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Bravington A, Johnson M, Macleod U. Turning a Curve: How People Use Everyday Resources to Negotiate Recovery From Cancer Treatment With Curative Intent. QUALITATIVE HEALTH RESEARCH 2024; 34:635-648. [PMID: 38230533 DOI: 10.1177/10497323231219389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Many more cancers are treated with intent to cure now than in previous decades, but for most, this involves significant effects from which people need to recover psychologically and socially, as well as physically. This longitudinal photo-elicitation interview study uses grounded theory to explain how people discharged from specialist care made use of everyday social and material resources to manage this process at home. Recovery is presented as a curve in life's pathway requiring gradual reorientation, drawing on social worlds and domestic resources to calibrate this process. Findings are described in three stages: (1) responding to diagnosis and treatment, (2) using social resources for meaning-making, and (3) developing assets for recovery. During treatment, participants drew on past identities to reinforce their sense of self, and personalized health care communication supported this process. In the weeks after treatment, new frameworks of understanding were constructed from perspectives on cancer encountered in the family, workplace, and outpatient clinics. Recovery processes included the negotiation of personal change, the renegotiation of close relationships, and the use of everyday resources to regain three sensations: control, comfort, and continuity. Supportive care would benefit from an individualized exploration of the assets that can help people to negotiate this challenging phase as treatment comes to a close. Possibilities for self-care (the maintenance of health and well-being in the context of everyday life) can be explored and assessed through personalized discussion around the identities, social worlds, and everyday resources available to each individual.
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Affiliation(s)
| | | | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
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Jahnen M, Lehner L, Meissner VH, Andreas Dinkel, Schiele S, Schulwitz H, Gschwend JE, Herkommer K. Cancer-related self-perception in men affected by prostate cancer after radical prostatectomy. J Cancer Surviv 2024; 18:509-520. [PMID: 36098942 PMCID: PMC10960910 DOI: 10.1007/s11764-022-01256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To identify factors associated with cancer-related self-perception after being affected by prostate cancer (PCa) and radical prostatectomy. SUBJECTS AND METHODS Men affected by PCa and radical prostatectomy were asked to choose one of 5 cancer-related identities ("patient," "victim," "someone who has had cancer," "cancer survivor," and "cancer conqueror"). Associations with clinical data, functional outcome (continence and sexual activity), and psychological factors were assessed. RESULTS One thousand seven hundred seventy-two men were included. Most men perceived themselves as "someone who has had cancer" (46.8%) which was associated with no cancer recurrence (OR: 0.54 [0.36-0.81]) and low cancer-related distress (OR: 0.69 [0.53-0.89]) or "patient" (35.4%) which was associated with ongoing therapy (OR: 2.59 [1.59-4.22]) and biochemical disease recurrence (OR: 1.91 [1.28-2.85]). Self-perception, as "cancer survivor" (7.8%), "cancer conqueror" (8.2%), or "victim" (1.8%), was less common. "Cancer survivor" was associated with high perceived disease severity (OR: 2.07 [1.33-3.24]) and incontinence (1.99 [1.27-3.12]). "Cancer survivor" and "cancer conqueror" were related to high benefit finding (OR: 2.05 [1.30-3.23], OR: 1.89 [1.27-2.81], respectively); only "cancer conqueror" was associated with higher quality of life (OR: 1.38 [1.21-1.58]). CONCLUSIONS Self-perception in men affected by PCa can vary widely and is associated with distinct characteristics that reflect the experienced severity of the disease, therapy side effects, and psychological well-being. IMPLICATIONS FOR CANCER SURVIVORS The assessment of cancer-related self-perception can give important insights when evaluating men affected by PCa who need assistance in coping with their disease.
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Affiliation(s)
- Matthias Jahnen
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Luisa Lehner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Langerstr.3, 81675, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helga Schulwitz
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Zebrack B. Cancer survivorship-a framework for quality cancer care. J Natl Cancer Inst 2024; 116:352-355. [PMID: 38113418 DOI: 10.1093/jnci/djad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 12/21/2023] Open
Abstract
When diagnosed with cancer or any other life-threatening condition, people must negotiate 2 once-separate but now integrated realms-a medical care industrial complex and an everyday life now lived in conscious awareness of mortality-a state of being subject to death. Life becomes a series of challenges and disruptions to relationships, body image and integrity, autonomy and independence, life goals, hopes, and dreams for the future. Whether one physically, emotionally, or spiritually survives, thrives, or succumbs to cancer is dependent on a treatment plan that accounts for the multiple and varied ways in which people experience dual citizenship in the realms of the well and the sick. A theory of cancer survivorship that integrates both medical and patient perspectives into a cogent and coherent framework has the potential to enhance the quality of cancer care and the patient experience. "Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.… Although we prefer to use the good passport, sooner or later each of us is obliged … to identify ourselves as citizens of that other place" (1).
