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Wu J, Li X, Zhang H, Lin L, Li M, Chen G, Wang C. Development and validation of a prediction model for all-cause mortality in maintenance dialysis patients: a multicenter retrospective cohort study. Ren Fail 2024; 46:2322039. [PMID: 38415296 PMCID: PMC10903750 DOI: 10.1080/0886022x.2024.2322039] [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: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The mortality risk varies considerably among individual dialysis patients. This study aimed to develop a user-friendly predictive model for predicting all-cause mortality among dialysis patients. METHODS Retrospective data regarding dialysis patients were obtained from two hospitals. Patients in training cohort (N = 1421) were recruited from the Fifth Affiliated Hospital of Sun Yat-sen University, and patients in external validation cohort (N = 429) were recruited from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The follow-up endpoint event was all-cause death. Variables were selected by LASSO-Cox regression, and the model was constructed by Cox regression, which was presented in the form of nomogram and web-based tool. The discrimination and accuracy of the prediction model were assessed using C-indexes and calibration curves, while the clinical value was assessed by decision curve analysis (DCA). RESULTS The best predictors of 1-, 3-, and 5-year all-cause mortality contained nine independent factors, including age, body mass index (BMI), diabetes mellitus (DM), cardiovascular disease (CVD), cancer, urine volume, hemoglobin (HGB), albumin (ALB), and pleural effusion (PE). The 1-, 3-, and 5-year C-indexes in the training set (0.840, 0.866, and 0.846, respectively) and validation set (0.746, 0.783, and 0.741, respectively) were consistent with comparable performance. According to the calibration curve, the nomogram predicted survival accurately matched the actual survival rate. The DCA showed the nomogram got more clinical net benefit in both the training and validation sets. CONCLUSIONS The effective and convenient nomogram may help clinicians quantify the risk of mortality in maintenance dialysis patients.
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Affiliation(s)
- Jingcan Wu
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xuehong Li
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hong Zhang
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Lin Lin
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Gangyi Chen
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng Wang
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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Cao C, Yang L, Schmitz KH, Ligibel JA. Prevalence and Cancer-Specific Patterns of Functional Disability Among US Cancer Survivors, 2017-2022. J Clin Oncol 2024; 42:2257-2270. [PMID: 38574313 DOI: 10.1200/jco.23.02536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To examine the prevalence and cancer-specific patterns of functional disabilities among US cancer survivors. METHODS Data from 47,768 cancer survivors and 2,432,754 noncancer adults age 18 years and older from the 2017 to 2022 Behavioral Risk Factor Surveillance System were analyzed. Functional disabilities assessed included mobility disability (ie, serious difficulty walking or climbing stairs) and self-care disability (ie, self-reported difficulty dressing or bathing). Multivariable logistic regression models were used to assess the associations between functional disabilities and sociodemographic, lifestyle, and health-related factors. RESULTS Cancer survivors tended to be older and non-Hispanic White than noncancer adults. The prevalence of mobility disability (27.9% v 13.4%) and self-care disability (7.4% v 3.8%) were higher among cancer survivors compared with noncancer adults. After multivariable adjustments, cancer survivors were more likely to report mobility (odds ratio [OR], 1.21 [95% CI, 1.16 to 1.26]) and self-care (OR, 1.19 [95% CI, 1.10 to 1.29]) disability than noncancer adults. The prevalence of mobility (34.9% v 26.3%) and self-care disability (9.8% v 6.7%) was higher in cancer survivors who were receiving active cancer treatment than in those who had completed cancer treatment. Higher prevalence of mobility and self-care disabilities was observed in cancer survivors who were racial/ethnic minorities and with higher BMI, low physical activity, lower levels of education and/or income, comorbidities, and those experiencing cancer/treatment-related pain. Patterns of mobility and self-care disabilities varied across cancer types. CONCLUSION Over a quarter of US cancer survivors reported mobility disability, and nearly 10% reported self-care disability, with patterns varying across cancer types and treatment status. Racial/ethnic minorities, along with underserved groups and individuals with unhealthy lifestyles or comorbidities, were notably more affected by functional disabilities, underscoring the need for targeted disability prevention efforts.
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Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Kao Y, Lin YJ, Weng SF, Wang JJ, Lee IC, Huang CC. Health-related quality of life by veterans RAND 12 and healthcare resource utilization in cancer patients with sleep disorders: insights from the Medical Expenditure Panel Survey. Support Care Cancer 2024; 32:443. [PMID: 38896166 DOI: 10.1007/s00520-024-08658-1] [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: 12/25/2023] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aims to investigate the joint effects of cancer and sleep disorders on the health-related quality of life (HRQoL), healthcare resource utilization, and expenditures among US adults. METHODS Utilizing the 2018-2019 Medical Expenditure Panel Survey (MEPS) database, a sample of 25,274 participants was categorized into four groups based on cancer and sleep disorder status. HRQoL was assessed using the VR-12 questionnaire. Generalized linear model (GLM) with a log-linear regression model combined gamma distribution was applied for the analysis of healthcare expenditure data. RESULTS Individuals with both cancer and sleep disorders (C+/S+) exhibited notably lower physical health (PCS) and mental health (MCS) scores-1.45 and 1.87 points lower, respectively. They also showed significantly increased clinic visits (2.12 times), outpatient visits (3.59 times), emergency visits (1.69 times), and total medical expenditures (2.08 times) compared to those without cancer or sleep disorders (C-/S-). In contrast, individuals with sleep disorders alone (C-/S+) had the highest number of prescription drug usage (2.26 times) and home health care days (1.76 times) compared to the reference group (C-/S-). CONCLUSIONS Regardless of cancer presence, individuals with sleep disorders consistently reported compromised HRQoL. Furthermore, those with cancer and sleep disorders experienced heightened healthcare resource utilization, underscoring the considerable impact of sleep disorders on overall quality of life. IMPLICATIONS FOR CANCER SURVIVORS The findings of this study address the importance of sleep disorders among cancer patients and their potential implications for cancer care. Healthcare professionals should prioritize screening, education, and tailored interventions to support sleep health in this population.
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Affiliation(s)
- Yuan Kao
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medicine Science Industries, Chang Jung Christian University, Tainan, Taiwan
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
- School of Medicine, College of Medicine, National SunYat-sen University, Kaohsiung, Taiwan
| | - Ying-Jia Lin
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - I-Chen Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- School of Medicine, College of Medicine, National SunYat-sen University, Kaohsiung, Taiwan.
- Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Cao C, Yang L, Nohria A, Mayer EL, Partridge AH, Ligibel JA. Association of N-terminal pro-brain natriuretic peptide with survival among US cancer survivors. J Natl Cancer Inst 2024; 116:938-947. [PMID: 38299668 PMCID: PMC11160495 DOI: 10.1093/jnci/djae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cardiac biomarker associated with the risk of heart failure and death in the general population, but it has not been explored in cancer survivors. METHODS Using a US nationally representative sample of adults 20 years of age and older from the National Health and Nutrition Examination Survey from 1999 to 2004, this study compared NT-proBNP levels between adults without cancer (n = 12 574) and adult cancer survivors (n = 787). It examined the association of NT-proBNP with all-cause and cause-specific mortality among cancer survivors. RESULTS Cancer survivors had higher NT-proBNP levels than adults without cancer (median [interquartile range] = 125.4 pg/mL [52.4-286.0] vs 43.2 pg/mL [20.3-95.0]). In particular, survivors of breast, prostate, and colorectal cancers had higher NT-proBNP levels than adults without cancer (multivariable-adjusted P < .05). In total, 471 survivors died (141 from cancer; 95 from cardiac disease) during a median follow-up period of 13.4 years (9393 person-years). Among cancer survivors, higher NT-proBNP levels were statistically associated with increased risks of all-cause death (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.18 to 1.46) and cardiac death (HR = 1.55, 95% CI = 1.21 to 2.00) but not with death from cancer (HR = 1.10, 95% CI = 0.92 to 1.32]). Higher NT-proBNP levels were associated with elevated overall mortality in survivors of prostate cancer (HR = 1.49, 95% CI = 1.22 to 1.81) and colorectal cancer (HR = 1.78, 95% CI = 1.00 to 3.16) (P = .169 for interaction). Nonlinear dose-response relationships were observed between NT-proBNP and mortality, with statistically significant relationships emerging above 125 pg/mL. CONCLUSIONS Cancer survivors had higher NT-proBNP levels than adults without cancer, and elevated NT-proBNP levels were associated with higher risks of all-cause and cardiac mortality in cancer survivors.
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Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer A Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Singh A, Gallaway MS, Rascon A. A comparison of chronic conditions and health characteristics between cancer survivors and non-cancer survivors. Chronic Illn 2024; 20:349-359. [PMID: 37724026 PMCID: PMC11046444 DOI: 10.1177/17423953231180191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe demographics, risk factors, and comorbid health conditions in adult cancer survivors. METHOD We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed. RESULTS Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors. DISCUSSION These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life.
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Affiliation(s)
- Anjin Singh
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
- CDC Foundation, 600 Peachtree St NE #100, Atlanta, GA, 30308
| | - Michael Shayne Gallaway
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333
| | - Addey Rascon
- Arizona Department of Health Services, 150 N. 18 Ave, Phoenix, AZ, 85007
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Singh J, Iqbal SA, Gajula S, Raghavan P, Rajpal S, Khan A. Assessment of Chemotherapy-Induced Cardiac Dysfunction in Breast Cancer Patients: A Prospective Study. Cureus 2024; 16:e59461. [PMID: 38826896 PMCID: PMC11141790 DOI: 10.7759/cureus.59461] [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] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Background Advances in cancer treatment have markedly improved survival rates but have also heightened morbidity due to treatment-related side effects. Despite this, the literature remains scarce on predicting the incidence of acute cardiac toxicity resulting from chemotherapy. We conducted a prospective evaluation to assess the incidence, timing, clinical correlates, global longitudinal strain (GLS), and response to heart failure (HF) therapy in patients experiencing cardiotoxicity. Aims and objectives Our study aimed to assess the cardiovascular complications of cancer therapy in breast cancer patients, with particular emphasis on therapy-related cardiac dysfunction. Materials and methods We conducted a prospective observational study to detect chemotherapy-related cardiac dysfunction (CTRCD) in breast cancer patients attending the outpatient department (OPD) or admitted to Dayanand Medical College and Hospital (DMCH), Ludhiana, Punjab, between March 1, 2020, and October 31, 2021. We assessed left ventricular ejection fraction (LVEF) at baseline, mid-chemotherapy, and post-chemotherapy. Patients who developed left ventricular dysfunction (LVD) had their chemotherapy regimen modified and were initiated on HF therapy. Results Ninety-seven patients (mean age: 50.74±10.30 years) were enrolled and categorized into the LVD group (n=13) and non-LVD group (n=84). CTRCD developed in 13 patients (13.4%). Patients with estrogen receptor (ER) positive, progesterone receptor (PR) positive, and human epidermal growth factor receptor 2 (HER2) positive status, as well as those in cancer stages III and IV, are at higher risk of developing LV dysfunction. Among the 13 patients, 10 (77%) experienced complete recovery, while three (23%) had partial recovery. Markers for partial recovery included cancer stages III-IV, younger age, lower body mass index (BMI), lower radiotherapy dosage, lower mean chemotherapy dosage, and left breast involvement. Conclusion Our findings suggest that acute cardiotoxicity is not linked to the cumulative dose of anthracyclines. Early detection, modification of chemotherapy regimens, and prompt initiation of CTRCD therapy can lead to substantial recovery of cardiac dysfunction.
