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Faithfull S, Greenfield D. Cancer survivor late-effects, chronic health problems after cancer treatment: what's the evidence from population and registry data and where are the gaps? Curr Opin Support Palliat Care 2024; 18:55-64. [PMID: 38170192 DOI: 10.1097/spc.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Improvements in cancer treatment have led to more people living with and beyond a cancer diagnosis but survivors may have increased health problems as they age. The purpose of this review is to critically evaluate population data exploring incidence of late effects for cancer survivors. RECENT FINDINGS 18 studies were identified between 2013 and 2023 that explored the impact on survivors' physical and emotional health. Patients who had been treated at least 2 years previously for cancer had significant cardiovascular risk factors compared with age-matched controls. Women with breast cancer were more likely to have cardiovascular disease, including hypertension, arrythmias and congestive heart failure. This was associated with anthracyclines and/or trastuzumab as part of systemic anti-cancer therapy. Survivors of colorectal cancer were three times more likely to have acute kidney injury than age-matched controls. Stress and mood disorders were higher in survivors of testicular cancer and prostate cancer. SUMMARY Population studies are important to identify the 'real world' consequences of cancer and its treatment beyond clinical trials. Knowledge is critical for managing an ageing cancer population. Data to personalise cancer survivorship care, not only helps determine potential health risks, but can improve secondary prevention, emotional health, recovery, and long-term outcomes.
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Affiliation(s)
- Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus Dublin 8, Ireland
| | - Diana Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust
- Medicine and Population Health, University of Sheffield, Sheffield, UK
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Baloch AN, Hagberg M, Thomée S, Steineck G, Sandén H. Disability pension among gynaecological cancer survivors with or without radiation-induced survivorship syndromes. J Cancer Surviv 2021; 16:834-843. [PMID: 34414517 PMCID: PMC9300541 DOI: 10.1007/s11764-021-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
Purpose Gynaecological cancer patients treated with external radiation therapy to the pelvis may face long-lasting and long-term gastrointestinal syndromes. The aim of this study was to assess the association between such radiation-induced survivorship syndromes and disability pension among gynaecological cancer survivors treated with pelvic radiation therapy. Methods This prospective register study included gynaecological cancer survivors (n=247) treated during 1991–2003, alive at the time of the study, and <65 years of age. In 2006, they completed a postal questionnaire measuring patient-reported outcomes. The self-reported data were linked to the national register on disability pensions. Relative risks and risk differences with 95% confidence intervals (CIs) of being granted a disability pension were estimated using log-binomial regression. Results Gynaecological cancer survivors with gastrointestinal syndromes had a higher risk of disability pension than survivors without such syndromes. Survivors with blood discharge syndrome had a 2.0 (95% CI 1.3–3.2) times higher risk of disability pension than survivors without blood discharge syndrome. The relative risk among survivors with urgency syndrome was 1.9 (1.3–2.9) and for leakage syndrome, 2.1 (1.4–3.1). Adjusting for age did not affect our interpretation of the results. Conclusions Gynaecological cancer survivors with a specific radiation-induced survivorship syndrome have a higher risk of disability pension than survivors without that specific syndrome. Implications for Cancer Survivors The findings highlight the need for more awareness and knowledge regarding the potential role of radiation-induced survivorship syndromes for continuing work among gynaecological cancer survivors. Work-life-related parameters should be considered during radiotherapy and rehabilitation after treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01077-9.
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Affiliation(s)
- Adnan Noor Baloch
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, P.O. Box 463, 405 30, Gothenburg, Sweden.