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Affiliation(s)
- Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI, USA
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Terenziani M, Tozzi AE, Diaco L, Biasin E, Cattoni A, Croci I, Fraschini D, Giorgiani G, Haupt R, Muraca M, Pillon M, Sironi G, Valsecchi MG, Mastronuzzi A. Current practices of follow-up programs for childhood cancer survivors in Italy. TUMORI JOURNAL 2023; 109:555-561. [PMID: 37434559 DOI: 10.1177/03008916231185981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Quality of life in childhood cancer survivors is largely affected by survivorship care and transition from treatment to long-term follow-up (LTFU). Referring to evidence-based recommendations, we wanted to evaluate LTFU care for survivors through a survey among the Italian Association for Pediatric Hematology-Oncology (AIEOP) centers. The project aimed to evaluate the availability of services in Italy, investigate strengths and weaknesses, analyze improvements of awareness in the field, and identify the gaps that need to be addressed by different centers. METHODS Together with the family representatives, on behalf of AIEOP's Late Effects Working Group, we developed a questionnaire on assisting childhood cancer survivors. All AIEOP centers received one questionnaire including information on local health system organizations; LTFU for childhood cancer survivors; services for adult survivors of childhood cancer; information provided to survivors/caregivers and care plan delivery. RESULTS Forty-eight AIEOP centers were contacted and 42 replied, with a response rate of 87.5%. The majority of respondents confirmed their interest in assisting patients with a survivorship care plan (95.2%), regardless of a clinic or dedicated staff. DISCUSSION This is the first overview of LTFU in Italy, which provides detailed results at national levels, prompting consideration of improvements in the last decade. Although there is a high level of interest in survivorship care, many centers lack resources to implement such programs. The identification of these challenges is useful for planning future strategies.
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Affiliation(s)
- Monica Terenziani
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
| | - Laura Diaco
- FIAGOP - Federazione Italiana Associazioni Genitori e Guariti Oncoematologia Pediatrica, Rome, Italy
| | - Eleonora Biasin
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Turin, Piemonte, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Ileana Croci
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
| | - Donatella Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Lombardia, Italy
| | - Giovanna Giorgiani
- Pediatric Onco-Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Riccardo Haupt
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Liguria, Italy
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Liguria, Italy
| | - Marta Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
| | - Giovanna Sironi
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Maria Grazia Valsecchi
- Bicocca Centre of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Milan, Lombardia, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology, Gene Therapy, Cell Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, Lazio, Italy
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Tlegenova Z, Balmagambetova S, Zholdin B, Kurmanalina G, Talipova I, Koyshybaev A, Sultanbekova G, Baspayeva M, Madinova S, Kubenova K, Amanova A, Tamadon A. Role of Clinical Risk Factors and B-Type Natriuretic Peptide in Assessing the Risk of Asymptomatic Cardiotoxicity in Breast Cancer Patients in Kazakhstan. Diagnostics (Basel) 2023; 13:3557. [PMID: 38066798 PMCID: PMC10706779 DOI: 10.3390/diagnostics13233557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 10/16/2024] Open
Abstract
The asymptomatic progression of chemotherapy-induced cardiotoxicity poses a significant risk to breast cancer patients. In the present single-center cohort study, a predictive model for evaluating the risk of cardiotoxicity during or by the end of chemotherapy was designed. The risk-prediction nomogram was delineated and assessed. In total, 34 patients out of 120 developed asymptomatic cardiotoxicity (28.3%). Of six explored biomarkers, only B-type natriuretic peptide showed a reliable pattern of incremental increase, revealing statistical significance between cardiotoxicity "+" and "-" groups by visit 4 or by the 9th month of monitoring (p 0.006). The following predictors were included in the model: age, hypertension, diabetes mellitus, baseline glomerular filtration rate, 6 min walk test measured at visit 4, BNP values at visit 4, left ventricular ejection fraction levels at visit 4, a total dose of radiotherapy received, and anthracycline cumulative doses. The model's AUC was 0.72 (95% CI 0.59; 0.86), evidencing the satisfactory predictive ability of the model; sensitivity 100% (95% CI 90.36; 100.0) at a specificity of 66.67% (95% CI 50.33; 79.79); PPV 54.1% [95% CI 47.13; 60.91]; PVN 100% [95% CI 94.64; 100.00]. The calibration plot showed satisfactory agreement between predicted and actual chances (p = 0.98). The designed model can be applied in settings lacking speckle tracking echocardiography.
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Affiliation(s)
- Zhenisgul Tlegenova
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Saule Balmagambetova
- Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan;
| | - Bekbolat Zholdin
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Gulnara Kurmanalina
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Iliada Talipova
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Arip Koyshybaev
- Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan;
| | - Gulmira Sultanbekova
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Mira Baspayeva
- Chemotherapy Division at University Medical Center, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (M.B.); (S.M.)
| | - Saule Madinova
- Chemotherapy Division at University Medical Center, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (M.B.); (S.M.)
| | - Kulparshan Kubenova
- Clinical Laboratory at University Medical Center, West Kazakhstan Marat Ospanov Medical University, Aktobe 030017, Kazakhstan;
| | - Aiganym Amanova
- Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (Z.T.); (B.Z.); (G.K.); (I.T.); (G.S.); (A.A.)
| | - Amin Tamadon
- Percia Vista R&D Co., Shiraz, Iran;
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
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6
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Fernandes DCR, Nelson D, Siriwardena AN, Law G, Andreyev HJN. Understanding colorectal cancer patient follow-up: a qualitative interview study. Support Care Cancer 2023; 31:634. [PMID: 37843671 DOI: 10.1007/s00520-023-08108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE There are increasing numbers of patients who have been treated for colorectal cancer (CRC) who struggle with ongoing physical and psychological symptoms. 'Cancer survivor' is often used to describe these patients but this terminology remains controversial. This study sought to understand the follow-up experience of CRC patients in the UK and identify the terminology they prefer following diagnosis and treatment. METHODS Purposeful sampling of patients from specialist CRC follow-up clinics was performed until data saturation was achieved. Two 1:1 semi-structured qualitative interviews were performed for each participant. Data were analysed thematically. RESULTS Seventeen participants, median age = 62, 53% male were interviewed. Several themes were identified. Of note, fear of cancer recurrence dominates patients' agendas at follow-up appointments. There are also clinical and administrative barriers to discussing symptoms including being embarrassed, feeling that their symptoms were not relevant or not having enough time to discuss issues. However, there are several methods which may improve this, such as through the use of video consultations and questionnaires. In addition, patients identified inadequate holistic support despite significant psychological and social distress. Our data suggest that labelling a diverse group of patients as 'cancer survivors' can be problematic. CONCLUSION It is important that clinicians systematically screen patients for symptoms that are known to occur following treatment. Clinicians and patients should have routine access to pathways and programmes that can support patients in navigating their life after cancer therapy.