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Affiliation(s)
- Jasvinder Singh
- Cardiology and Electrophysiology, Asian Institute of Gastroenterology (AIG) Hospital, Hyderabad, IND
| | - Syed Abid Iqbal
- Internal Medicine, Asian Institute of Gastroenterology (AIG) Hospital, Hyderabad, IND
| | - Sahini Gajula
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | | | - Shreyaa Rajpal
- Internal Medicine, Osmania Medical College, Hyderabad, IND
| | - Aadil Khan
- Trauma Surgery, OSF St Francis Medical Centre, University of Illinois College of Medicine, Peoria, USA
- Cardiology, University of Illinois Chicago, Chicago, USA
- Internal Medicine, Lala Lajpat Rai (LLR) Hospital, Kanpur, IND
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Koç Z, Kaplan E, Tanrıverdi D. The effectiveness of telehealth programs on the mental health of women with breast cancer: A systematic review. J Telemed Telecare 2024; 30:405-419. [PMID: 35108131 DOI: 10.1177/1357633x211069663] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: The purpose of this systematic review is to determine the evidence-based information and results about the effectiveness of telehealth programs on the mental health of women with breast cancer. Methods: The research process was carried out using PRISMA guidelines. Randomized controlled trials with available abstract and full text, which were published in English with the keywords "telehealth," "telemedicine," "web-based therapy," "telepsychiatry," "online therapy" and "breast cancer" in Pub Med, PsycINFO, Medline, Science Direct, Scopus, Web of Sciences and Cochrane databases between 2015-2019 were searced. As a result of the evaluations, the research was completed with 16 studies meeting the research criteria. Results: There was strong evidence for reduce the fear of relapse of cancer, depressive symptoms and severity of depression, distress, intrusive thoughts, anxiety, sleep disorder, insomnia, improve quality of life and for improve cognitive functions, improve psychological strength and sleep quality of telehealth programs in women with breast cancer. Furthermore, evidence was found for increase psychological health, functionality, optimism and control over the future, positive mood and life appreciation, and drug compliance of these programs. Conclusion: This review found evidence for the effectiveness of telehealth programs on the mental problems of women with breast cancer. In this sense, it is recommended to expand the use of telehealth programs, which can save time and cost, are accessible and easily applicable by nurses, to improve the mental health of women with breast cancer, and further studies are recommended.
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Affiliation(s)
- Zeynep Koç
- Faculty of Health Sciences, Department of Nursing, Gaziantep University, Gaziantep, Turkey
| | - Ece Kaplan
- Faculty of Health Sciences, Department of Nursing, Gaziantep University, Gaziantep, Turkey
| | - Derya Tanrıverdi
- Faculty of Health Sciences, Department of Nursing, Gaziantep University, Gaziantep, Turkey
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Romero Acero LM, Nanna M. The added value of left atrial strain in cancer-therapy-related cardiac dysfunction. Echocardiography 2024; 41:e15792. [PMID: 38456254 DOI: 10.1111/echo.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Laura-M Romero Acero
- Albert Einstein Coll of Medicine/Cardiac Care and Vascular Medicine, Bronx, New York, USA
| | - Michele Nanna
- Albert Einstein Coll of Medicine/Cardiac Care and Vascular Medicine, Bronx, New York, USA
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Weaver KE, Dressler EV, Smith S, Nightingale CL, Klepin HD, Lee SC, Wells BJ, Hundley WG, DeMari JA, Price SN, Foraker RE. Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives. BMC Cancer 2024; 24:158. [PMID: 38297229 PMCID: PMC10829276 DOI: 10.1186/s12885-024-11912-8] [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: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. METHODS This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. RESULTS Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). CONCLUSIONS Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. TRIAL REGISTRATION NCT03935282, Registered 10/01/2020.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, 417 N 11th St 4th Floor, Richmond, VA, 23219, USA
| | - Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO, 63110, USA
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10
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Plasencia G, Gray SC, Hall IJ, Smith JL. Multimorbidity clusters in adults 50 years or older with and without a history of cancer: National Health Interview Survey, 2018. BMC Geriatr 2024; 24:50. [PMID: 38212690 PMCID: PMC10785430 DOI: 10.1186/s12877-023-04603-9] [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: 07/31/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Multimorbidity is increasing among adults in the United States. Yet limited research has examined multimorbidity clusters in persons aged 50 years and older with and without a history of cancer. An increased understanding of multimorbidity clusters may improve the cancer survivorship experience for survivors with multimorbidity. METHODS We identified 7580 adults aged 50 years and older with 2 or more diseases-including 811 adults with a history of primary breast, colorectal, cervical, prostate, or lung cancer-from the 2018 National Health Interview Survey. Exploratory factor analysis identified clusters of multimorbidity among cancer survivors and individuals without a history of cancer (controls). Frequency tables and chi-square tests were performed to determine overall differences in sociodemographic characteristics, health-related characteristics, and multimorbidity between groups. RESULTS Cancer survivors reported a higher prevalence of having 4 or more diseases compared to controls (57% and 38%, respectively). Our analysis identified 6 clusters for cancer survivors and 4 clusters for controls. Three clusters (pulmonary, cardiac, and liver) included the same diseases for cancer survivors and controls. CONCLUSIONS Diseases clustered differently across adults ≥ 50 years of age with and without a history of cancer. Findings from this study may be used to inform clinical care, increase the development and dissemination of multilevel public health interventions, escalate system improvements, and initiate innovative policy reform.
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Affiliation(s)
- Gabriela Plasencia
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Department of Family Medicine & Community Health, Duke University Medical Center, Durham, NC, USA.
- National Clinician Scholars Program, Duke University, Durham, NC, USA.
| | - Simone C Gray
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ingrid J Hall
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Zhao T, Jia W, Zhao C, Wu Z. Survival benefit of surgery for second primary esophageal cancer following gastrointestinal cancer: a population-based study. J Gastrointest Surg 2024; 28:1-9. [PMID: 38353068 DOI: 10.1016/j.gassur.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND The incidence of second primary malignancy is increasing. However, although there is some information on second primary esophageal cancer (SPEC) itself, there is no study or guideline on the use of surgery for SPEC after gastrointestinal cancer (SPEC-GC). Thus, this study aimed to gather evidence for the benefits of surgery by analyzing a national cohort and determining the prognostic factors and clinical treatment decisions for SPEC-GC. METHODS Data for patients with SPEC-GC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The prognostic factors of SPEC-GC were investigated by stepwise Cox proportional hazards regression and Kaplan-Meier analyses for overall survival and cancer-specific survival. RESULTS A total of 8308 patients with SPEC were selected, including 582 patients with SPEC-GC. Multivariate analysis revealed that surgery, year of diagnosis, scope of regional lymph node surgery, tumor differentiation grade, SEER historic stage, and triple therapy were significant predictors of survival outcomes (P < .05). Surgery seemed to improve the prognosis of patients with SPEC-GC significantly compared with no surgery and chemoradiotherapy (P < .001). CONCLUSIONS Surgery should be considered as the main treatment for SPEC-GC. Surgery, year of diagnosis, scope of regional lymph node surgery, tumor differentiation grade, SEER historic stage, and triple therapy were found to be independent prognostic factors for these patients. These factors should be considered in the clinical diagnosis and treatment of SPEC-GC.
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Affiliation(s)
- Tianhao Zhao
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Wenxin Jia
- Department of Mental Health, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Chun Zhao
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Zhijun Wu
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China.
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12
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Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA. Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:2018-2031. [PMID: 37499186 DOI: 10.1093/eurjpc/zwad243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. METHODS AND RESULTS We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. CONCLUSION Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. REGISTRATION CRD42022298741.
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Affiliation(s)
- Akhmetzhan Galimzhanov
- Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
| | - Sedralmontaha Istanbuly
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Benay Ozbay
- Basaksehir Cam and Sakura State Hospital Department of Cardiology, Istanbul, Turkey
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Meral Kayikcioglu
- Department of Cardiology, Faculty of Medicine, 60521 Ege University, Izmir, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
- Department of Cardiology, Erasmus MC, Thorax Center, Erasmus University, Rotterdam, The Netherlands
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Husam Abdel-Qadir
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK
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13
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Del Cid Fratti J, Paleru V, Bajaj M, Bhardwaj C. The toxic tango: TKI and TCI cardiotoxicities. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:44. [PMID: 38057847 DOI: 10.1186/s40959-022-00152-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 12/27/2022] [Indexed: 12/08/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) and Tyrosine kinase inhibitors (TKI) are effective for several types of cancers, but they can have several cardiotoxicity sides effects. We present a case of TKI-ICI toxicity resulting in multiorgan inflammatory syndrome with myocarditis and thrombotic STEMI that were successfully treated with high-dose steroids and PCI. CASE PRESENTATION Seventy-two year-old man patient treated with on pembrolizumab 200 mg IV every 3 weeks and Axitinib 5 mg PO q12h for the past 5 months complained of acute shortness of breath, altered mental status, and chronic diarrhea. Coronary angiography demonstrated a thrombotic lesion in the right coronary artery (RCA) that was treated successfully with percutaneous coronary intervention (PCI). Despite PCI he continued to complain of shortness of breath further workup with Cardiac MRI (CMR) was obtained showed an ejection fraction of 38%, small pericardial effusion, and delayed gadolinium enhancement (DGE) in the inferior wall suggestive of myocarditis. An empirical trial of high-dose steroids improved all patient symptoms and ejection fraction; therefore, the chemotherapy regimen was changed. CONCLUSION This case report highlights the potential vasculogenic effects of Axitinib and immune-related myocarditis of pembrolizumab. Cardiologists and oncologists should be vigilant for the cardiotoxic effects of Axitinib and pembrolizumab.
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Affiliation(s)
- Juan Del Cid Fratti
- Cardiology Department, OSF Healthcare/ University of Illinois at Peoria, Peoria, IL, USA.
| | - Vijaysree Paleru
- Cardiology Department, OSF Healthcare/ University of Illinois at Peoria, Peoria, IL, USA
| | - Madhuri Bajaj
- Oncology Department, OSF Healthcare/ University of Illinois at Peoria, Peoria, IL, USA
| | - Chetan Bhardwaj
- Cardiology Department, OSF Healthcare/ University of Illinois at Peoria, Peoria, IL, USA
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14
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Kume M, Ahmad A, DeFea KA, Vagner J, Dussor G, Boitano S, Price TJ. Protease-Activated Receptor 2 (PAR2) Expressed in Sensory Neurons Contributes to Signs of Pain and Neuropathy in Paclitaxel Treated Mice. THE JOURNAL OF PAIN 2023; 24:1980-1993. [PMID: 37315729 PMCID: PMC10615692 DOI: 10.1016/j.jpain.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting side effect of cancer therapy. Protease-activated receptor 2 (PAR2) is implicated in a variety of pathologies, including CIPN. In this study, we demonstrate the role of PAR2 expressed in sensory neurons in a paclitaxel (PTX)-induced model of CIPN in mice. PAR2 knockout/wildtype (WT) mice and mice with PAR2 ablated in sensory neurons were treated with PTX administered via intraperitoneal injection. In vivo behavioral studies were done in mice using von Frey filaments and the Mouse Grimace Scale. We then examined immunohistochemical staining of dorsal root ganglion (DRG) and hind paw skin samples from CIPN mice to measure satellite cell gliosis and intra-epidermal nerve fiber (IENF) density. The pharmacological reversal of CIPN pain was tested with the PAR2 antagonist C781. Mechanical allodynia caused by PTX treatment was alleviated in PAR2 knockout mice of both sexes. In the PAR2 sensory neuronal conditional knockout (cKO) mice, both mechanical allodynia and facial grimacing were attenuated in mice of both sexes. In the DRG of the PTX-treated PAR2 cKO mice, satellite glial cell activation was reduced compared to control mice. IENF density analysis of the skin showed that the PTX-treated control mice had a reduction in nerve fiber density while the PAR2 cKO mice had a comparable skin innervation as the vehicle-treated animals. Similar results were seen with satellite cell gliosis in the DRG, where gliosis induced by PTX was absent in PAR cKO mice. Finally, C781 was able to transiently reverse established PTX-evoked mechanical allodynia. PERSPECTIVE: Our work demonstrates that PAR2 expressed in sensory neurons plays a key role in PTX-induced mechanical allodynia, spontaneous pain, and signs of neuropathy, suggesting PAR2 as a possible therapeutic target in multiple aspects of PTX CIPN.
