.11, 1.04-1.19; distress 1.09, 1.02-1.15; poor/fair QoL 1.15, 1.08-1.23) and melanoma (disability 1.02, 0.94-1.10; distress 0.96, 0.89-1.03; poor/fair QoL 0.92, 0.83-1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes.

CONCLUSIONS

Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.

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

BACKGROUND

To investigate the association between physical activity (PA) and quality of life (QoL) among breast and colorectal cancer survivors in Korea.

METHODS

A total of 224 cancer survivors (151 breast and 73 colorectal cancers) who completed treatments were recruited. We measured PA level with Godin Leisure-Time Exercise Questionnaire and QoL with European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30.

RESULTS

Moderate to vigorous PA was significantly correlated with global QoL (r = .311, p < 0.01), physical functioning (r = .231, p < 0.01), fatigue (r = -.176, p < 0.05), pain (r = -.154, p < 0.05), and dyspnea (r = -.221, p < 0.01) while no correlation was found between light PA and QoL after controlling for potential confounders. When we further divided our participants into four groups by total PA level, we found a strong linear dose-response relationship between higher total PA and better QoL outcomes (p < .001). Compared with participants in the lowest quartile, those in the highest quartile had significantly better score in global QoL (65.8 ± 2.7 vs. 77.6 ± 2.8, p = 0.003), physical functioning (67.2 ± 2.3 vs. 85.3 ± 2.4, p = 0.007), fatigue (35.9 ± 3.2 vs. 23.6 ± 3.2, p = 0.008), pain (22.7 ± 3.3 vs. 13.0 ± 3.4, p = 0.046), and dyspnea (13.7 ± 2.5 vs. 5.9 ± 2.6, p = 0.034).

CONCLUSIONS

Higher PA level was associated with better QoL among breast and colorectal cancer survivors in Korea. Increasing PA levels should be included as one of important strategies to improve QoL in cancer survivors.

Quality of life in "chronic" cancer survivors: a meta-analysis

PURPOSE

Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis.

METHODS

A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10.

RESULTS

Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies.

CONCLUSION

QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.

Health-related quality of life among breast cancer survivors and noncancer controls over 10 years: Pink SWAN

BACKGROUND

The goal of this study was to compare health-related quality of life (HRQL) from diagnosis to 10 years postdiagnosis among breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different HRQL trajectories.

METHODS

Our analysis included 141 BCS and 2086 controls from the Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort study of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (cases) or did not develop (controls) incident breast cancer after enrollment. We assessed HRQL with SF-36 Mental Component Summary and Physical Component Summary scores. We modeled each as a function of case/control status, years since diagnosis, years since diagnosis squared, and the interaction terms between case/control status and the 2 time variables in linear models. We characterized heterogeneity in postdiagnosis HRQL of cases using group-based trajectories.

RESULTS

BCS had significantly lower HRQL compared with controls at diagnosis and 1 year postdiagnosis. By 2 years, BCS and controls no longer differed significantly. Among BCS, 2 trajectory groups were identified for both scores. For the Mental Component Summary, 88.4% of BCS had consistently good and 11.6% had very low scores. For the Physical Component Summary, 73.9% had good scores, and 26.1% had consistently low scores. Prediagnosis perceived stress and current smoking were related to being in the low mental trajectory group, and a higher number of comorbidities was related to being in the low physical trajectory group.

CONCLUSION

Although the majority of BCS have HRQL similar to non-cancer controls after 2 years, subgroups of BCS continue to have low HRQL. Prediagnosis stress, comorbidities, and smoking are vulnerability factors for long-term, low HRQL in BCS.

What Is Missing for You to Be Happy? Comparison of the Pursuit of Happiness Among Cancer Patients, Informal Caregivers, and Healthy Individuals

CONTEXT

After cancer diagnosis, personal value priorities may change in a way that would transform such values and how life is perceived by cancer patients and their caregivers, including happiness and its pursuit.

OBJECTIVES

The objective of the study was to analyze and compare what cancer patients, informal caregivers, and healthy population believe that would make them happy.