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Affiliation(s)
- Darren C R Fernandes
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK.
- Community and Health Research Unit, University of Lincoln, Lincoln, UK.
| | - David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Macmillan Cancer Support, London, UK
| | | | - Graham Law
- Lincoln Clinical Trials Unit, University of Lincoln, Lincoln, UK
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - H Jervoise N Andreyev
- The Department of Gastroenterology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincoln, UK
- The Biomedical Research Centre, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Morgan B, Kapadia V, Crawford L, Martin S, McCollom J. Bridging the gap: Palliative care integration into survivorship care. Curr Probl Cancer 2023; 47:101019. [PMID: 37866988 DOI: 10.1016/j.currproblcancer.2023.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
As the number of cancer survivors grows, there is an increasing need for comprehensive care to address the unique physical, psychological, and social needs of this population. Palliative care (PC) integration within survivorship care offers a promising model of care, however, there is no comprehensive review of literature to guide clinical practice. This manuscript presents a scoping review of the research literature on models of care that integrate PC with survivorship care, as well as a detailed description of an exemplar clinical model. We identified 20 articles that described various models of survivorship care with integrated PC, highlighting the diversity of approaches and the multidisciplinary nature of interventions. Few studies reported outcomes but those that did demonstrated improvements in pain, self-efficacy, depression, function, and documentation of advance care planning. The evidence base remains limited, indicating the need for further research in this area with a focus on exploring outcomes using prospective experimental designs. Future clinical practice and research should explore sustainable payment models and the implementation of integrated survivorship care in value-based payment systems.
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Affiliation(s)
- Brianna Morgan
- Department of Medicine, Division of Geriatrics and Palliative Care, New York University Grossman School of Medicine, New York City, NY
| | - Vishal Kapadia
- Landmark Health, Part of Optum Home and Community, Irving, TX
| | - Lesa Crawford
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN
| | - Samina Martin
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN
| | - Joseph McCollom
- Parkview Health, Parkview Packnett Family Cancer Institute, Fort Wayne, IN.
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Sun D, Zhang X, Cui M. Association between self-esteem and fear of cancer recurrence in cancer survivors: A cross-sectional study. Eur J Oncol Nurs 2023; 64:102334. [PMID: 37148748 DOI: 10.1016/j.ejon.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE There may be a correlation between self-esteem as an important psychological resource for individuals and Fear of cancer recurrence (FCR), but the relationship between the two is unclear. The aim of our investigation was to evaluate the association of FCR and self-esteem in cancer survivors. METHODS Cross-sectional sampling was used to select cancer survivors. The study instruments used included: General information questionnaire, Rosenberg Self-Esteem Scale, Perceived Social Support Scale, Fear of Cancer Recurrence Inventory- Shorter Form. We used logistic regression, where models were adjusted considering confounding variables to determine odds ratios (ORs) with 95% confidence intervals (CIs) for the association of FCR with self-esteem. RESULTS Between February 2022 to July 2022, we screened 380 participants for eligibility, of whom 348 were included in the study. The percentage of cancer survivors who experienced clinical level of FCR was 73.9% and the self-esteem score was 27.73 ± 3.67 at a moderate level. The Pearson' s correlation coefficient indicated a significant inverse relationship between FCR and self-esteem (p < 0.001; r = -0.375). In a multivariable logistic regression model, FCR still has a negative correlation with self-esteem (OR, 0.812; 95%CI, 0.734-0.898). Subgroup analysis indicated that the correlation between FCR and self-esteem in cancer survivors was nearly the same in various strata, demonstrating its soundness and stability. CONCLUSIONS This study confirms that elevated self-esteem in individuals surviving cancer may be a protective factor for FCR. Improving the level of self-esteem in cancer survivors can be one of the important directions of clinical interventions for FCR.
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Affiliation(s)
- Di Sun
- School of Nursing, Liaoning University of Traditional Chinese Medicine, No.79, Chongshan East Road, Shenyang, Liaoning, 110033, China
| | - Xu Zhang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Mengyao Cui
- Department of Breast Surgery, The First Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China.