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Affiliation(s)
- Moeno Kume
- University of Texas at Dallas, Department of Neuroscience and Center for Advanced Pain Studies
| | - Ayesha Ahmad
- University of Texas at Dallas, Department of Neuroscience and Center for Advanced Pain Studies
| | | | | | - Gregory Dussor
- University of Texas at Dallas, Department of Neuroscience and Center for Advanced Pain Studies
| | - Scott Boitano
- University of Arizona Bio5 Research Institute
- University of Arizona Heath Sciences, Asthma and Airway Disease Research Center
- University of Arizona Heath Sciences, Department of Physiology
| | - Theodore J. Price
- University of Texas at Dallas, Department of Neuroscience and Center for Advanced Pain Studies
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15
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Pituskin E, Foulkes SJ, Cox-Kennett N, Driga A, Dimitry R, Thompson RB, Kirkham A, Prado C, Gyenes G, Haykowsky MJ. Cardio-oncology and Cancer Rehabilitation: Is an Integrated Approach Possible? Can J Cardiol 2023; 39:S315-S322. [PMID: 37758015 DOI: 10.1016/j.cjca.2023.09.024] [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: 06/20/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
With significant improvements in the understanding of cancer biology, improved detection, and the use of novel adjuvant therapies, each year more Canadians are surviving a cancer diagnosis. Despite their effectiveness these therapies often result in short- and long-term deleterious effects to major organ systems, particularly cardiovascular. Cardio-oncology is an emerging field of study with the aim to improve cardiovascular health across the oncology disease spectrum. International guidelines distinguish "cardio-oncology" rehabilitation from "cancer" rehabilitation, but how this is navigated is currently unknown. How such care should be assessed and integrated acutely or in the longer term remains unknown. Accordingly, the aim of this article is to consider the cancer patient's needs beyond the scope of cardio-oncology rehabilitation to holistically integrate cancer rehabilitation across the disease trajectory.
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Affiliation(s)
- Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephen J Foulkes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy Driga
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | - Rebecca Dimitry
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | | | - Amy Kirkham
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada
| | - Carla Prado
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Gabor Gyenes
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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16
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Becevic M, Anbari AB, McElroy JA. It's Not Always Easy: Cancer Survivorship Care in Primary Care Settings. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1592-1599. [PMID: 37133797 DOI: 10.1007/s13187-023-02304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
By 2040, an anticipated 26.1 million people with a history of cancer will be part of the healthcare system. The purpose of this study was to explore Missouri-based non-oncology clinicians' perspectives on caring for patients with a history of cancer to identify needs of rural-based clinicians to optimize their patients' survivorship care. Using an interpretive qualitative descriptive approach, we conducted semi-structured interviews with 17 non-oncology clinicians. We encouraged clinicians to discuss their approach to caring for patients with a history of cancer and invited them to talk about what might help them increase their knowledge of survivorship care best practices. Through interpretive qualitative descriptive analysis methods including first level coding and constant comparison, we found there is consensus that cancer survivorship care is important; however, training that now guides our clinicians occurred mostly during residency, if at all. Clinicians relied on previous patient encounters and oncology notes combined with their patients' personal account of treatment history to inform the best next steps. Clinicians expressed strong interest in having a simple protocol of their patient's treatment with prompts of known long-term cancer treatment-related effects and a patient-centric follow-up monitoring schedule (mandatory vs recommended vs optional). Clinicians expressed interest in educational opportunities about cancer care and ability for curbside consults with oncologists. They consistently noted the limited resources available in rural areas and that rural patients may have different preferences and approaches to cancer survivorship. There is a clear opportunity to improve non-oncology clinicians' knowledge of the needs of people with a history of cancer as well as their own knowledge base and self-efficacy, especially in rural settings.
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Affiliation(s)
- Mirna Becevic
- Department of Dermatology, School of Medicine, University of Missouri, 1 Hospital Drive, MA111, Columbia, MO, 65212, USA.
- Missouri Telehealth Network, University of Missouri, 4215 Phillips Farm Road, Suite 121, MO, 65212, Columbia, USA.
- Institute for Data Science and Informatics, University of Missouri, 241 Naka Hall, Columbia, MO, 65211, USA.
| | - Allison B Anbari
- Sinclair School of Nursing, University of Missouri, 915 Hitt St., Columbia, MO, 65212, USA
| | - Jane A McElroy
- Family and Community Medicine, University of Missouri, Medical Sciences Building, 1 Hospital Drive, MA306, Columbia, MO, 65212, USA
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17
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Werts SJ, Robles-Morales R, Bea JW, Thomson CA. Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01464-4. [PMID: 37768420 DOI: 10.1007/s11764-023-01464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. METHODS A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world. RESULTS Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance. CONCLUSIONS Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population. IMPLICATIONS FOR CANCER SURVIVORS Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.
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Affiliation(s)
- Samantha J Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Rogelio Robles-Morales
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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18
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Arana-Chicas E, Prisco LMH, Sharma S, Stauffer F, McGee M, Dauphin S, Ban-Hoefen M, Navarette J, Zittel J, Cupertino AP, Magnuson A, Mustian KM, Mohile SG. Cancer survivorship challenges of rural older adults: a qualitative study. BMC Cancer 2023; 23:917. [PMID: 37770838 PMCID: PMC10536752 DOI: 10.1186/s12885-023-11395-z] [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: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults. METHODS This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study. RESULTS Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them. CONCLUSIONS Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.
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Affiliation(s)
- Evelyn Arana-Chicas
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA.
| | - Laura M Hincapie Prisco
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Fiona Stauffer
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
| | - Martha McGee
- Specialized Oncology Care & Research for our Elders Board Patient and Caregiver Advocate Board (SOCAREboard), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Makiko Ban-Hoefen
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jason Zittel
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
| | - Karen M Mustian
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Geriatric Oncology Research Group, University of Rochester Medical Center, Rochester, NY, USA
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, New York, USA
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19
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Arab M, Vasef M, Talayeh M, Hosseini MS, Farzaneh F, Ashrafganjoei T. The Effect of Radiofrequency Therapy on Sexual Function in Female Cancer Survivors (Gynecologic and Breast) and Non-cancer Menopausal Women: A Single-Arm Trial. J Lasers Med Sci 2023; 14:e32. [PMID: 37744017 PMCID: PMC10517569 DOI: 10.34172/jlms.2023.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/01/2023] [Indexed: 09/26/2023]
Abstract
Introduction: Up to 90% of postmenopausal women and female cancer survivors may be affected by the genitourinary syndrome of menopause (GSM), with a negative impact on sexual function and quality of life. A novel energy-based device among the treatment options for GSM is radiofrequency therapy (RFT). RFT is a treatment option that uses energy from radio waves to heat the tissue. The objective of this study was to assess the impact of RFT on sexual function in female cancer survivors (gynecologic and breast) and non-cancer menopausal women. Methods: In a single-arm prospective trial, the efficacy of RFT in both female cancer survivors (gynecologic and breast) and non-cancer menopausal women with sexual dysfunction at a tertiary and referral center (Imam Hossein Medical Center, Tehran, Iran) was evaluated between April 2022 and December 2022. The study protocol consisted of 3 monthly RFT sessions. Examination was performed at baseline (T0) and 3 months after the last RFT session (T1). The primary outcome was sexual function, which was assessed using the Female Sexual Function Index (FSFI). In addition, adverse events were evaluated during treatment and at T1. Results: A total of 37 female cancer survivors (mean [SD] age: 49.4 [8.9] years) and 37 non-cancer menopausal women (mean [SD] age: 53.8 [5.5] years) were enrolled. Patients exposed to RFT showed a significant improvement in FSFI scores when compared to baseline scores for both female cancer survivors (13.07, 95% CI: 12.27 - 13.86) and non-cancer menopausal women (13.18, 95% CI: 12.34 - 14.03). There was no difference in FSFI total score improvement between the two groups (t(72)=0.06, P=0.951). There were no serious adverse events associated with RFT. Conclusion: The efficacy of RFT as a treatment for sexual dysfunction has been demonstrated in both non-cancer menopausal women and female cancer survivors. In both groups, a significant improvement was confirmed.
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Affiliation(s)
- Maliheh Arab
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mahshid Vasef
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Talayeh
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Sadat Hosseini
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Farzaneh
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Ashrafganjoei
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Francisci S, Tursini F, Dal Maso L, Gigli A, Guzzinati S. Projecting cancer prevalence by phase of care: a methodological approach for health service planning. Front Oncol 2023; 13:1201464. [PMID: 37711195 PMCID: PMC10499514 DOI: 10.3389/fonc.2023.1201464] [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: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
Background In most developed countries, the number of cancer survivors is expected to increase in the coming decades because of rising incidence and survival rates and an aging population. These patients are heterogeneous in terms of health service demands: from recently diagnosed patients requiring first-course therapy to patients with extensive care needs and severe disabilities to long-term survivors who only need minimal care. Therefore, in terms of providing healthcare planners and policymakers with useful indicators for addressing policies according to health service demands, it is worth supplying updated measures of prevalence for groups of patients based on the level of care they require. The aim of this paper is to illustrate a new method for estimating short-term projections of cancer prevalence by phase of care that applies to areas covered by cancer registration. Methods The proposed method combines linear regression models to project limited duration prevalence derived from cancer registry data and a session of the freely available software COMPREV to estimate the projected complete prevalence into three distinct clinically relevant phases of care: initial, continuing, and final. The method is illustrated and validated using data from the Veneto region in Italy for breast, colorectal, and lung cancers. Results Prevalence is expected to increase in 2015-2026 for all considered cancer sites and sexes, with average annual variations spanning from 2.6% for women with lung cancer to 0.5% for men with colorectal cancer. The only exception is lung cancer prevalence in men, which shows an average annual decrease of 1.9%. The majority of patients are in the continuing phase of care, followed by the initial and final phases, except for lung cancer, where the final phase of care prevails over the initial one. Discussion The paper proposes a method for estimating (short-term) future cancer healthcare needs that is based on user-friendly and freely available software and linear regression models. Validation results confirm the applicability of our method to the most frequent cancer types, provided that cancer registry data with at least 15 years of registration are available. Evidence from this method is addressed to policymakers for planning future cancer care, thus improving the cancer survivorship experience for patients and caregivers.
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Affiliation(s)
- Silvia Francisci
- National Center for Disease Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Francesco Tursini
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Stefano Guzzinati
- Regional Epidemiological Service, Veneto Cancer Registry (RTV), Azienda Zero, Padova, Italy
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21
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Salafia C, Bellizzi KM, Ligus K, Fritzson E, Park CL. Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support. J Cancer Surviv 2023:10.1007/s11764-023-01444-8. [PMID: 37606815 PMCID: PMC11018111 DOI: 10.1007/s11764-023-01444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress. METHODS The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression. RESULTS Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (β = - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (β = - .11, p < .05). CONCLUSION Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.