METHODS

A qualitative content analysis was performed on the responses to a single question: "What is missing for you to be happy?" Narratives of cancer patients (n = 242, face-to-face interview), informal caregivers (n = 125, face-to-face interview), and healthy participants (n = 1,671, recruited through social media, online survey) were analyzed. Word clouds were created for each group of participants. Contents were identified and frequencies were compared among participants by means of chi-square and Fisher's exact tests.

RESULTS

Overall, participants were pursuing better health (n = 288, 14.1%), better interpersonal relationships (n = 456, 22.4%), money (n = 412, 20.2%), and work-related aspects (n = 481, 23.6%). Cancer patients and informal caregivers sought better health and cure more often than when compared to healthy people (P < 0.001). Among cancer patients, survivors' profile tended to be similar to that of the healthy population concerning what they need to be happy. Unexpectedly, "cure" (22.7%) was more frequent among participants with incurable cancer.

CONCLUSION

Regardless of the group they were in, participants sought happiness in what they considered to be important to their lives, but it was something they did not have at the time of the interview. Psychoeducational and cognitive-behavioral strategies focused on how to deal with life expectations among people facing cancer are awaited.

Breast cancer survivors' preferences for mHealth physical activity interventions: findings from a mixed methods study

PURPOSE

Despite the benefits of physical activity for breast cancer survivors, the majority remain insufficiently active. Mobile health (mHealth) physical activity interventions may be a more scalable strategy to increase activity among survivors. However, little is known about their preferences for mHealth intervention features. This study explored survivors' preferences for these features.

METHODS

Survivors (N = 96; Mage = 55.8 (SD = 10.2)) self-reported demographic and disease characteristics, physical activity. A subset (n = 28) completed a semi-structured phone interview. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported interests and preferences for intervention features via online questionnaires. Quantitative data were analyzed using descriptive statistics.

RESULTS

Five themes emerged from interview data: (1) importance of relevance to breast cancer survivors; (2) easy to use; (3) integration with wearable activity trackers; (4) provide sense of accomplishment; and (5) variability in desired level of structure and personalization. The highest ranked intervention features were: daily and weekly progress feedback (87.5%), newsfeed (86.6%), activity challenges (81.3%), and scheduling tool (79.2%). Survivors were interested in receiving progress feedback (80.2%) and motivational (78.1%) and reminder (75.0%) messages.

CONCLUSIONS

Breast cancer survivors are interested in mHealth physical activity promotion interventions, but preferences varied around themes of relevance, ease of use, and enhancing personal motivation.

IMPLICATIONS FOR CANCER SURVIVORS

Engaging survivors in developing and implementing remotely delivered mHealth activity promotion interventions may enhance their effectiveness.

Treat patient, not just the disease: holistic needs assessment for haematological cancer patients

Haematological malignancies can have devastating effects on the patients' physical, emotional, psycho-sexual, educational and economic health. With the improvement of therapies patients with these malignancies are living longer, however significant proportion these patient show poor quality of life (QoL) due to various physical and psychological consequences of the disease and the treatments. Health-related QoL (HRQoL) is multi-dimensional and temporal, relating to a state of functional, physical, psychological and social/family well-being. Compared with the general population, HRQoL of these patients is worse in most dimensions. However without routine holistic need assessment (HNA), clinicians are unlikely to identify patients with clinically significant distress. Surviving cancer is a chronic life-altering condition with several factors negatively affecting their QoL, such as psychological problems, including depression and excessive fear of recurrence, as well as social aspects, such as unemployment and social isolation. These need to be adequately understood and addressed in the healthcare of long-term survivors of haematological cancer. Applying a holistic approach to patient care has many benefits and yet, only around 25% of cancer survivors in the UK receive a holistic needs assessment. The efforts of the last decade have established the importance of ensuring access to psychosocial services for haematological cancer survivors. We need to determine the most effective practices and how best to deliver them across diverse settings. Distress, like haematological cancer, is not a single entity, and one treatment does not fit all. Psychosocialoncology needs to increase its research in comparative effectiveness.