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Avery J, Thomas R, Howell D, Dubouloz Wilner CJ. Empowering Cancer Survivors in Managing Their Own Health: A Paradoxical Dynamic Process of Taking and Letting Go of Control. QUALITATIVE HEALTH RESEARCH 2023; 33:412-425. [PMID: 36825869 PMCID: PMC10126457 DOI: 10.1177/10497323231158629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In cancer care, gaps in support to help patients manage and live with the side-effects from cancer treatments have increased the emphasis on empowering patients to be more active and involved in managing their own health. However, empowerment in relation to promoting self-management behaviors is not well understood. Using the social constructivist grounded theory approach, our goal was to develop a theoretical understanding of this phenomenon in relation to the self-management behaviors of post-treatment cancer patients. Twenty-two post-treatment cancer patients participated in a semi-structured focused interview to co-construct with us how empowerment is defined, described, and experienced in relation to their capacity to self-manage. Through this co-construction, we defined empowerment as a process of personal growth, a display of fortitude and strength when participants confronted the impact of their illness that emerged in two dynamic and paradoxical ways: 1) establishing control over the impact of the illness as a means to maintain normalcy and to circumvent change over an eroding and changing sense of self and 2) relinquishing control over aspects of the illness deemed irrepressible and acknowledging and accepting change. When successful at establishing and/or relinquishing control, participants no longer viewed cancer as a threat, but re-interpreted their illness as also having a beneficial "empowering" experience and more capable of managing. Findings will guide the development of self-management interventions that use empowerment as a core construct.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Roanne Thomas
- Department of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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CanCOG ®: Cultural Adaptation of the Evidence-Based UCLA Cognitive Rehabilitation Intervention Program for Cancer Survivors in Portugal. Healthcare (Basel) 2023; 11:healthcare11010141. [PMID: 36611601 PMCID: PMC9819200 DOI: 10.3390/healthcare11010141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Cognitive difficulties are highly prevalent and negatively impact cancer survivors' quality of life. The UCLA Cognitive Rehabilitation Intervention Program (in short, UCLA program) is an evidence-based intervention developed and tested in the US to address the cognitive complaints of cancer survivors. Since there are no cognitive rehabilitation programs available for Portuguese cancer-related settings, this study aimed to culturally adapt the UCLA program to Portugal. Nine steps were implemented for this cultural adaptation: needs assessment, initial contacts, translation, cultural adaptation, independent review by a panel of experts (n = 6), focus group discussions with cancer survivors (n = 11), systematization of inputs and improvement of the final materials, fidelity check, and preliminary acceptability assessment. The findings suggested that changes to the original materials were needed. A Portuguese name, "CanCOG®-Reabilitação Cognitiva no Cancro" (in English "CanCOG®-Cognitive Rehabilitation in Cancer"), and a logo were created to make it more memorable and appealing for the Portuguese population. The language was adjusted to ensure content accessibility and semantic and conceptual equivalence. Finally, references to several cultural aspects, such as habits, customs, and traditions, were adapted to fit the new cultural context. The UCLA program may be a promising tool to help alleviate the cognitive difficulties reported by cancer survivors in different cultural contexts. Future research is needed to confirm the feasibility, acceptability, and preliminary efficacy of its Portuguese version, "CanCOG®-Reabilitação Cognitiva no Cancro".
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Uspenskii SA, Khaptakhanova PA. Boron nanoparticles in chemotherapy and radiotherapy: the synthesis, state-of-the-art, and prospects. Russ Chem Bull 2022. [DOI: 10.1007/s11172-022-3686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Wanzer MB, Simon KG, Cliff NJ. Interpreting Cancer Survivors' Perceptions of the Survivor Label Through Social Identity and Communication Accommodation Theories. HEALTH COMMUNICATION 2022; 37:1600-1608. [PMID: 33823693 DOI: 10.1080/10410236.2021.1909263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study uses social identity theory and communication accommodation theory as lenses to examine former cancer patients' perspectives of the "survivor" label, replacement labels for their experience, and use of survivor services. Semi-structured interviews of 43 former cancer patients offer insight into their unique cancer experiences and explain how these events influence their perceptions of the term survivor. Coders used constant comparison methods to capture six themes related to the participants' impressions of the survivor label. When sharing perceptions of the survivor label, participants expressed language that illustrated convergence (It means everything to me), divergence (I don't like to be called anything), convergence and divergence (Part of me is happy … Part of me is kind of aggravated), and apathy (I have no feelings toward the label). Participants also generated new labels that captured their cancer experiences and six unique themes emerged from these responses. Most of the former cancer patients were aware of survivorship programs; however, relatively few used these programs regularly and cited reasons for nonuse explained by social identity theory.
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Affiliation(s)
| | - Kathryn G Simon
- Department of Communication Arts and Sciences, Penn State University
| | - Noah J Cliff
- Sales and Leasing Department, Uniland Development
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Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72:409-436. [PMID: 35736631 DOI: 10.3322/caac.21731] [Citation(s) in RCA: 1033] [Impact Index Per Article: 516.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Theresa Devasia
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Joan Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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14
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Azimzadeh-Sadeghi S. Electronic and structural computing features of some chromene derivatives and evaluating their anticancer activities. MAIN GROUP CHEMISTRY 2022. [DOI: 10.3233/mgc-210136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic and structural features of some of representative chromene derivatives were investigated in this work towards recognizing their anticancer roles. Density functional theory (DFT) calculations were performed to obtain five structures of chromene derivatives with the same skeleton of original structure. In addition to obtaining optimized structural geometries, electronic molecular orbital features were evaluated for the models. Energy levels of the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO) indicated effects of additional R group pf chromene derivatives on electronic features. Based on such results, it was predicted that one of derivatives, L5, could better participate in interactions with other substances in comparison with other ligand structures. This achievement was obtained based on availability of HOMO and LUMO levels in lower energies easily catchable for electron transferring. On the other hand, L5 was assumed to interact in the weakest mode with other substances. Indeed, the main goal of this work was to examine anticancer activity of the investigated chromene derivatives, in which each of L1–L5 chromene derivatives were analyzed first to recognized electronic and structural features. Next, molecular docking (MD) simulations were performed to examine anticancer role of L1–L5 against methyltransferase cancerous enzyme target. The results indicated that formations of ligand-target complexes could be occurred within different types of interactions and surrounding amino acids of central ligand. In agreement with the achievements of analyses of single-standing L1–L5 compounds, L4-Target was seen as the strongest complex among possible complex formations. Moreover, values of binding energies and inhibition constant indicated that all five chromene derivatives could work as inhibitors of methyltransferase cancerous enzyme by the most advantage for L4 ligand. And as a final remark, details of such anticancer activity were recognized by graphical representations of ligand-target complexes showing types of interactions and involving amino acids in interactions.