| | - Mats Hagberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, P.O. Box 463, 405 30, Gothenburg, Sweden
| | - Sara Thomée
- Department of Psychology, University of Gothenburg, Box 500, 405 30, Gothenburg, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences at University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Helena Sandén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine at University of Gothenburg, P.O. Box 463, 405 30, Gothenburg, Sweden
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Horsbøl TA, Dalton SO, Ammitzbøll G, Johansen C, Andersen EAW, Jensen PT, Frøding LP, Lajer H, Kjaer SK. Gynaecological cancer leads to long-term sick leave and permanently reduced working ability years after diagnosis. J Cancer Surviv 2020; 14:867-877. [PMID: 32564197 DOI: 10.1007/s11764-020-00899-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the study was to investigate overall patterns in labour market affiliation, risk for permanently reduced work ability and prevalence of long-term sickness absence among women diagnosed with gynaecological cancer. METHODS We followed 8451 women diagnosed with ovarian, endometrial or cervical cancer, and 72,311 women with no history of cancer in nationwide registers for up to 19 years (mean 7.5 years). We computed hazards ratios for permanently reduced working ability and annual proportions of long-term sick leave. RESULTS Patterns of labour market affiliation varied by cancer diagnosis and stage. The hazard of permanently reduced working ability was increased for survivors of all three cancers but most pronounced for women diagnosed with advanced ovarian cancer. The highest hazard ratios were found 2-5 years after diagnosis, and they persisted for years in all groups and throughout the follow-up period of 19 years in women diagnosed with advanced cervical cancer. In the subgroups of women who continued to be potentially active on the labour market, long-term sick leave was more prevalent among cancer survivors than women with no history of cancer up to 10 years after diagnosis. CONCLUSIONS Women diagnosed with localised as well as advanced gynaecological cancer are at prolonged risk for permanently reduced working ability and long-term sick leave. IMPLICATIONS FOR CANCER SURVIVORS Gynaecological cancer can have long-term as well as permanent consequences for working ability, and survivors who remain active on the labour market might have to take more sick leave even years after cancer diagnosis than other women at their age.
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Affiliation(s)
- Trine Allerslev Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,National Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Rådmandsengen 5, 4700, Næstved, Denmark
| | - Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,National Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Rådmandsengen 5, 4700, Næstved, Denmark
| | - Christoffer Johansen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Late Effect Research Unit CASTLE, Copenhagen University Hospital, Blegdamsvej 58, 2100, Copenhagen, Denmark
| | | | - Pernille Tine Jensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.,Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | | | - Henrik Lajer
- Department of Gynaecology, Copenhagen University Hospital, Juliane Maries Vej 10, 2100, Copenhagen, Denmark
| | - Susanne K Kjaer
- Department of Gynaecology, Copenhagen University Hospital, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.,Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
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Dahl AA, Bentzen AG, Fosså SD, Hess SL, Steen R, Kiserud CE. Long-term cervical cancer survivors on disability pension: a subgroup in need of attention from health care providers. J Cancer Surviv 2020; 14:578-585. [PMID: 32279150 PMCID: PMC7360663 DOI: 10.1007/s11764-020-00877-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Survivors of cervical cancer have an increased risk for permanently reduced work ability qualifying for disability pension (DP). Few studies describe the social and health situation of long-term survivors of cervical cancer (LSCCs) on DP as a subgroup among LSCCs. The purpose was to investigate the socio-demographic and health status of LSCCs holding DP in a population-based cohort using LSCCs holding paid work as reference. METHODS Altogether, 354 LSCCs under 67 years (age of retirement pension in Norway) at survey participated in this study. They responded to a mailed questionnaire containing social, health, and clinical issues. RESULTS Among LSCCs 24% held DP at a median of 11 years (range 6-15) after diagnosis versus 12% in the general female population. Compared to LSCCs in paid work, those on DP had significantly higher mean age at survey, short education, more comorbid somatic diseases, poorer self-rated health, higher level of neurotoxic side effects, more chronic fatigue, and higher mean levels of anxiety and depression. Increased age, presence of musculo-skeletal diseases, and increased levels of depression and pain remained significantly associated with DP in multivariate analysis. CONCLUSIONS One in four LSCCs held DP which was twice the rate of the general female population. Several somatic and psychological conditions amenable to treatment were significantly associated with holding DP. IMPLICATIONS FOR CANCER SURVIVORS LSCCs holding DP should check their health regularly since conditions that can be treated are common, and health care providers should be aware of this opportunity.