Longitudinal Study on Quality of Life and Psychosocial Conditions in Light of Responses to Illness-Related Information in Postoperative Cancer Patients

Objective:

Illness-related information can be significant for cancer patients after gastrointestinal (GI) surgery in terms of their performing adaptive tasks. This study longitudinally investigated the health outcomes of Japanese patients who read a booklet about cancer patients’ problems and adaption tasks and evaluated the association between the responses to the booklet and the patients’ health outcomes.

Methods:

A questionnaire survey about quality of life (QOL), fatigue, anxiety, cognitive plight, and resilience was administered to postoperative patients with GI cancer 1 week after their discharge from hospital and 6 months after surgery. The questionnaires were returned by email.

Results:

The mean age of the 32 patients at 1 week was 60.9 years; nearly 68.8% of them were men. As a whole, only two variables, QOL and anxiety, were significantly improved at 6 months over those at 1 week. Three statements were taken to gauge the responses to the booklet. In the two-way ANOVA that took QOL and responses to the booklet as independent variables, the post hoc test found that QOL was significantly improved in patients who agreed with the statement “I vaguely understood the content” or “I will deal with my tasks as described in the scenarios” but not in patients who agreed with the statement “The scenarios reflect my situation.” The anxiety in patients who agreed with the statement “The scenarios reflect my situation” was high at both survey points.

Conclusions:

This study suggests that associations between the responses to the informational booklet and patients’ health outcomes partially indicate the directional property of how to support their information usage.

Optimization of a technology-supported physical activity intervention for breast cancer survivors: Fit2Thrive study protocol

Fit2Thrive is a theory-guided physical activity promotion trial using the Multiphase Optimization Strategy (MOST) to test efficacy for improving physical activity of five technology-supported physical activity promotion intervention components among breast cancer survivors. This trial will recruit 256 inactive breast cancer survivors nationwide. All participants will receive the core intervention which includes a Fitbit and standard self-monitoring Fit2Thrive smartphone application which will be downloaded to their personal phone. Women will be randomized to one of 32 conditions in a factorial design involving five factors with two levels: support calls (No vs. Yes), app type (standard vs. deluxe), text messaging (No vs. Yes), online gym (No vs. Yes) and Fitbit Buddy (No vs. Yes). The proposed trial examines the effects of the components on physical activity at 12 and 24weeks. Results will support the selection of a final package of intervention components that has been optimized to maximize physical activity and is subject to an upper limit of cost. The optimized intervention will be tested in a future trial. Fit2Thrive is the first trial to use the MOST framework to develop and test a physical activity promotion intervention in breast cancer survivors and will lead to an improved understanding of how to effectively change survivors' physical activity. These findings could result in more scalable, effective physical activity interventions for breast cancer survivors, and, ultimately, improve health and disease outcomes.

Breast Cancer Survivors' Contribution to Psychosocial Adjustment of Newly Diagnosed Breast Cancer Patients in a Computer-Mediated Social Support Group

This study investigated the role of breast cancer survivors in a computer-mediated social support (CMSS) group for women with breast cancer. Applying a computer-aided content analytic method, the present study examined the differences in support provision between survivors and newly diagnosed patients. This study further investigated the impacts of survivor-provided social support on psychosocial adjustment of newly diagnosed patients. The results revealed that, compared with newly diagnosed patients, breast cancer survivors provided more emotional and informational support. Receiving emotional support from survivors contributed to an improvement in the quality of life and the depression of patients. The effects of survivor-provided informational support were not significant.

When life gives you lemons: The effectiveness of culinary group intervention among cancer patients

RATIONALE

Previous studies have shown that the dietary habits of cancer patients and survivors have significant implications for their recovery and quality of life. The current study examined the effectiveness of an innovative culinary group intervention on cancer patients' quality of life through changes in their eating behaviors, as manifested by an increase in their tendency towards intuitive eating and healthy food choices.