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Affiliation(s)
- Caroline Salafia
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA.
| | - Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Kaleigh Ligus
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Emily Fritzson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, U-1020, Storrs, CT, 06269, USA
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22
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Telles R, Zia S, Greteman B, Thaker P, Penedo F, Charlton M, Goodheart M, Armer J, Noble A, Sood A, Lutgendorf S. Well-being and stress vulnerability in ovarian cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2023; 42:299-314. [PMID: 37587850 PMCID: PMC10873467 DOI: 10.1080/07347332.2023.2244474] [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] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study was designed to examine (1) whether ovarian cancer (OC) survivors would have greater well-being vs. elevated distress compared to community members during a universal health stressor (COVID-19) and (2) how resources and risk factors at diagnosis predicted vulnerability to a subsequent health-related stressor. METHODS One hundred seventeen OC survivors were recruited from two academic medical centers and compared to a community-based sample on COVID-related distress and disruption. Latent class analysis identified differentially impacted groups of survivors. RESULTS Survivors reported lower distress than community members. Predictors of higher distress included shorter-term survivorship, greater disruption, and poorer emotional well--being (EWB) at diagnosis. Survivors were divided into high- and low-COVID-19-impact subgroups; high-impact individuals endorsed higher perceived stress and lower EWB at diagnosis. CONCLUSION Survivors reported lower COVID-related distress than community participants. While depression at diagnosis did not predict later distress, EWB was a strong predictor of response to a novel health-related stressor.
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Affiliation(s)
- Rachel Telles
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA
| | - Sharaf Zia
- Institute of Clinical and Translational Sciences, University of Iowa Hospital & Clinics, Iowa City, IA
| | - Breanna Greteman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Premal Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO
| | - Frank Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Michael Goodheart
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Jessica Armer
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA
| | - Alyssa Noble
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA
| | - Anil Sood
- Departments of Gynecologic Oncology, Cancer Biology and Center for RNA Interference and Noncoding RNA, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Susan Lutgendorf
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
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23
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Wennberg A, Ding M, Feychting M, Modig K. Risk of All-Cause Dementia, Alzheimer Disease, and Vascular Dementia in Breast Cancer Survivors: A Longitudinal Register-Based Study. Neurol Clin Pract 2023; 13:e200173. [PMID: 37188244 PMCID: PMC10176959 DOI: 10.1212/cpj.0000000000200173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
Background and Objectives Now more than two-thirds of cancer survivors are aged 65 years or older, but evidence about their long-term health is thin. Cancer and its treatments have been linked to accelerated aging, so there is a concern that aging cancer survivors have an increased risk of age-related diseases, including dementia. Methods We examined the risk of dementia among 5-year breast cancer survivors using a matched cohort study design. We included breast cancer survivors aged 50 years and older at diagnosis (n = 26,741) and cancer-free comparison participants (n = 249,540). Women eligible for inclusion in the study were those born 1935-1975 and registered in the Swedish Total Population Register between January 1, 1991, and December 31, 2015. We defined breast cancer survivors as women with an initial breast cancer diagnosis between 1991 and 2005 who survived 5 or more years after their first diagnosis. We assessed all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD) using International Classification of Diseases codes. Survival analyses were conducted using age-adjusted subdistribution hazard models accounting for competing risk of death. Results We did not observe an association between breast cancer survivorship and risk of all-cause dementia, AD, or VaD. However, in models stratified by age at cancer diagnosis, women diagnosed with cancer after age 65 years had a higher risk of all-cause dementia (subdistribution hazard ratio [SHR] = 1.30, 95% CI 1.07-1.58), AD (SHR = 1.35, 95% CI 1.05-1.75), and VaD (SHR = 1.64, 95% CI 1.11-2.43) in models adjusted for age, education, and country of origin. Discussion Older breast cancer survivors who survive cancer have a higher risk for dementia than their peers without a cancer diagnosis, in contrast to earlier studies showing that prevalent or incident cancer is associated with a lower risk of dementia. With the older adult population growing rapidly and because cancer and dementia are 2 of the most common and debilitating diseases among older adults, it is critical that we understand the link between the 2.
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Affiliation(s)
- Alexandra Wennberg
- Unit of Epidemiology (AW, MD, MF, KM), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology (AW, MD, MF, KM), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology (AW, MD, MF, KM), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology (AW, MD, MF, KM), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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24
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Wennberg AM, Matthews A, Talbäck M, Ebeling M, Ek S, Feychting M, Modig K. Frailty Among Breast Cancer Survivors: Evidence From Swedish Population Data. Am J Epidemiol 2023; 192:1128-1136. [PMID: 36883906 PMCID: PMC10326604 DOI: 10.1093/aje/kwad048] [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: 05/24/2022] [Revised: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Incidence and survival of breast cancer, the most common cancer among women, have been increasing, leaving survivors at risk of aging-related health conditions. In this matched cohort study, we examined frailty risk with the Hospital Frailty Risk Score among breast cancer survivors (n = 34,900) and age-matched comparison subjects (n = 290,063). Women born in 1935-1975, registered in the Swedish Total Population Register (1991-2015), were eligible for inclusion. Survivors had a first breast cancer diagnosis in 1991-2005 and survived ≥5 years after initial diagnosis. Death date was determined by linkage to the National Cause of Death Registry (through 2015). Cancer survivorship was weakly associated with frailty (subdistribution hazard ratio (SHR) = 1.04, 95% confidence interval (CI): 1.00, 1.07). In age-stratified models, those diagnosed at younger ages (<50 years) had higher risk of frailty (SHR = 1.12, 95% CI: 1.00, 1.24) than those diagnosed at ages 50-65 (SHR = 1.03, 95% CI: 0.98, 1.07) or >65 (SHR = 1.09, 95% CI: 1.02, 1.17) years. Additionally, there was increased risk of frailty for diagnoses in 2000 or later (SHR = 1.15, 95% CI: 1.09, 1.21) compared with before 2000 (SHR = 0.97, 95% CI: 0.93, 1.17). This supports work from smaller samples showing that breast cancer survivors have increased frailty risk, particularly when diagnosed at younger ages.
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Affiliation(s)
- Alexandra M Wennberg
- Correspondence to Dr. Alexandra Wennberg, Unit of Epidemiology, Institutet of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden (e-mail: )
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25
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Toffolutti F, Guzzinati S, De Paoli A, Francisci S, De Angelis R, Crocetti E, Botta L, Rossi S, Mallone S, Zorzi M, Manneschi G, Bidoli E, Ravaioli A, Cuccaro F, Migliore E, Puppo A, Ferrante M, Gasparotti C, Gambino M, Carrozzi G, Stracci F, Michiara M, Cavallo R, Mazzucco W, Fusco M, Ballotari P, Sampietro G, Ferretti S, Mangone L, Rizzello RV, Mian M, Cascone G, Boschetti L, Galasso R, Piras D, Pesce MT, Bella F, Seghini P, Fanetti AC, Pinna P, Serraino D, Dal Maso L. Complete prevalence and indicators of cancer cure: enhanced methods and validation in Italian population-based cancer registries. Front Oncol 2023; 13:1168325. [PMID: 37346072 PMCID: PMC10280813 DOI: 10.3389/fonc.2023.1168325] [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: 02/17/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To describe the procedures to derive complete prevalence and several indicators of cancer cure from population-based cancer registries. Materials and methods Cancer registry data (47% of the Italian population) were used to calculate limited duration prevalence for 62 cancer types by sex and registry. The incidence and survival models, needed to calculate the completeness index (R) and complete prevalence, were evaluated by likelihood ratio tests and by visual comparison. A sensitivity analysis was conducted to explore the effect on the complete prevalence of using different R indexes. Mixture cure models were used to estimate net survival (NS); life expectancy of fatal (LEF) cases; cure fraction (CF); time to cure (TTC); cure prevalence, prevalent patients who were not at risk of dying as a result of cancer; and already cured patients, those living longer than TTC at a specific point in time. CF was also compared with long-term NS since, for patients diagnosed after a certain age, CF (representing asymptotical values of NS) is reached far beyond the patient's life expectancy. Results For the most frequent cancer types, the Weibull survival model stratified by sex and age showed a very good fit with observed survival. For men diagnosed with any cancer type at age 65-74 years, CF was 41%, while the NS was 49% until age 100 and 50% until age 90. In women, similar differences emerged for patients with any cancer type or with breast cancer. Among patients alive in 2018 with colorectal cancer at age 55-64 years, 48% were already cured (had reached their specific TTC), while the cure prevalence (lifelong probability to be cured from cancer) was 89%. Cure prevalence became 97.5% (2.5% will die because of their neoplasm) for patients alive >5 years after diagnosis. Conclusions This study represents an addition to the current knowledge on the topic providing a detailed description of available indicators of prevalence and cancer cure, highlighting the links among them, and illustrating their interpretation. Indicators may be relevant for patients and clinical practice; they are unambiguously defined, measurable, and reproducible in different countries where population-based cancer registries are active.
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Affiliation(s)
- Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | | | | | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Emanuele Crocetti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Sandra Mallone
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Gianfranco Manneschi
- Tuscany Cancer Registry, Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Forlì, Italy
| | - Francesco Cuccaro
- Registro Tumori Puglia - Sezione Azienda Sanitaria Locale (ASL) Barletta-Andria-Trani, Epidemiologia e Statistica, Barletta, Italy
| | - Enrica Migliore
- Piedmont Cancer Registry, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte and University of Turin, Turin, Italy
| | - Antonella Puppo
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Margherita Ferrante
- Registro tumori integrato di Catania-Messina-Enna, Igiene Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Cinzia Gasparotti
- Struttura Semplice Epidemiologia, Agenzia di Tutela della Salute (ATS) Brescia, Brescia, Italy
| | - Maria Gambino
- Registro tumori ATS Insubria (Provincia di Como e Varese) Responsabile S.S. Epidemiologia Registri Specializzati e Reti di Patologia, Varese, Italy
| | - Giuliano Carrozzi
- Emilia-Romagna Cancer Registry, Modena Unit, Public Health Department, Local Health Authority, Modena, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maria Michiara
- Emilia-Romagna Cancer Registry, Parma Unit, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rossella Cavallo
- Cancer Registry Azienda Sanitaria Locale (ASL) Salerno- Dipartimento di Prevenzione, Salerno, Italy
| | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP) di Palermo, Palermo, Italy
| | - Mario Fusco
- Registro Tumori ASL Napoli 3 Sud, Napoli, Italy
| | | | | | - Stefano Ferretti
- Emilia-Romagna Cancer Registry, Ferrara Unit, Local Health Authority, Ferrara, and University of Ferrara, Ferrara, Italy
| | - Lucia Mangone
- Emilia-Romagna Cancer Registry, Reggio Emilia Unit, Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Giuseppe Cascone
- Azienda Sanitaria Provinciale (ASP) Ragusa - Dipartimento di Prevenzione -Registro Tumori, Ragusa, Italy
| | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS Centro di Riferimento Oncologico di Basilicata (CROB), Rionero in Vulture, Italy
| | | | - Maria Teresa Pesce
- Monitoraggio rischio ambientale e Registro Tumori ASL Caserta, Caserta, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Siracusa, Italy
| | - Pietro Seghini
- Emilia-Romagna Cancer Registry, Piacenza Unit, Public Health Department, AUSL Piacenza, Piacenza, Italy
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Agenzia di Tutela della Salute della Montagna, Sondrio, Italy
| | - Pasquala Pinna
- Nuoro Cancer Registry, RT Nuoro, Servizio Igiene e Sanità Pubblica, ASL Nuoro, Nuoro, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
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26
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Rivard SJ, Vitous CA, Bamdad MC, Lussiez A, Anderson MS, Varlamos C, Duby A, Suwanabol PA. "I Wish There had been Resources": A Photo-Elicitation Study of Rectal Cancer Survivorship Care Needs. Ann Surg Oncol 2023; 30:3530-3537. [PMID: 36847958 PMCID: PMC10460498 DOI: 10.1245/s10434-022-13042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/09/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Rectal cancer survivors experience unique, prolonged posttherapy symptoms. Previous data indicate that providers are not skilled at identifying the most pertinent rectal cancer survivorship issues. Consequently, survivorship care is incomplete with the majority of rectal cancer survivors reporting at least one unmet posttherapy need. METHODS This photo-elicitation study combines participant-submitted photographs and minimally structured qualitative interviews to explore one's lived experiences. Twenty rectal cancer survivors from a single tertiary canter provided photographs representative of their life after rectal cancer therapy. The iterative steps informed by inductive thematic analysis were used to analyze the transcribed interviews. RESULTS Rectal cancer survivors had several recommendations to improve their survivorship care, which fell into three major themes: (1) informational needs (e.g., more details about posttherapy side effects); (2) continued multidisciplinary follow up care (e.g., dietary support); and (3) suggestions for support services (e.g., subsidized bowel altering medications and ostomy supplies). CONCLUSIONS Rectal cancer survivors desired more detailed and individualized information, access to longitudinal multidisciplinary follow-up care, and resources to ease the burdens of daily life. These needs may be met through the restructuring of rectal cancer survivorship care to include disease surveillance, symptom management, and support services. As screening and therapy continues to improve, providers must continue to screen and to provide services that address the physical and psychosocial needs of rectal cancer survivors.