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15
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Jiang C, Deng L, Karr M, Wen Y, Wang Q, Perimbeti S, Shapiro CL, Han X. Chronic comorbid conditions among adult cancer survivors in the United States: Results from the National Health Interview Survey, 2002-2018. Cancer 2022; 128:828-838. [PMID: 34706057 PMCID: PMC8792209 DOI: 10.1002/cncr.33981] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer survivors develop other chronic medical conditions because of shared risk factors and delayed effects of cancer treatment. This study investigated trends in the prevalence of chronic diseases and estimated their population sizes among adult cancer survivors in the United States from 2002 to 2018. METHODS Using 2002-2018 National Health Interview Survey data, this study calculated the age-sex-race/ethnicity-adjusted prevalences and estimated the population sizes for the following chronic conditions among cancer survivors: hypertension, diabetes, stroke, heart disease, chronic obstructive pulmonary disease (COPD)/asthma, hepatitis, arthritis, liver disease, kidney disease, and morbid obesity. This study also examined multiple chronic conditions (MCC; 3 or more health conditions). MCC trends were further examined by sociodemographic factors to identify high-risk populations. Parallel analyses were performed for participants without a cancer history to provide a reference. RESULTS Among 30,728 cancers survivors, increasing trends were observed in the prevalence of hypertension, diabetes, kidney disease, liver disease, and morbid obesity, whereas decreasing prevalence trends were observed for ischemic heart disease, COPD, and hepatitis. Cancer survivors with MCC increased from 4.7 million in 2002 to 8.1 million in 2018 (the prevalence increased from 43.7% to 46.6%). The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the MCC prevalence also increased, although more slowly than among survivors. CONCLUSIONS The number of adult cancer survivors in the United States with comorbid illnesses has increased substantially over the past 2 decades. Optimal management of comorbid conditions and aggressive interventions for risk reduction may benefit the cancer survivor population.
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Affiliation(s)
- Changchuan Jiang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lei Deng
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Karr
- Department of Medicine, Mount Sinai Morningside/Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yumeng Wen
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuthi Perimbeti
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Charles L. Shapiro
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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16
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McGillivray HMK, Piccolo EEL, Wassersug RJ. "Partner", "Caregiver", or "Co-Survivor"-Might the Label We Give the Partners of Cancer Patients Affect the Health Outcome of the Patients and Their Partners? Curr Oncol 2021; 29:122-129. [PMID: 35049684 PMCID: PMC8774593 DOI: 10.3390/curroncol29010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Having a life partner significantly extends survival for most cancer patients. The label given to the partners of cancer patients may, however, influence the health of not just the patients but their partners. "Caregiver" is an increasingly common label for the partners of patients, but it carries an implicit burden. Referring to partners as "caregivers" may be detrimental to the partnerships, as it implies that the individuals are no longer able to be co-supportive. Recognizing this, there has been some effort to relabel cancer dyads as "co-survivors". However, many cancer patients are not comfortable being called a "survivor", and the same may apply to their partners. Cancer survivorship, we argue, could be enhanced by helping keep the bond between patients and their partners strong. This includes educating patients and partners about diverse coping strategies that individuals use when facing challenges to their health and wellbeing. We suggest that preemptive couples' counselling in cancer centers may benefit both patients and their partners.
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Affiliation(s)
| | | | - Richard J. Wassersug
- Department of Cellular and Physiological Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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17
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Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10204696. [PMID: 34682818 PMCID: PMC8539984 DOI: 10.3390/jcm10204696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.
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18
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Doose M, Mollica MA, Attai DJ, Nasso SF, Elena JW, Jacobsen PB, Tonorezos ES, Nekhlyudov L. Identifying and describing cancer survivors: Implications for cancer survivorship research and clinical care. Cancer 2021; 128:383-390. [PMID: 34597418 PMCID: PMC8738118 DOI: 10.1002/cncr.33937] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/27/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gathering information directly from cancer survivors has advanced our understanding of the cancer survivorship experience. However, it is unknown whether surveys can distinguish important subgroups of cancer survivors. This study aimed to describe the current landscape of survey questions used to identify and describe cancer survivors in national cross-sectional studies. METHODS Using publicly available databases, the authors identified national cross-sectional surveys used in the United States within the past 15 years that included a question on self-reported history of cancer. After abstracting questions and response items used to identify cancer survivors, they conducted a descriptive analysis. RESULTS The authors identified 14 national cross-sectional surveys, with half administered to the general population and the other half administered to cancer survivors. The most common question used to identify cancer survivors was "Have you ever been told by a doctor or other health professional that you had cancer?" Most surveys had questions asking participants to identify a single cancer type (n = 11), multiple prior cancer diagnoses or types (n = 11), and the time from diagnosis (n = 12). Treatment questions varied from active treatment status to specific treatments received. Questions addressing cancer stage (n = 2), subtypes (n = 1), metastatic status (n = 3), and recurrence (n = 4) were less frequently included. CONCLUSIONS There is no standard method for assessing self-reported cancer history, and this limits the ability to distinguish among potentially important subgroups of survivors. Future cross-sectional surveys that capture nuanced data elements, such as cancer types, stages/subtypes, metastatic/recurrent status, and treatments received, can help to fill important gaps in cancer survivorship research and clinical care.