METHODS

In total, 190 cancer patients participated in this study, and were allocated to an intervention or a wait-list control group. A battery of self-report questionnaires assessing food choices, intuitive eating, health-related quality of life, and subjective well-being was administered at two time points: Before the intervention (T1) and at the end of the three month intervention (T2).

RESULTS

Analyses revealed an increase in health-related quality of life and well-being among the intervention group. Intuitive eating and healthy food choices also increased among the intervention but not wait-list control group. Finally, results indicated that participation in the culinary group intervention and improvements in health-related quality of life and well-being were mediated by changes in eating behaviors.

CONCLUSIONS

Our findings demonstrate that nutrition and eating behaviors have a significant effect on cancer patients' physical and emotional adjustment. A culinary group intervention seems to target patients' physical and emotional needs and promote their adjustment.

Physical resilience of older cancer survivors: An emerging concept

OBJECTIVES

To characterize factors contributing to physical resilience in older cancer survivors, as demonstrated by resistance to decline or recovery (resilience).

MATERIALS AND METHODS

We conducted a secondary analysis of data from a randomized controlled trial of cancer survivors ≥65years old and ≥5years from cancer diagnoses. Physical function was assessed quarterly over 2years, with Short-Form 36 physical function subscale. Participants with ≥2 follow-up assessments (n=594) were evaluated for physical resilience: 1) Resistance was defined as lack of any decline, where decline was a drop of ≥13 points, and 2) resilience (i.e., recovery) was defined as regaining ≥50% of lost function, subsequent to decline.

RESULTS

Mean age was 73.1years and 89.1% were Caucasian. Forty-nine percent (n=289) were resistant to decline in function; these individuals were younger, had higher education and income, were more likely to be Caucasian, and had higher baseline physical function (mean difference [MD] 7.8 points, 95% CI 5.0-10.8) and general health (MD 7.5 points, 95% CI 4.9-10.1). Fifty-seven percent (n=137 of 239) demonstrated resilience, with 91.2% (n=125) recovering within 6months of declines; these participants had higher baseline physical function (MD 6.6 points, 95% CI 1.8-11.4), but similar pre-decline function. More participants who were resistant, and more who showed resilience, reported high self-efficacy and social support.

CONCLUSIONS

The majority of older cancer survivors exhibited physical resilience; this was associated with high baseline health, physical function, self-efficacy, and social support. Assessing and targeting psychosocial factors may be important for interventions seeking to promote physical resilience.

Association between Time since Cancer Diagnosis and Health-Related Quality of Life: A Population-Level Analysis

OBJECTIVES

To examine the association between time since cancer diagnosis and health-related quality of life (HRQOL) among cancer survivors in remission.

METHODS

Analyzing data from 3,610 cancer survivors and 59,539 individuals without cancer in the Medical Expenditure Panel Survey, we examined the relationship between time since cancer diagnosis and HRQOL, taking remission status into account and controlling for patients' demographic characteristics and comorbidities. HRQOL measurements included the six-dimensional health state short form (derived from 36-item short form health survey) (SF-6D) utility scores, the physical component summary score, and the mental component summary score.

RESULTS

The relationship between time since cancer diagnosis and HRQOL varied substantially across cancer types. Compared with individuals without cancer, survivors of breast, prostate, or poor-prognosis cancer had statistically lower SF-6D scores within 2 years of diagnosis (-0.044, -0.062, and -0.088, respectively). Breast cancer survivors had SF-6D scores similar to those of individuals without cancer after 2 years, as did patients with poor-prognosis cancer after 5 years. Nevertheless, even after a period of 10 years, survivors of prostate or cervical cancer had a lower level of SF-6D scores (-0.027 and -0.042, respectively). The comparisons of physical health between cancer survivors and individuals without cancer were similar to those of SF-6D. In contrast, most cancer survivors did not experience poorer mental health; survivors of prostate or cervical cancer, however, had lower mental component summary scores after 10 years of diagnosis.

CONCLUSIONS

The level of HRQOL among cancer survivors depends on time since cancer diagnosis and cancer type. Some cancer survivors have lower HRQOL after a decade of diagnosis, even in remission.