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Affiliation(s)
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | | | - Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Maia S Anderson
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Ashley Duby
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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27
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Emerson MA, Reeve BB, Gilkey MB, Elmore SNC, Hayes S, Bradley CJ, Troester MA. Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women. J Cancer Surviv 2023; 17:805-814. [PMID: 36103105 PMCID: PMC10011019 DOI: 10.1007/s11764-022-01252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Breast cancer survivorship has improved in recent decades, but few studies have assessed the patterns of employment status following diagnosis and the impact of job loss on long-term well-being in ethnically diverse breast cancer survivors. We hypothesized that post-treatment employment status is an important determinant of survivor well-being and varies by race and age. METHODS In the Carolina Breast Cancer Study, 1646 employed women with primary breast cancer were longitudinally evaluated for post-diagnosis job loss and overall well-being. Work status was classified as "sustained work," "returned to work," "job loss," or "persistent non-employment." Well-being was assessed by the Functional Assessment of Cancer Therapy (FACT-G) instrument. Analysis of covariance was used to evaluate the association between work status and well-being (physical, functional, social, and emotional). RESULTS At 25 months post-diagnosis, 882 (53.6%) reported "sustained work," 330 (20.1%) "returned to work," 162 (9.8%) "job loss," and 272 (16.5%) "persistent non-employment." Nearly half of the study sample (46.4%) experienced interruptions in work during 2 years post-diagnosis. Relative to baseline (5-month FACT-G), women who sustained work or returned to work had higher increases in all well-being domains than women with job loss and persistent non-employment. Job loss was more common among Black than White women (adjusted odds ratio = 3.44; 95% confidence interval 2.37-4.99) and was associated with service/laborer job types, lower education and income, later stage at diagnosis, longer treatment duration, and non-private health insurance. However, independent of clinical factors, job loss was associated with lower well-being in multiple domains. CONCLUSIONS Work status is commonly disrupted in breast cancer survivors, but sustained work is associated with well-being. Interventions to support women's continued employment after diagnosis are an important dimension of breast cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Our findings indicate that work continuation and returning to work may be a useful measure for a range of wellbeing concerns, particularly among Black breast cancer survivors who experience greater job loss.
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Affiliation(s)
- Marc A Emerson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA.
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shekinah N C Elmore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - Melissa A Troester
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA
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Sargas C, Ayala R, Larráyoz MJ, Chillón MC, Rodriguez-Arboli E, Bilbao C, Prados de la Torre E, Martínez-Cuadrón D, Rodríguez-Veiga R, Boluda B, Gil C, Bernal T, Bergua J, Algarra L, Tormo M, Martínez-Sánchez P, Soria E, Serrano J, Alonso-Dominguez JM, García R, Amigo ML, Herrera-Puente P, Sayas MJ, Lavilla-Rubira E, Martínez-López J, Calasanz MJ, García-Sanz R, Pérez-Simón JA, Gómez Casares MT, Sánchez-García J, Barragán E, Montesinos P. Comparison of the 2022 and 2017 European LeukemiaNet risk classifications in a real-life cohort of the PETHEMA group. Blood Cancer J 2023; 13:77. [PMID: 37173322 PMCID: PMC10182047 DOI: 10.1038/s41408-023-00835-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Next-Generation Sequencing is needed for the accurate genetic risk stratification of acute myeloid leukemia according to European LeukemiaNet (ELN) guidelines. We validated and compared the 2022 ELN risk classification in a real-life cohort of 546 intensively and 379 non-intensively treated patients. Among fit patients, those aged ≥65 years old showed worse OS than younger regardless risk classification. Compared with the 2017 classification, 14.5% of fit patients changed the risk with the 2022 classification, increasing the high-risk group from 44.3% to 51.8%. 3.7% and 0.9% FLT3-ITD mutated patients were removed from the favorable and adverse 2017 categories respectively to 2022 intermediate risk group. We suggest that midostaurin therapy could be a predictor for 3 years OS (85.2% with vs. 54.8% without midostaurin, P = 0.04). Forty-seven (8.6%) patients from the 2017 intermediate group were assigned to the 2022 adverse-risk group as they harbored myelodysplasia (MDS)-related mutations. Patients with one MDS-related mutation did not reach median OS, while patients with ≥2 mutations had 13.6 months median OS (P = 0.002). Patients with TP53 ± complex karyotype or inv(3) had a dismal prognosis (7.1 months median OS). We validate the prognostic utility of the 2022 ELN classification in a real-life setting providing supportive evidences to improve risk stratification guidelines.
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Affiliation(s)
- Claudia Sargas
- Grupo Acreditado de Investigación en Hematología, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rosa Ayala
- Hospital Universitario 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | | | - María C Chillón
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Eduardo Rodriguez-Arboli
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Cristina Bilbao
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - David Martínez-Cuadrón
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Blanca Boluda
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Cristina Gil
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Teresa Bernal
- Hospital Universitario Central de Asturias, Instituto Universitario (IUOPA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Juan Bergua
- Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | | | - Elena Soria
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Josefina Serrano
- IMIBIC, Hematology, Hospital Universitario Reina Sofía, UCO, Córdoba, Spain
| | | | | | | | | | | | | | | | | | - Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca (HUS/IBSAL), CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - José A Pérez-Simón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS/CSIC), Universidad de Sevilla, Sevilla, Spain
| | - María T Gómez Casares
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Eva Barragán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Servicio Análisis Clínicos, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Pau Montesinos
- Servicio de Hematología, Grupo Acreditado de Investigación en Hematología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
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D'Souza RS, Alvarez GAM, Dombovy-Johnson M, Eller J, Abd-Elsayed A. Evidence-Based Treatment of Pain in Chemotherapy-Induced Peripheral Neuropathy. Curr Pain Headache Rep 2023; 27:99-116. [PMID: 37058254 DOI: 10.1007/s11916-023-01107-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE OF REVIEW Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and often painful condition that occurs after administration of chemotherapeutic agents. The primary objective of this systematic review was to appraise the literature on conservative, pharmacological, and interventional treatment options for CIPN pain. RECENT FINDINGS There is level I evidence supporting modest to moderate improvement in CIPN pain from duloxetine treatment, as well as short-term modest improvement from physical therapy and acupuncture. Although opioid and cannabis administration may provide short-term modest improvement, administration is commonly limited by side effects. Generally, most studies reported no clinical benefit from yoga, topical neuropathic agents, gabapentinoids, and tricyclic antidepressants. Evidence is currently equivocal for scrambler therapy and transcutaneous electrical nerve stimulation. Finally, evidence on neuromodulation options is limited to mostly case reports/series and one observational study highlighting moderate improvement with auricular nerve stimulation. This systematic review provides an overview of conservative, pharmacologic, and interventional treatment modalities for CIPN pain. Furthermore, it provides a level of evidence and degree of recommendation based on the United States Preventive Services Task Force (USPSTF) criteria for each specific treatment modality.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | | | - Marissa Dombovy-Johnson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, USA
| | - Jennifer Eller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
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Millar MM, Herget KA, Ofori-Atta B, Codden RR, Edwards SL, Carter ME, Belnap B, Kirchhoff AC, Sweeney C. Cancer survivorship experiences in Utah: an evaluation assessing indicators of survivors' quality of life, health behaviors, and access to health services. Cancer Causes Control 2023; 34:337-347. [PMID: 36723708 PMCID: PMC10367944 DOI: 10.1007/s10552-023-01671-5] [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: 06/27/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE The 2016-2020 Utah Comprehensive Cancer Prevention and Control Plan prioritized strategies to address cancer survivorship experiences. In this paper we present estimates for nine indicators evaluating these priorities, trends over time, and assess disparities in survivorship experiences across demographic subgroups. METHODS We surveyed a representative sample of Utah cancer survivors diagnosed between 2012 and 2019 with any reportable cancer diagnosis. We calculated weighted percentages and 95% confidence intervals (CI) for each indicator. We assessed change over time using a test for trend across survey years in a logistic regression model and used Rao-Scott F-adjusted chi-square tests to test the association between demographic characteristics and each survivorship indicator. RESULTS Most of the 1,793 respondents (93.5%) reported their pain was under control, 85.7% rated their overall health as good, very good, or excellent, but 46.5% experienced physical, mental, or emotional limitations. Only 1.7% of survivors aged 75 or older were current smokers, compared to 5.8% of 65-74-year-olds and 7.9% of survivors aged 55-74 (p < 0.006). No regular physical activity was reported by 20.6% and varied by survivor age and education level. The proportion who received a survivorship care plan increased from 34.6% in 2018 to 43.0% in 2021 (p = 0.025). However, survivors under age 55 were significantly less likely to receive a care plan than older survivors. CONCLUSION This representative survey of cancer survivors fills a gap in understanding of the cancer survivorship experience in Utah. Results can be used to evaluate and plan additional interventions to improve survivorship quality of life.
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Affiliation(s)
- Morgan M Millar
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA.
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | | | | | - Rachel R Codden
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
| | | | - Brad Belnap
- Utah Department of Health and Human Services, Utah Cancer Control Program, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carol Sweeney
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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31
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Li S, Gao Y, Lin Y, Wu W, Fang Q, Ni X, Zhou Y, Hong M, Zhang R, Lou Y. Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors. J Clin Nurs 2023; 32:1186-1217. [PMID: 35285109 DOI: 10.1111/jocn.16272] [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: 09/07/2021] [Revised: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors. AIMS AND OBJECTIVES The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties. DESIGN This was a mixed-method study. METHODS The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity. RESULTS A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well. CONCLUSIONS The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.
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Affiliation(s)
- Shuaini Li
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China.,The Children's Hospital Zhejiang University School of Medicine (National Clinical Research Center for Child Health), Hangzhou, Zhejiang Province, China
| | - Yating Gao
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ying Lin
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Wanying Wu
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Qunying Fang
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Xiaosha Ni
- Hangzhou Ninth People's Hospital, Hangzhou, Zheijiang province, China
| | - Yao Zhou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Meirong Hong
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ruolin Zhang
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Yan Lou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
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Kerns SL, Williams JP, Marples B. Modeling normal bladder injury after radiation therapy. Int J Radiat Biol 2023; 99:1046-1054. [PMID: 36854008 PMCID: PMC10330568 DOI: 10.1080/09553002.2023.2182000] [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: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE For decades, Dr. John Moulder has been a leading radiation biologist and one of the few who consistently supported the study of normal tissue responses to radiation. His meticulous modeling and collaborations across the field have offered a prime example of how research can be taken from the bench to the bedside and back, with the ultimate goal of providing benefit to patients. Much of the focus of John's work was on mitigating damage to the kidney, whether as the result of accidental or deliberate clinical exposures. Following in his footsteps, we offer here a brief overview of work conducted in the field of radiation-induced bladder injury. We then describe our own preclinical experimental studies which originated as a response to reports from a clinical genome-wide association study (GWAS) investigating genomic biomarkers of normal tissue toxicity in prostate cancer patients treated with radiotherapy. In particular, we discuss the use of Renin-Angiotensin System (RAS) inhibitors as modulators of injury, agents championed by the Moulder group, and how RAS inhibitors are associated with a reduction in some measures of toxicity. Using a murine model, along with precise CT-image guided irradiation of the bladder using single and fractionated dosing regimens, we have been able to demonstrate radiation-induced functional injury to the bladder and mitigation of this functional damage by an inhibitor of angiotensin-converting enzyme targeting the RAS, an experimental approach akin to that used by the Moulder group. We consider our scientific trajectory as a bedside-to-bench approach because the observation was made clinically and investigated in a preclinical model; this experimental approach aligns with the exemplary career of Dr. John Moulder. CONCLUSIONS Despite the differences in functional endpoints, recent findings indicate a commonality between bladder late effects and the work in kidney pioneered by Dr. John Moulder. We offer evidence that targeting the RAS pathway may provide a targetable pathway to reducing late bladder toxicity.