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Affiliation(s)
- Michelle Doose
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Michelle A Mollica
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Deanna J Attai
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Emily S Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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19
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Jahnen M, Mynzak E, Meissner VH, Schiele S, Schulwitz H, Ankerst DP, Gschwend JE, Herkommer K, Dinkel A. Diversity of cancer-related identities in long-term prostate cancer survivors after radical prostatectomy. BMC Cancer 2021; 21:1041. [PMID: 34544381 PMCID: PMC8454161 DOI: 10.1186/s12885-021-08776-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Individuals affected by cancer need to integrate this experience into their personal biography as their life continues after primary therapy, leading to substantial changes in self-perception. This study identified factors uniquely associated with 5 different cancer-related identities in order to improve the understanding of how self-perception in men affected by prostate cancer is associated with certain clinical and psychosocial characteristics. METHODS In this cross-sectional study, long-term prostate cancer survivors after radical prostatectomy were asked to choose one of 5 cancer-related identities that described them best. Associations with sociodemographic, clinical, and psychological variables were investigated using multivariable logistic regression. RESULTS Three thousand three hundred forty-seven men (mean age 78.1 years) surveyed on average 15.6 years after prostatectomy were included. Most men favored the terms "someone who has had cancer" (43.9%) which was associated with a mild disease course, and "patient" (26.3%) which was associated with ongoing therapy and biochemical disease recurrence. The self-descriptions "cancer survivor" (16.8%), "cancer conqueror" (10.9%) and "victim" (2.1%) were less common. "Cancer survivor" was associated with high perceived disease severity (OR: 1.86 [1.44-2.40]). "Cancer survivor" and "cancer conqueror" were related to high benefit finding (OR: 1.89 [1.48-2.40], OR: 1.46 [1.12-1.89] respectively), and only "cancer conqueror" was associated with high well-being (OR: 1.84 [1.35-2.50]). Identification as "victim" was associated with a positive depression screening and low well-being (OR: 2.22 [1.15-4.31], OR: 0.38 [0.20-0.72] respectively) (all p < 0.05). CONCLUSIONS Although long-term survival is common among men affected by PCa, they display a large diversity in cancer-related identities, which are associated with unique clinical and psychological characteristics. These cancer-related identities and their distinctive properties are associated with psychological well-being even after a long follow-up.
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Affiliation(s)
- Matthias Jahnen
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Eike Mynzak
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helga Schulwitz
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Donna P Ankerst
- Department of Mathematics, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Langerstr.3, 81675, Munich, Germany.
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20
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MicroRNAs Patterns as Potential Tools for Diagnostic and Prognostic Follow-Up in Cancer Survivorship. Cells 2021; 10:cells10082069. [PMID: 34440837 PMCID: PMC8394126 DOI: 10.3390/cells10082069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Advances in screening methods and pharmacological treatments are increasing the life expectancy of cancer patients. During recent decades, the community of long-term disease-free cancer survivors (LCS) has grown exponentially, raising the issues related to cancer follow-up. Cancer relapse and other cancer-related diseases, as well as lifestyle, influence cancer survival. Recently, the regulatory role of microRNAs (miRNAs) in gene expression and their involvement in human diseases, including cancer, has been identified. Extracellular circulating miRNAs (ECmiRNAs) have been found in biological fluids and specific ECmiRNAs have been associated with cancer development and progression or with a therapy response. Here, we focus on the pivotal role of ECmiRNAs as biomarkers in cancer diagnosis and prognosis. Then, we discuss the relevance of ECmiRNAs expression in cancer survivors for the identification of specific ECmiRNAs profiles as potential tools to assess cancer outcome and to control LCS follow-up.
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21
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Dalton KL, Garland SN, Miller P, Miller B, Ambrose C, Wassersug RJ. Factors Associated with "Survivor Identity" in Men with Breast Cancer. ACTA ACUST UNITED AC 2021; 28:1696-1705. [PMID: 33946247 PMCID: PMC8161786 DOI: 10.3390/curroncol28030158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Cancer patients vary in their comfort with the label “survivor”. Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer “survivor”. Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the “survivor” label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term “survivor”, 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label “survivor” for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as “survivors” in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.
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Affiliation(s)
- Kathryn L. Dalton
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1B 3X9, Canada; (K.L.D.); (S.N.G.)
| | - Sheila N. Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1B 3X9, Canada; (K.L.D.); (S.N.G.)
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Peggy Miller
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Bret Miller
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Cheri Ambrose
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Richard J. Wassersug
- Department of Cellular & Physiological Science, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: ; Tel.: +1-604-563-9915
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22
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Wee M, Dau H, Gastonguay L, De Vera MA. How do individuals with colorectal cancer perceive the term "cancer survivor": a cross-sectional survey. J Cancer Surviv 2021; 16:257-268. [PMID: 33709303 DOI: 10.1007/s11764-021-01015-9] [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: 11/11/2020] [Accepted: 02/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are growing discussions regarding the term "cancer survivor," particularly how patients with cancer relate to it. OBJECTIVE To assess how individuals diagnosed with colorectal cancer (CRC) perceive the term "cancer survivor." METHODS We conducted an international cross-sectional study and, using social media, invited individuals who were ≥18 years; received a diagnosis for CRC; and can communicate in English. We administered an online survey comprising both quantitative (e.g., multiple choice) and qualitative (e.g., open-ended) questions. We used logistic regression to assess determinants of participants' perspectives towards the term "cancer survivor." Qualitative responses were analyzed using content analysis. RESULTS In all, 539 participants with CRC completed the survey, including 122 (22.6%) undergoing treatment and 417 (77.4%) who completed treatment. Participants who had completed treatment were four times more likely to relate with term "cancer survivor" compared to those undergoing treatment (adjusted odds ratio (aOR), 4.0; 95% confidence interval (CI) 2.4 to 6.7). Participants diagnosed with CRC ≥50 years were also more likely to relate with the term compared to those diagnosed < 50 years (aOR, 1.88; 95% (CI) 1.2 to 3.0). Analysis of open-ended survey responses revealed aversion, discomfort, indifference, reluctance, and acceptance as themes which capture the spectrum of feelings towards the term "cancer survivor." CONCLUSION Perspectives of individuals with CRC towards the term "cancer survivor" differ according to treatment status and age of diagnosis. IMPLICATION OF CANCER SURVIVORS Our study amplifies voices of the CRC community towards reconsideration of the term "cancer survivor", considering the implications of treatment status and age in highlighting the importance of language.