Haematological cancer and quality of life: a systematic literature review

The aim of this study is to examine the impact of haematological cancers on quality of life (QoL). A review of the international literature was conducted from the databases ‘PsycInfo' and 'Medline' using the keywords: 'haematological cancer', 'quality of life', 'physical', 'psychological', 'social', 'vocational', 'professional', 'economic', 'cognitive', and 'sexual'. Twenty-one reliable studies were analysed. Among these studies, 12 showed that haematological cancer altered overall QoL, 8 papers found a deterioration of physical dimension, 8 papers reported on functional and role dimensions, 11 papers reported on the psychological component and 9 on the social component. Moreover, one study and two manuscripts, respectively, reported deteriorated sexual and cognitive dimensions. Our review demonstrates that the different dimensions of QoL are deteriorated by haematological malignancies and, probably, by the side effects of treatment.

Performance of activities of daily living among hospitalized cancer patients

BACKGROUND

Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data.

METHODS

Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55).

RESULTS

All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments.

CONCLUSION

Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

Quality of life and related factors in patients with newly diagnosed advanced lung cancer: a longitudinal study

PURPOSE/OBJECTIVES

To examine the changes in quality of life (QOL), symptoms, self-efficacy for coping with cancer, and factors related to those changes in patients with newly diagnosed advanced lung cancer.

DESIGN

Longitudinal and correlational.

SETTING

Oncology inpatient wards and outpatient departments of a medical center in northern Taiwan.

SAMPLE

101 patients newly diagnosed with stage IIIB or IV lung cancer.

METHODS

Questionnaires were used to assess patients' QOL, symptoms, and self-efficacy before treatment and at one and three months following treatment. Factors related to the changes in global QOL and five functional dimensions were analyzed using six generalized estimating equation models.

MAIN RESEARCH VARIABLES

QOL, symptoms, and self-efficacy for coping with cancer.

FINDINGS

Patients reported moderate levels of global QOL, symptom severity, and self-efficacy for coping with cancer. They also reported high physical and cognitive functions, but relatively low role and social functions. Factors were significantly related to the most functional dimensions, including self-efficacy, fatigue, pain, sleep difficulties, and demographic- and disease-related factors. Self-efficacy was the most robust factor for predicting QOL.

CONCLUSIONS

Patients with advanced lung cancer experience a compromised global QOL and relatively low social and role functioning during the first three months following cancer diagnosis. Levels of self-efficacy and symptoms significantly affected changes in QOL and functioning.

IMPLICATIONS FOR NURSING

Applying a systematic assessment of changes in QOL and developing comprehensive interventions with self-efficacy training and symptom management are strongly recommended for clinical care to improve the QOL of patients with advanced lung cancer.

Physical activity and quality of life in breast cancer survivors: the role of self-efficacy and health status

OBJECTIVE

Mechanisms underlying the relationship between physical activity and quality of life (QOL) in breast cancer survivors are not well understood. The purpose of the present study was to longitudinally test a model examining self-efficacy and health status as potential mediators of this relationship.

METHODS

At baseline and 6 months, breast cancer survivors (n = 1527) completed physical activity, self-efficacy, health status, and QOL measures, and a subsample (n = 370) wore an accelerometer. Panel analysis within a covariance modeling framework was used to test the hypothesis that physical activity indirectly influences QOL across time.

RESULTS

The hypothesized model provided a good fit in the full sample (χ(2)  = 409.06; d.f. = 91, p < 0.001; comparative fit index (CFI) = 0.98; standardized root mean residual (SRMR) = 0.04) and the accelerometer subsample (χ(2)  = 320.96, d.f. = 134, p < 0.001; CFI = 0.95; SRMR = 0.05), indicating that physical activity indirectly, via self-efficacy and health status indicators, influences QOL across time.

CONCLUSIONS

Physical activity may influence QOL in breast cancer survivors through more proximal, modifiable factors.

Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

BACKGROUND

Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.

METHODS

We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.

FINDINGS

Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses.

INTERPRETATION

Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.

FUNDING

None.

Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care

BACKGROUND

Cancer survivors represent a growing population, heterogeneous in their need for medical care, psychosocial support, and practical assistance. To inform survivorship research and practice, this manuscript will describe the prevalent population of cancer survivors in terms of overall numbers and prevalence by cancer site and time since diagnosis.

METHODS

Incidence and survival data from 1975-2007 were obtained from the Surveillance, Epidemiology, and End Results Program and population projections from the United States Census Bureau. Cancer prevalence for 2012 and beyond was estimated using the Prevalence Incidence Approach Model, assuming constant future incidence and survival trends but dynamic projections of the U.S. population.

RESULTS

As of January 1, 2012, approximately 13.7 million cancer survivors were living in the United States with prevalence projected to approach 18 million by 2022. Sixty-four percent of this population have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. Over the next decade, the number of people who have lived 5 years or more after their cancer diagnosis is projected to increase approximately 37% to 11.9 million.

CONCLUSIONS

A coordinated agenda for research and practice is needed to address cancer survivors' long-term medical, psychosocial, and practical needs across the survivorship trajectory.

IMPACT

Prevalence estimates for cancer survivors across the survivorship trajectory will inform the national research agenda as well as future projections about the health service needs of this population.

Molecular mechanisms underlying skeletal muscle weakness in human cancer: reduced myosin-actin cross-bridge formation and kinetics

Many patients with cancer experience physical disability following diagnosis, although little is known about the mechanisms underlying these functional deficits. To characterize skeletal muscle adaptations to cancer in humans, we evaluated skeletal muscle structure and contractile function at the molecular, cellular, whole-muscle, and whole-body level in 11 patients with cancer (5 cachectic, 6 noncachectic) and 6 controls without disease. Patients with cancer showed a 25% reduction in knee extensor isometric torque after adjustment for muscle mass (P < 0.05), which was strongly related to diminished power output during a walking endurance test (r = 0.889; P < 0.01). At the cellular level, single fiber isometric tension was reduced in myosin heavy chain (MHC) IIA fibers (P = 0.05) in patients with cancer, which was explained by a reduction (P < 0.05) in the number of strongly bound cross-bridges. In MHC I fibers, myosin-actin cross-bridge kinetics were reduced in patients, as evidenced by an increase in myosin attachment time (P < 0.01); and reductions in another kinetic parameter, myosin rate of force production, predicted reduced knee extensor isometric torque (r = 0.689; P < 0.05). Patients with cancer also exhibited reduced mitochondrial density (-50%; P < 0.001), which was related to increased myosin attachment time in MHC I fibers (r = -0.754; P < 0.01). Finally, no group differences in myofilament protein content or ultrastructure were noted that explained the observed functional alterations. Collectively, our results suggest reductions in myofilament protein function as a potential molecular mechanism contributing to muscle weakness and physical disability in human cancer.

Characterizing the psychological distress response before and after a cancer diagnosis

Psychological distress among cancer survivors is common. It is unknown if symptoms predate diagnosis or differ from patients without cancer because studies are limited to patient follow-up. Linked cohort (Wisconsin Longitudinal Study) and tumor registry records were used to assess the psychological distress response pre- to post-cancer diagnosis. Adjusted predicted probabilities of being in one of five categories of change for three psychological distress measures (depression, anxiety, well-being) were compared for participants diagnosed with cancer between 1993-1994 and 2004-2005 and participants without cancer (N = 5,162). Cancer survivors were more likely to experience clinically significant increases (≥0.8 standard deviation) in depression (15, 95 % CI = 12-18 %) and anxiety (19 %, CI = 16-22 %) compared to their no-cancer counterparts (10 %, CI = 10-11 %; 11 %, CI = 11-12 %). Cancer survivors <5 years from diagnosis were more likely to experience worsening depression. Survivors ≥5 years were more likely to experience worsening anxiety. No significant results were found for well-being. Characterizing the psychological distress response is a prerequisite for identifying at-risk patients and communicating expected symptoms, allowing for proactive resource provision.

What happens now? Psychosocial care for cancer survivors after medical treatment completion

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.