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Affiliation(s)
- Sarah L. Kerns
- Department of Department of Radiation Oncology, the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacqueline P. Williams
- Departments of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Departments of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Brian Marples
- Departments of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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Oakley-Girvan I, Yunis R, Fonda SJ, Neeman E, Liu R, Aghaee S, Ramsey ME, Kubo A, Davis SW. A novel smartphone application for the informal caregivers of cancer patients: Usability study. PLOS DIGITAL HEALTH 2023; 2:e0000173. [PMID: 36867639 PMCID: PMC9983832 DOI: 10.1371/journal.pdig.0000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/29/2022] [Indexed: 03/04/2023]
Abstract
Informal caregivers are a critical source of support for cancer patients. However, their perspectives are not routinely collected, despite health impacts related to the burden of caregiving. We created the TOGETHERCare smartphone application (app) to collect observer-reported outcomes regarding the cancer patient's health and caregiver's perceptions of their own mental and physical health, and to provide tips and resources for self-care and patient care. We enrolled 54 caregivers between October 2020 and March 2021 from Kaiser Permanente Northern California (KPNC), an integrated healthcare system. Fifty caregivers used the app for approximately 28 days. Usability and acceptability were assessed using questions from the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), the Net Promoter Score (NPS), and semi-structured interviews. The caregivers' mean age was 54.4 years, 38% were female and 36% were non-White. The SUS total mean score was 83.4 (SD = 14.2), for a percentile rank of 90-95 ("excellent"). Median MARS responses to the functionality questions were also high. The NPS score of 30 at the end of the study indicated that most caregivers would recommend the app. Themes from semi-structured interviews were consistent across the study period and indicated that the app was easy to use and helpful. Caregivers indicated a need for feedback from the app, suggested some changes to the wording of questions, the app's visuals, and timing of notifications. This study demonstrated that caregivers are willing to complete frequent surveys about themselves and their patients. The app is unique because it provides a remote method to collect caregivers' observations about the patient that may be useful for clinical care. To our knowledge, TOGETHERCare is the first mobile app developed specifically to capture adult cancer patient symptoms from the informal caregiver's perspective. Future research will examine whether use of this app can help improve patient outcomes.
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Affiliation(s)
| | - Reem Yunis
- Medable Inc., Palo Alto, California, United States of America
| | | | - Elad Neeman
- Kaiser Permanente Northern California, San Francisco Medical Center, San Francisco, California, United States of America
| | - Raymond Liu
- Kaiser Permanente Northern California, San Francisco Medical Center, San Francisco, California, United States of America
- Kaiser Permanente Northern California, Division of Research, Oakland, California, United States of America
| | - Sara Aghaee
- Kaiser Permanente Northern California, Division of Research, Oakland, California, United States of America
| | - Maya E. Ramsey
- Kaiser Permanente Northern California, Division of Research, Oakland, California, United States of America
| | - Ai Kubo
- Kaiser Permanente Northern California, Division of Research, Oakland, California, United States of America
| | - Sharon W. Davis
- Medable Inc., Palo Alto, California, United States of America
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Chen YH, Cabanillas M, Sperling J, Xu L, Goswami M, Maniakas A, Williams MD, Lai SY, Busaidy N, Dadu R, Zafereo ME, Wang JR. Prior Thyroid and Nonthyroid Cancer History Do Not Significantly Alter Overall Survival in Patients Diagnosed with Anaplastic Thyroid Cancer. Thyroid 2023; 33:321-329. [PMID: 36511380 DOI: 10.1089/thy.2022.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: A history of thyroid and nonthyroid malignancies has traditionally been an exclusion criterion in patients with anaplastic thyroid cancer (ATC) seeking to enroll in clinical trials. In this study, we examined the impact of prior malignancies on overall survival (OS) in patients diagnosed with ATC. Methods: In our retrospective cohort study, we identified 451 patients with ATC treated at MD Anderson between 2000 and 2019. Clinical and pathological information was obtained through chart review. Survival analyses were conducted using the Kaplan-Meier method and multivariable Cox proportional hazard models. Results: A history of clinically documented differentiated thyroid cancer (DTC) was reported in 14% of patients with ATC (n = 62), most commonly papillary thyroid cancer (81%, n = 50). The median time from diagnosis of prior DTC to ATC diagnosis was 3.5 years (range: 6 months to 35 years). Concomitant DTC was found on pathology in a higher proportion of patients (52%, n = 234). A history of nonthyroid cancer was reported in 23% of patients (n = 102), where 19% (n = 87) had one, 2% (n = 10) had two, and 1% (n = 5) had three prior cancers. The median time from diagnosis of prior nonthyroid cancer to ATC diagnosis was 8 years (range: 3 months to 53 years). The most common prior nonthyroid cancers were nonmelanoma skin (28.4%), prostate (19.6%), and breast cancers (16.7%). In a subgroup analysis performed in patients with available tumor mutation information (n = 183), the frequency of detected tumor driver mutations (BRAF, RAS, TP53) was not significantly different between patients with ATC with and without a history of nonthyroid cancer. On multivariate analysis after adjusting for age and overall stage, prior DTC, concomitant DTC, and prior nonthyroid cancers, all had no significant impact on OS. Conclusions: The presence of prior malignancy does not significantly impact OS in patients with ATC. Revision of eligibility criteria for enrollment of patients with ATC into clinical trials is warranted.
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Affiliation(s)
- Yu Han Chen
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jared Sperling
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Li Xu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maitrayee Goswami
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Rui Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Li D, Deng C, Fu F, Bai J, Li Y, Zhang Y, Chen H. Impact of Prior Cancer History on Outcomes of Resected Lung Cancer. Ann Surg Oncol 2023; 30:1534-1540. [PMID: 36635522 DOI: 10.1245/s10434-022-12597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Previous studies concerning the impact of prior cancer on newly diagnosed lung cancer are mainly based on databases and obtained mixed results. Utilizing a large study population, we aimed to reveal this impact. PATIENTS AND METHODS Lung cancer patients from January 2008 to April 2021 were enrolled. The Kaplan-Meier method was used to perform survival analyses. To investigate the impact of prior cancer, a Cox proportional hazards model was conducted. To minimize the influence of the heterogeneity of prior cancer, stratified analyses were carried out. RESULTS In total, 17,423 lung cancer patients were reviewed, among which we identified 1469 (8.4%) patients with a history of prior cancer. Cox regression analysis revealed that prior cancer was an independent poor prognostic factor on overall survival (HR = 1.430, 95% CI: 1.147-1.784, p = 0.001) but did not affect lung cancer-specific survival (HR = 1.120, 95% CI: 0.876-1.434, p = 0.366). Interestingly, in further stratified analyses, we found that prior cancer history affected overall survival only in pTNM stage 0/I patients (HR = 1.670, 95% CI: 1.247-2.237, p = 0.001), but not in pTNM stage II/III/IV patients (HR = 1.237, 95% CI: 0.877-1.743, p = 0.226). Similarly, prior cancer was an independent poor prognostic factor on overall survival only for pN0 patients. Subsequently, subgroup analyses indicated that the impact of prior cancer varied in pTNM stage 0/I patients according to the type of prior cancer and the interval time. CONCLUSIONS Considering that prior cancer affects overall survival in patients with clinically curable lung cancer, clinicians should pay attention to this effect and improve the management of these patients to achieve a better prognosis.
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Affiliation(s)
- Di Li
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinsong Bai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China. .,Institute of Thoracic Oncology, Fudan University, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China. .,Institute of Thoracic Oncology, Fudan University, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Iwahata H, Kim SY, Iwahata Y, Suzuki N, Woodruff TK. Thyroid hormone triiodothyronine does not protect ovarian reserve from DNA damage induced by X-ray and cisplatin. J Assist Reprod Genet 2023; 40:481-490. [PMID: 36805842 PMCID: PMC10033774 DOI: 10.1007/s10815-023-02740-z] [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: 10/31/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Cancer therapy can induce premature ovarian insufficiency, necessitating methods for preserving fertility in female cancer patients. However, the only accepted clinical practice for doing so is cryopreservation of embryos, unfertilized ova, and ovarian tissue, despite potential options such as in vitro maturation of follicles. Therefore, considerable interest has arisen in fertoprotective agents, with research on rat ovarian granulosa cells suggesting that triiodothyronine (T3) regulates an anti-apoptosis mechanism that protects the ovarian reserve from paclitaxel-induced DNA damage. In this study, we used postnatal day 5 mouse ovary to confirm the existence of T3 thyroid hormone receptor (THR), as well as to investigate the potential protective effects of T3 against cisplatin- and X-ray-induced apoptosis. We also tested the potential anti-apoptotic effect of T3 in the breast cancer cell line MDA-MB-231. METHODS We treated cultured mouse ovaries with varying concentration of T3 and 4 μM cisplatin and 0.2 Gy X-ray. Real-time PCR, histological analysis, immunoblot analysis, and immunofluorescence were performed to assess the potential anti-apoptotic effects of T3. RESULTS We confirmed that THR alpha and beta are expressed in the mouse ovary. T3 (0.1, 1, 10, 100 nM, and 1 µM) does not protect ovarian reserve from cisplatin- or X-ray-induced apoptosis or DNA damage. Similarly, it does not protect mouse granulosa cells and MDA-MB-231 cells from cisplatin- or X-ray-induced apoptosis. CONCLUSION Our findings suggest that T3 is ineffective as a fertoprotective agent, and its candidacy as a potential agent to preserve fertility should be reconsidered.
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Affiliation(s)
- Hideyuki Iwahata
- Department of Obstetrics and Gynecology, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki Kanagawa, Japan
| | - So-Youn Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Obstetrics and Gynecology, College of Medicine, Olson Center for Women's Health, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA
| | - Yuriko Iwahata
- Department of Obstetrics and Gynecology, Division of Reproductive Science in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki Kanagawa, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki Kanagawa, Japan
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki Kanagawa, Japan.
- Department of Obstetrics and Gynecology, Michigan State University, East Lansing, MI, USA.
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Jahn J, Diamond B, Hsu J, Montoya S, Totiger TM, Landgren O, Maura F, Taylor J. Therapy-selected clonal hematopoiesis and its role in myeloid neoplasms. Leuk Res 2023; 126:107020. [PMID: 36696829 PMCID: PMC11305114 DOI: 10.1016/j.leukres.2023.107020] [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: 11/22/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Therapy-related myeloid neoplasms (t-MN) account for approximately 10-15% of all myeloid neoplasms and are associated with poor prognosis. Genomic characterization of t-MN to date has been limited in comparison to the considerable sequencing efforts performed for de novo myeloid neoplasms. Until recently, targeted deep sequencing (TDS) or whole exome sequencing (WES) have been the primary technologies utilized and thus limited the ability to explore the landscape of structural variants and mutational signatures. In the past decade, population-level studies have identified clonal hematopoiesis as a risk factor for the development of myeloid neoplasms. However, emerging research on clonal hematopoiesis as a risk factor for developing t-MN is evolving, and much is unknown about the progression of CH to t-MN. In this work, we will review the current knowledge of the genomic landscape of t-MN, discuss background knowledge of clonal hematopoiesis gained from studies of de novo myeloid neoplasms, and examine the recent literature studying the role of therapeutic selection of CH and its evolution under the effects of antineoplastic therapy. Finally, we will discuss the potential implications on current clinical practice and the areas of focus needed for future research into therapy-selected clonal hematopoiesis in myeloid neoplasms.