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Affiliation(s)
- Myles Wee
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Hallie Dau
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Louise Gastonguay
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada. .,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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23
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MacDonald C, Theurer JA, Doyle PC. "Cured" but not "healed": The application of principles of palliative care to cancer survivorship. Soc Sci Med 2021; 275:113802. [PMID: 33714794 DOI: 10.1016/j.socscimed.2021.113802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Application of principles of palliative care to the concept of survivorship may serve to establish an interdisciplinary approach to guide those treated for cancer through the experience of being "cured" but not "healed". Valuable lessons may be garnered from palliative care if its principles are considered within the context of survivorship. This work aims to define key terms including cured, healed, survivorship, and quality of life (QoL) and delineate the central tenets of palliative care and disease-modifying care. Since pursuit of a cure tends to dominate provision of oncological care, Western society's prevailing death denying attitudes often equate to the prioritization of advanced medial treatment to postpone death. Accordingly, the "modern paradox" of medicine (Cassell, 2004) is examined in consideration of the suffering that often results from advanced medical treatment that is intended to alleviate the cause of suffering and ultimately, "deny" death. However, owing to the profound consequences of advanced medical treatment and the associated losses of function concomitant with cancer, there is an apparent need for a framework of care that attends to these survivorship issues. When the experience of being cured but not healed is articulated through a theoretical discussion of liminality and the "remission society" (Frank, 1995), the applicability of palliative care to survivorship care becomes apparent. By embracing principles of palliative care, survivorship care may be guided by a theoretical foundation that provides cancer survivors with care that supports increased QoL, biopsychosocial symptom management, and a holistic perspective of the illness experience. Accordingly, application of palliative care to survivorship may establish congruence between notions of cured and healed.
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Affiliation(s)
- Chelsea MacDonald
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, London, ON, N6G 1H1, Canada.
| | - Julie A Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, N6G 1H1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, N6A 5W9, Canada
| | - Philip C Doyle
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, London, ON, N6G 1H1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, N6A 5W9, Canada; Department of Otolaryngology - Head and Neck Surgery Stanford University School of Medicine, Stanford, CA, 94305, USA
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24
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Ueland V, Rørtveit K, Dysvik E, Furnes B. Life after cancer treatment - existential experiences of longing. Int J Qual Stud Health Well-being 2020; 15:1838041. [PMID: 33112718 PMCID: PMC7599008 DOI: 10.1080/17482631.2020.1838041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The study aimed to gain insight into existential longing as experienced by people treated for cancer. Method: An exploratory phenomenological–hermeneutical design was used, and data were collected through in-depth interviews with 21 people recruited from a cancer organization. Results: Three themes emerged: longing to be oneself, longing for relief from suffering, and longing for rootedness. The theoretical understanding of well-being developed by Todres and Galvin was used to illuminate how the life-fulfilling power of longing is inherent in dwelling–mobility. Conclusions: During the theoretical interpretation and discussion of these findings, a new analytic step revealed a state of uncertainty that can influence longing. The findings of this study may help fill the gap in the current health-care approach to cancer survivors by highlighting the importance of a new professional perspective of listening to patients describe their existential burden. Such an approach may create greater clarity and thereby allow longing to flow more freely towards future possibilities and well-being.
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Affiliation(s)
- Venke Ueland
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
| | - Kristine Rørtveit
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway.,Researcher of Psychiatric Nursing at Department of Research, Stavanger University Hospital , Stavanger, Norway
| | - Elin Dysvik
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
| | - Bodil Furnes
- Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
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25
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Attai DJ. Action Items for Breast Cancer Awareness Month. J Patient Cent Res Rev 2020; 7:291-294. [PMID: 33163548 PMCID: PMC7644128 DOI: 10.17294/2330-0698.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Plage S. Cancer survivorship reimagined: A qualitative study on evolving interpretative repertoires of cancer and survivorship using participant-produced photography. Eur J Cancer Care (Engl) 2020; 29:e13320. [PMID: 32875657 DOI: 10.1111/ecc.13320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE As more people live with cancer and for longer time periods, it is important to understand the growing diversity in lived experiences of survivorship. This study explored interpretative repertoires around cancer and their implications for survivorship from the perspectives of people with cancer to inform communication in cancer care. METHODS The sample included 11 participants (7 male, 4 female) with diverse cancer diagnoses and prognoses recruited through two public cancer care centres in Queensland, Australia. A narrative analysis of sequential interviews (n = 20) and photographs produced by the participants (n = 455) was conducted. RESULTS Four interrelated metaphors and narratives emerged in the interpretative repertoires of participants: cancer as a presence, survivorship as a struggle for meaning, survivorship as movement and survivorship as confluence. Continuities with "battle" and "journey" terminology were evident. However, these were subtly adapted and reimagined within participants' own lived experience. This was particularly pronounced among participants with incurable cancers, as they strived to make sense of contradictions within cancer survivorship. CONCLUSION The findings offer in-depth insights into the complexity and nuances of cancer survivorship. Such insights can contribute to facilitating successful and open-ended communication between cancer care providers, people with cancer and their families.