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Affiliation(s)
- Alv A Dahl
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Gry Bentzen
- Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway
| | - Sophie D Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| | - Siri Lothe Hess
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| | - Rita Steen
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
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Zhang Y, Guo Y, Zhou X, Wang X, Wang X. Prognosis for different patterns of distant metastases in patients with uterine cervical cancer: a population-based analysis. J Cancer 2020; 11:1532-1541. [PMID: 32047560 PMCID: PMC6995375 DOI: 10.7150/jca.37390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/01/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Uterine cervical cancer (UCC) is a common malignant tumor in women. We conducted this work to provide a though description on the patterns of distant metastases and to investigate the relevant factors for prognosis of UCC patients based on a large population. Patients and methods: UCC patients with FIGO stage IVB, being the study group, were identified from the Surveillance, Epidemiology, and End Result (SEER) database from 2010 to 2016. UCC patients with same inclusion criteria, being validation group, were identified from Tianjin First Central Hospital from 2004 to 2017. Patterns of distant metastases were described according to the number of metastatic sites. Survival of different patterns were calculated and prognostic factors were investigated by Cox hazard regression analysis. Results: Distant metastases were recorded in 1448 UCC patients among whom 295 patients (30.8%) developed metastases in two or more organs. Compared with the median OS of 8 (95%CI, 7.07-8.93) months in the patients with the single site, worse survival of 5 (95%CI, 4.29-5.71) months was noticed in the patients with multiple metastases. Age ≥ 65 years, black race, higher grade, higher T stage and more metastatic sites were proved to be the prognostic factors for all the patients in the advanced stage and the results were partly validated in the validation cohort. Moreover, black race and higher T-stage for the patients with the single metastatic sites and age ≥ 65, uninsured status, surgical treatment and metastatic pattern for the patients with two metastatic sites were prognostic factors. No independent factor was found in patients with three or more metastases. Conclusion: Around 70% of the patients suffered one site distant metastasis in UCC patients with IVB stage while 30% with multiple metastases and a significantly reduced survival. Different survivals and prognostic factors were noticed for different patterns of distant metastases.
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Affiliation(s)
- Yiran Zhang
- International Medical Center, Tianjin First Central Hospital, Tianjin, China
| | - Ying Guo
- Nursing department, Tianjin First Central Hospital, Tianjin, China
| | - Xinzi Zhou
- International Medical Center, Tianjin First Central Hospital, Tianjin, China
| | - Xuena Wang
- International Medical Center, Tianjin First Central Hospital, Tianjin, China
| | - Xiaofei Wang
- International Medical Center, Tianjin First Central Hospital, Tianjin, China
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Buchanan T, Pierce JY, Graybill W, Kohler M, Creasman W. Why do we continue to overtreat stage Ia carcinoma of the cervix? Am J Obstet Gynecol 2017; 217:413-417. [PMID: 28522321 DOI: 10.1016/j.ajog.2017.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/09/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
The current recommended treatment for stage Ia2 cervical cancer is a radical or modified radical hysterectomy. Although in the United States the incidence of cervical cancer is low and declining, almost 50% of the >4000 new cases will present in early stages. An estimated 2200 women each year will undergo radical hysterectomy and many will have both early- and late-onset complications. The purpose of this review is to examine if there is still a role for radical hysterectomy in the proper treatment of stage Ia2 cervical cancer given most recent data. Sufficient histological evidence suggests that although parametrial involvement and lymph node metastases can increase the risk for recurrence, they are relatively uncommon at early stages. Worldwide data that challenge radical hysterectomy as standard of care have shown that conservative management of stage Ia2 cervical cancer results in similar survival and recurrence rates. It is the recommendation based on all reviewed data that radical hysterectomy should no longer be considered standard of care in all cases of stage Ia2 cervical cancer.
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Feasibility and Acceptability of the Use of Patient-Reported Outcome Measures in the Delivery of Nurse-Led, Supportive Care to Women With Cervical Cancer. CLIN NURSE SPEC 2017; 31:E1-E10. [DOI: 10.1097/nur.0000000000000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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