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Affiliation(s)
- Jacob Jahn
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, United States
| | - Benjamin Diamond
- Myeloma Division, Department of Medicine, University of Miami Miller School of Medicine, United States
| | - Jeffrey Hsu
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, United States
| | - Skye Montoya
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, United States
| | - Tulasigeri M Totiger
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, United States
| | - Ola Landgren
- Myeloma Division, Department of Medicine, University of Miami Miller School of Medicine, United States
| | - Francesco Maura
- Myeloma Division, Department of Medicine, University of Miami Miller School of Medicine, United States
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, United States; Leukemia Program, Department of Medicine, University of Miami Miller School of Medicine, United States.
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Cai JS, Li Y, Wang X. Is prior cancer history a hindrance for non-small cell lung cancer patients to participate in clinical trials? BMC Cancer 2023; 23:155. [PMID: 36793002 PMCID: PMC9930244 DOI: 10.1186/s12885-023-10551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND This study aimed to explore the effect of a prior cancer history on the survivals of resected non-small cell lung cancer (NSCLC) patients. METHODS Kaplan-Meier method with a log-rank test was used to compare overall survival (OS) and disease-free survival (DFS) between groups. Propensity score matching (PSM) method was used to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. RESULTS A total of 4,102 eligible cases were included in this study. The rate of patients with a prior cancer was 8.2% (338/4,102). Patients with a prior cancer tended to be younger and have early-stage tumors when compared with those without prior cancer. Before PSM, the survivals of the patients with a prior cancer were similar to those of the patients without prior cancer (OS: P = 0.591; DFS: P = 0.847). After PSM, patients with a prior cancer and those without prior cancer still had comparable survival rates (OS: P = 0.126; DFS: P = 0.054). The LASSO-penalized multivariable Cox analysis further confirmed that a prior cancer history was not a prognostic factor for both OS and DFS. CONCLUSIONS A prior cancer history was not associated with resected NSCLC patients' survivals, and we proposed that it might be reasonable for clinical trials to enroll the NSCLC patients with a prior cancer.
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Affiliation(s)
- Jing-Sheng Cai
- grid.411634.50000 0004 0632 4559Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, 100044 People’s Republic of China ,grid.411634.50000 0004 0632 4559Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, 100044 People’s Republic of China
| | - Yun Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China. .,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
| | - Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China. .,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
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Herrera CD, Guerra CE, Narayan V, Guzzo TJ, Mamtani R, Lee DJ, Tasian GE, Talwar R. Financial toxicity in prostate cancer survivors: A national cross-sectional assessment of subjective financial burden. Urol Oncol 2023; 41:105.e1-105.e8. [PMID: 36372635 DOI: 10.1016/j.urolonc.2022.10.014] [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: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In prostate cancer (CaP) survivorship, subjective financial burden (SFB), an aspect of financial toxicity, has not been studied using a national sample. Our goal was to explore and identify factors associated with patient-reported SFB in CaP survivors. MATERIALS AND METHODS We conducted a retrospective, cross-sectional study of 264 adult individuals with a history of CaP that completed the AHRQ - Medical Expenditures Panel Survey - Household Component and Cancer Self-Administered Questionnaire Supplement in 2016 or 2017. Primary outcomes were the presence of cancer-related SFB and the severity of this burden. Multivariable ordinal logistic regression and logistic regression models were used to identify factors associated with the severity of SFB and different domains of burden. RESULTS Most participants were non-Hispanic white, had 3 or more comorbidities and had a median age of 72 years. 62.1% of survivors indicated SFB associated with their CaP care and long-term effects. 49.2% of CaP survivors indicated coping SFB, 27.7% psychological, and 29.2% material. Older (OR: 0.95, 95%CI 0.92-0.98) was associated with less SFB. Low-income level (OR: 2.1, 95%CI 1.01-4.36) was associated with higher SFB. Hispanic survivors (OR: 2.8 95%CI 1.1-7.4) indicated more psychologic SFB. Presence of a caregiver was noted as a predictor of material (OR 2.6, 95%CI 1.45-4.49) and psychological (OR: 2.2, 95%CI 1.13-3.91) SFB. CONCLUSIONS Many CaP survivors experience SFB and associated factors differ in domain of financial burden. This provides evidence and groundwork for understanding financial burden and improving the quality of counseling and care for this population.
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Affiliation(s)
- Christopher D Herrera
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Carmen E Guerra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Vivek Narayan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronac Mamtani
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ruchika Talwar
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Shahbazi M, Zhang X, Dinh PC, Sanchez VA, Trendowski MR, Shuey MM, Nguyen T, Feldman DR, Vaughn DJ, Fung C, Kollmannsberger C, Martin NE, Einhorn LH, Cox NJ, Frisina RD, Travis LB, Dolan ME. Comprehensive association analysis of speech recognition thresholds after cisplatin-based chemotherapy in survivors of adult-onset cancer. Cancer Med 2023; 12:2999-3012. [PMID: 36097363 PMCID: PMC9939144 DOI: 10.1002/cam4.5218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Deficits in speech understanding constitute one of the most severe consequences of hearing loss. Here we investigate the clinical and genetic risk factors for symmetric deterioration of speech recognition thresholds (SRT) among cancer survivors treated with cisplatin. METHODS SRT was measured using spondaic words and calculating the mean of measurements for both ears with symmetric SRT values. For clinical associations, SRT-based hearing disability (SHD) was defined as SRT≥15 dB hearing loss and clinical variables were derived from the study dataset. Genotyped blood samples were used for GWAS with rank-based inverse normal transformed SRT values as the response variable. Age was used as a covariate in association analyses. RESULTS SHD was inversely associated with self-reported health (p = 0.004). Current smoking (p = 0.002), years of smoking (p = 0.02), BMI (p < 0.001), and peripheral motor neuropathy (p = 0.003) were positively associated with SHD, while physical activity was inversely associated with SHD (p = 0.005). In contrast, cumulative cisplatin dose, peripheral sensory neuropathy, hypertension, and hypercholesterolemia were not associated with SHD. Although no genetic variants had an association p value < 5 × 10-8 , 22 genetic variants were suggestively associated (p < 10-5 ) with SRT deterioration. Three of the top variants in 10 respective linkage disequilibrium regions were either positioned within the coding sequence or were eQTLs for genes involved in neuronal development (ATE1, ENAH, and ZFHX3). CONCLUSION Current results improve our understanding of risk factors for SRT deterioration in cancer survivors. Higher BMI, lower physical activity, and smoking are associated with SHD. Larger samples would allow for expansion of the current findings on the genetic architecture of SRT.
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Affiliation(s)
| | - Xindi Zhang
- Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Paul C. Dinh
- Department of Medical OncologyIndiana UniversityIndianapolisIndianaUSA
| | - Victoria A. Sanchez
- Department of Otolaryngology—Head and Neck SurgeryUniversity of South FloridaTampaFloridaUSA
| | | | - Megan M. Shuey
- Department of Medicine and Vanderbilt Genetics Institute, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Tessa Nguyen
- Center for Audiology, Speech, Language and LearningNorthwesthern UniversityChicagoIllinoisUSA
| | | | - Darren R. Feldman
- Department of Medical Oncology, Memorial Sloan‐Kettering Cancer CenterNew YorkNew YorkUSA
| | - David J. Vaughn
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Neil E. Martin
- Department of Radiation OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Nancy J. Cox
- Department of Medicine and Vanderbilt Genetics Institute, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Robert D. Frisina
- Departments of Medical Engineering and Communication Sciences and Disorders, Global Center for Hearing and Speech ResearchUniversity of South FloridaTampaFloridaUSA
| | - Lois B. Travis
- Department of Medical OncologyIndiana UniversityIndianapolisIndianaUSA
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Fink M, Pasche S, Schmidt K, Tewes M, Schuler M, Mülley BW, Schadendorf D, Scherbaum N, Kowalski A, Skoda EM, Teufel M. Neurofeedback Treatment Affects Affective Symptoms, But Not Perceived Cognitive Impairment in Cancer Patients: Results of an Explorative Randomized Controlled Trial. Integr Cancer Ther 2023; 22:15347354221149950. [PMID: 36691908 PMCID: PMC9893099 DOI: 10.1177/15347354221149950] [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] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND EEG biofeedback (NF) is an established therapy to enable individuals to influence their own cognitive-emotional state by addressing changes in brainwaves. Psycho-oncological approaches of NF in cancer patients are rare and effects are hardly studied. OBJECTIVE The aim of this explorative, randomized controlled trial was to test the effectiveness of an alpha and theta NF training protocol, compared to mindfulness based therapy as an established psycho-oncological treatment. METHODS Of initially 62 screened patients, 56 were included (inclusion criteria were cancer independent of tumor stage, age >18 years, German speaking; exclusion criteria suicidal ideation, brain tumor). Randomization and stratification (tumor stage) was conducted by a computer system. Participants got 10 sessions over 5 weeks, in (a) an NF intervention (n = 21; 13 female, 8 male; MAge = 52.95(10 519); range = 31 to 73 years)) or (b) a mindfulness group therapy as control condition (CG; n = 21; ie, 15 female, 6 male; MAge = 50.33(8708); range = 32 to 67 years)). Outcome parameters included self-reported cognitive impairment (PCI) as primary outcome, and secondary outcomes of emotional distress (DT, PHQ-8, GAD-7), fatigue (MFI-20), rumination (RSQ), quality of life (QoL, EORTC-30 QoL), self-efficacy (GSE), and changes in EEG alpha, and theta-beta band performance in the NF condition. RESULTS No changes in cognitive impairment were found (P = .079), neither in NF nor CG. High affective distress was evident, with 70.7% showing elevated distress and 34.1% showing severe depressive symptoms. Affective symptoms of distress (P ≤ .01), depression (P ≤ .05) and generalized anxiety (P ≤ .05) decreased significantly over time. No differences between NF and CG were found. There was a significant increase of the alpha band (P ≤ .05; N = 15) over the NF sessions. Self-efficacy predicted QoL increase in NF with P ≤ .001 and an explained variance of 48.2%. CONCLUSION This is the first study to investigate NF technique with regard to basic mechanisms of effectiveness in a sample of cancer patients, compared to an established psycho-oncological intervention in this field. Though there were no changes in cognitive impairment, present data show that NF improves affective symptoms comparably to mindfulness-based therapy and even more pronounced in QoL and self-efficacy.Trial registration: ID: DRKS00015773.