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Affiliation(s)
- Stefanie Plage
- Centre for Social Research in Health (CSRH), The University of New South Wales, Kensington, NSW, Australia
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Ueland V, Dysvik E, Rørtveit K, Furnes B. Homeworld/Alienworld: a qualitative study about existential experiences after cancer treatment. Scand J Caring Sci 2020; 35:701-709. [PMID: 32808312 DOI: 10.1111/scs.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND As a group, cancer survivors experience significant vulnerability and existential challenges. The biomedical approach dominating health care is insufficient to meet such existential challenges in an individualistic, holistic way. OBJECTIVE This study aimed to explore the existential experiences of those treated for different cancers. METHODS An exploratory phenomenological-hermeneutical design was used to obtain an understanding of existential experiences after cancer treatment. Data were collected through in-depth interviews with 21 individuals who represented a purposive sample and were recruited from a cancer organisation. RESULTS Three overriding themes emerged from the phenomenological-hermeneutical analysis are as follows: Experiencing an unfamiliar tiredness; Experiencing not being fully oneself; and Experiencing a feeling of being alone. CONCLUSIONS Existential suffering after cancer treatment involves living on the edge of the old homeworld and the experience of a new alienworld. Individuals undergoing such suffering need a transformational process, from the alienworld to the homeworld, which must be supported by the healthcare system. IMPLICATIONS FOR PRACTICE To facilitate the transformational process, healthcare professionals should communicate with patients throughout their cancer journey about how their existential experiences have been integrated into their lifeworld, allowing them to tell their own story from the perspective of lifeworld brokenness.
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Affiliation(s)
- Venke Ueland
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Elin Dysvik
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kristine Rørtveit
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Bodil Furnes
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Owusu C, Nock NL, Hergenroeder P, Austin K, Bennet E, Cerne S, Moore H, Petkac J, Schluchter M, Schmitz KH, Webb Hooper M, Atkins L, Asagba O, Wimbley L, Berger NA. IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Rationale, design and methods. Contemp Clin Trials 2020; 92:106001. [PMID: 32304828 PMCID: PMC7325580 DOI: 10.1016/j.cct.2020.106001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND African Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS. METHODS This is a mixed-methods study that includes a randomized-controlled trial, "IMPROVE", to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 weeks, unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms. DISCUSSION Results of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Nora L Nock
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, United States of America
| | - Paul Hergenroeder
- Department of Medicine, Division of Hematology/Oncology, MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Kristina Austin
- The Gathering Place, Beachwood, OH, United States of America
| | | | - Stephen Cerne
- The Gathering Place, Beachwood, OH, United States of America
| | - Halle Moore
- Cleveland Clinic, Department of Hematology/Oncology, Cleveland, OH, United States of America
| | - Jean Petkac
- University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Department of Population and Quantitative Health Sciences, CWRU, Cleveland, OH, United States of America
| | - Kathryn H Schmitz
- Penn State University College of Medicine, Hershey, PA, United States of America
| | - Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Lindsay Atkins
- California Baptist University, Riverside, CA, United States of America
| | - Oghenerukeme Asagba
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Leonard Wimbley
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, United States of America
| | - Nathan A Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
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Cherian R, Le G, Whall J, Gomez S, Sarkar U. Content shared on social media for national cancer survivors day 2018. PLoS One 2020; 15:e0226194. [PMID: 31940384 PMCID: PMC6961846 DOI: 10.1371/journal.pone.0226194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies estimate that the number of cancer survivors will double by 2050 due to improvements in diagnostic accuracy and treatment efficacy. Despite the growing population of cancer survivors, there is a paucity of research regarding how these individuals experience the transition from active treatment to long-term surveillance. While research has explored this transition from more organized venues, such as support groups for cancer survivors, this paper explores the discourses surrounding cancer survivorship on social media, paying particular attention to how individuals who identify as cancer survivors represent their experience. METHODS We identified social media posts relating to cancer survivorship on Twitter and Instagram in early June 2018, in order to coincide with National Cancer Survivorship Day on June 3, 2018. We used nine pre-selected hashtags to identify content. For each hashtag, we manually collected the 150 most recent posts from Twitter and the 100 most recent plus the top 9 posts from Instagram. Our preliminary sample included 1172 posts; after eliminating posts from one hashtag due to irrelevance, we were left with 1063 posts. We randomly sampled 200 of these to create a subset for analysis; after review for irrelevant posts, 193 posts remained for analysis (118 from Instagram and 75 from Twitter). We utilized a grounded theory approach to analyze the posts, first open-coding a subset to develop a codebook, then applying the codebook to the rest of the sample and finally memo writing to develop themes. RESULTS Overall, there is substantial difference in the tone and thematic content between Instagram and Twitter posts, Instagram takes on a more narrative form that represents journeys through cancer treatment and subsequent survivorship, whereas Twitter is more factual, leaning towards advocacy, awareness and fundraising. In terms of content type, 120 posts (62%) of the sample were images, of which 42 (35%) were images of the individual posting and 28 (23%) were images of patients posted by family or friends. Of the remaining images, 14 (12%) were of support groups and 7 (6%) were of family or friends. We identified four salient themes through analysis of the social media posts from Twitter and Instagram: social support, celebrating milestones and honoring survivors, expressing identity, and renewal vs. rebirth. DISCUSSION We observed a marked relationship between physical appearance, functional status and survivorship. Additionally, our findings suggest the importance of social support for cancer patients and survivors as well as the role social media can pay in identity formation. CONCLUSION Our findings suggest that individuals who identify as survivors on social media define their identity fluidly, incorporating elements of physical, emotional and psychological health as well as autonomy.
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Affiliation(s)
- Roy Cherian
- Department of Medicine, Division of General Internal Medicine University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Gem Le
- Department of Medicine, Division of General Internal Medicine University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - James Whall
- California Northstate University College of Medicine, Elk Grove, California, United States of America
| | - Scarlett Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
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