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Affiliation(s)
- Madeleine Fink
- University of Duisburg-Essen, Essen, Germany,Madeleine Fink, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, Essen 45147, Germany. Emails: ;
| | | | | | - Mitra Tewes
- University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- University of Duisburg-Essen, Essen, Germany,Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany
| | - Bernhard W. Mülley
- University of Duisburg-Essen, Essen, Germany,University of Wuppertal, Wuppertal, Germany
| | - Dirk Schadendorf
- University of Duisburg-Essen, Essen, Germany,University Hospital Essen, Essen, Germany
| | | | - Axel Kowalski
- NeuroFit GmbH, Krefeld, Germany,IB University of Applied Health and Social Sciences, Berlin, Germany
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Oakley-Girvan I, Yunis R, Fonda SJ, Neeman E, Liu R, Aghaee S, Ramsey ME, Kubo A, Davis SW. Usability evaluation of mobile phone technologies for capturing cancer patient-reported outcomes and physical functions. Digit Health 2023; 9:20552076231186515. [PMID: 37456127 PMCID: PMC10338665 DOI: 10.1177/20552076231186515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background By eliminating the requirement for participants to make frequent visits to research sites, mobile phone applications ("apps") may help to decentralize clinical trials. Apps may also be an effective mechanism for capturing patient-reported outcomes and other endpoints, helping to optimize patient care during and outside of clinical trials. Objectives We report on the usability of Digital BioMarkers for Clinical Impact (DigiBioMarC™ (DBM)), a novel smartphone-based app used by cancer patients in conjunction with a wearable device (Apple Watch®). DBM is designed to collect patient-reported outcomes and record physical functions. Methods In a fully decentralized "bring-your-own-device" smartphone study, we enrolled 54 cancer patient and caregiver dyads from Kaiser Permanente Northern California (KPNC) from October 2020 through March 2021. Patients used the app for at least 28 days, completed weekly questionnaires about their symptoms, physical functions, and mood, and performed timed physical tasks. Usability was determined through a subset of the Mobile App Rating Scale (MARS), the full System Usability Scale (SUS), the Net Promoter Score (NPS), and semi-structured interviews. Results We obtained usability survey data from 50 of 54 patients. Median responses to the selected MARS questions and the mean SUS scores indicated above average usability. The NPS from the semi-structured interviews at the end of the study was 24, indicating a favorable score. Conclusions Cancer patients reported above average usability for the DBM app. Qualitative analyses indicated that the app was easy to use and helpful. Future work will emphasize implementing further patient recommendations and evaluating the app's clinical efficacy in multiple settings.
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Affiliation(s)
- Ingrid Oakley-Girvan
- Strategy and Science Departments, Medable Inc., Palo Alto, CA, USA
- The Data and Technology Proving Ground, The Public Health Institute, Oakland, CA, USA
| | - Reem Yunis
- Strategy and Science Departments, Medable Inc., Palo Alto, CA, USA
| | | | - Elad Neeman
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sara Aghaee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Maya E Ramsey
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ai Kubo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sharon W Davis
- Strategy and Science Departments, Medable Inc., Palo Alto, CA, USA
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Sun Y, Wu J, Tian H, Qiu X, Fang Y, Xiao Y, Zheng J, Zhou Y. Global research trends in palliative care for breast cancer from 2012 to 2022: A scientometric analysis. Front Oncol 2023; 13:1104531. [PMID: 36910665 PMCID: PMC9996305 DOI: 10.3389/fonc.2023.1104531] [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: 11/21/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE We used bibliometric methods to evaluate the global scientific output of palliative care breast cancer research and to explore the current status and further research directions in the field over the past decade. METHODS All relevant publications from the year 2012 to 2022 were retrieved from Web of Science. We applied VOSviewer and Bibliometrix R v4.2.1 to obtain information on subject domains, annual publication output and citations, countries and authors with the highest productivity, influential journals and articles, and popular keywords. RESULTS In total, 1529 publications were included in the final analysis. Health services and supportive care, pain and symptom management were the focus of the research in the field. From the year 2017 to 2021, the annual publication output was abundant and peaked in 2018. The systematic review by Fitzmaurice et al. in 2017 was the most-cited publication. The United States was the leading country with the maximum number of publications, citations, and link strengths with other countries. The most contributing institution was University of Toronto. E. Bruera was the most prolific author, ranking first among the authors in both the H and M index. The journal with the most publications was Palliative & Supportive Care. Keywords analysis indicated that exploring the significant degree of palliative care to reduce anxiety and depression in breast cancer patients may be a good research direction. In addition, how to assess the optimal timing of palliative care interventions and further exploring the specific contradiction between insufficient medical resources and palliative care are also possible research directions. CONCLUSION Palliative care plays an important role in the treatment of breast cancer. With the help of a scientometric analysis in this field, researchers can clarify the current research status and hotspots worth fully exploring.
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Affiliation(s)
- Yixian Sun
- Department of Thyroid, Breast, and Hernia Surgery, General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jinyao Wu
- Department of Thyroid, Breast, and Hernia Surgery, General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Huiting Tian
- Department of Thyroid, Breast, and Hernia Surgery, General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiuhua Qiu
- Department of Educational Administration Office/Humanistic Education, Shantou University Medical College, Guangdong, China
| | - Ying Fang
- Department of Mental Health and Counseling Center, Shantou University Medical College, Guangdong, China
| | - Yingjie Xiao
- Department of Medical Humanities, Shantou University Medical College, Guangdong, China
- *Correspondence: Yingjie Xiao, ; Jiehua Zheng, ; Yanqiong Zhou,
| | - Jiehua Zheng
- Department of Thyroid, Breast, and Hernia Surgery, General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Yingjie Xiao, ; Jiehua Zheng, ; Yanqiong Zhou,
| | - Yanqiong Zhou
- Department of Pharmacy, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Yingjie Xiao, ; Jiehua Zheng, ; Yanqiong Zhou,
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Demuru E, Rossi S, Ventura L, Dal Maso L, Guzzinati S, Katalinic A, Lamy S, Jooste V, Di Benedetto C, De Angelis R. Estimating complete cancer prevalence in Europe: validity of alternative vs standard completeness indexes. Front Oncol 2023; 13:1114701. [PMID: 37168378 PMCID: PMC10166634 DOI: 10.3389/fonc.2023.1114701] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Comparable indicators on complete cancer prevalence are increasingly needed in Europe to support survivorship care planning. Direct measures can be biased by limited registration time and estimates are needed to recover long term survivors. The completeness index method, based on incidence and survival modelling, is the standard most validated approach. Methods Within this framework, we consider two alternative approaches that do not require any direct modelling activity: i) empirical indices derived from long established European registries; ii) pre-calculated indices derived from US-SEER cancer registries. Relying on the EUROCARE-6 study dataset we compare standard vs alternative complete prevalence estimates using data from 62 registries in 27 countries by sex, cancer type and registration time. Results For tumours mostly diagnosed in the elderly the empirical estimates differ little from standard estimates (on average less than 5% after 10-15 years of registration), especially for low prognosis cancers. For early-onset cancers (bone, brain, cervix uteri, testis, Hodgkin disease, soft tissues) the empirical method may produce substantial underestimations of complete prevalence (up to 20%) even when based on 35-year observations. SEER estimates are comparable to the standard ones for most cancers, including many early-onset tumours, even when derived from short time series (10-15 years). Longer observations are however needed when cancer-specific incidence and prognosis differ remarkably between US and European populations (endometrium, thyroid or stomach). Discussion These results may facilitate the dissemination of complete prevalence estimates across Europe and help bridge the current information gaps.
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Affiliation(s)
- Elena Demuru
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Leonardo Ventura
- Clinical and Descriptive Epidemiology Unit, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | | | - Alexander Katalinic
- Cancer Registry of Schleswig-Holstein, Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sebastien Lamy
- Tarn Cancer Registry, Claudius Regaud Institute - Center for Epidemiology and Research in Population Health (CERPOP U1295), University of Toulouse - Inserm, Toulouse, France
| | - Valerie Jooste
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | | | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
- *Correspondence: Roberta De Angelis,
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Tevaarwerk AJ, Zhang X, Haine J, Norslien K, Henningfield MF, Stietz C, Hahn D, Sesto ME. Re-engineering Survivorship Care Plans to Support Primary Care Needs and Workflow: Results From an Engineering, Primary Care and Oncology Collaborative for Survivorship Health (EPOCH). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1654-1661. [PMID: 33904117 PMCID: PMC8546004 DOI: 10.1007/s13187-021-02008-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/11/2023]
Abstract
Maintaining the health of survivors requires communication, collaboration and care coordination between oncology and primary care. Primary care clinicians have been acknowledged as important recipients of survivorship care plans (SCPs); however, current SCP templates have not been evaluated for usefulness in the primary care context. We surveyed and interviewed primary care clinicians from a rural research network regarding SCP content, format and layout (phase 1), and potential use and clinical workflows around SCPs (phase 2). Based on these data, an existing SCP template was iteratively redesigned to better support survivorship care in the primary care setting. A total of 13 clinicians (9 MDs, 4 APPs) participated. Interviewees advocated for maintaining a single SCP document shared by survivors and clinicians. Changes to the SCP template included prioritizing follow-up over summary of treatment and removing or down-playing screening recommendations not impacted by cancer or cancer treatment. The re-engineered SCP was regarded as highly relevant for survivors, but clinicians noted the significant effort to "disassemble" SCPs in order to enter the information into on the receiving health record. Primary care clinicians value the information in SCPs but had important recommendations regarding content, layout, and format. Additionally, a significant effort appears to be required by recipients in order to extract SCP information for future use.
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Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA.
- Carbone Cancer Center, Madison, WI, USA.
| | | | - James Haine
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - Mary F Henningfield
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - David Hahn
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Mary E Sesto
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
- Carbone Cancer Center, Madison, WI, USA
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Cull Weatherer AL, Krebsbach JK, Tevaarwerk AJ, Kerch SC, LoConte NK. The current status of survivorship care provision at the state level: a Wisconsin-based assessment. J Cancer Surviv 2022; 16:1355-1365. [PMID: 34609701 PMCID: PMC8490831 DOI: 10.1007/s11764-021-01117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE As the number of cancer survivors grows, the responsibility for addressing their unique physical and emotional needs also increases. Survivorship care services vary by geography, health system, and insurance coverage. We aimed to understand the state of survivorship care services in Wisconsin's cancer facilities. METHODS The selection of cancer treatment facilities sought to provide a geographically representative sample. An adapted Patient-Centered Survivorship Care Index was comprised of questions regarding different aspects of survivorship practices. Areas of interest included disciplines incorporated, services provided, standards of care, and discussion of late-term effects, among others. RESULTS Out of 90 sites invited, 40 responded (44.4%). Oncologists, physician assistants, and nurse practitioners were the most common follow-up care disciplines. Risk reduction services, dietary services, access to physical activity, and behavioral health specialist referral were described as standards of care in less than half of sites. All sites reported working with community partners, 92.5% of which worked with YMCA-related programs. Discussion of long-term effects was a standard of care for all sites. Effects such as emotional distress and health practice changes were frequently discussed with almost all patients, while sexual functioning and fertility were not. CONCLUSIONS Services and specialties related to behavioral health, fertility/sexual health, and rehabilitation and physical activity varied between sites. Such services may be offered less often due to variable insurance coverage. IMPLICATIONS FOR CANCER SURVIVORS Policy solutions should be explored to increase insurance coverage and provision rates of necessary survivorship services to keep up with the projected increase in demand. Given imperfect and evolving measurement tools to assess needs for cancer survivorship care services, cancer survivors should feel empowered to voice when they have unmet needs and request referrals.
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Affiliation(s)
| | - John K Krebsbach
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
| | - Amye J Tevaarwerk
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sarah C Kerch
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
| | - Noelle K LoConte
- University of Wisconsin Carbone Cancer Center, 610 N Walnut St., Room 370 WARF, Madison, WI, 53726, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Li Q, Pan X, Li X, Huang W. Association of Physical Activity Intensity with All-Cause Mortality in Cancer Survivors: A National Prospective Cohort Study. Cancers (Basel) 2022; 14:cancers14235760. [PMID: 36497247 PMCID: PMC9740265 DOI: 10.3390/cancers14235760] [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: 10/08/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
We designed this study to investigate the associations between physical activity (PA) and the risk of all-cause mortality in cancer survivors using a nationally representative cohort of US adults. This cohort study included 13 cycles of the National Health Interview Surveys, and by matching participants with the National Death Index (2015), survival status was determined. The main outcome was all-cause mortality during follow-up. A total of 20,088 participants aged 62.2 (15.9) years (62.4% women) were analyzed. After an average follow-up of 117.5 months, 7214 (35.9%) participants died. Compared with inactive cancer survivors, we observed a 25% lower all-cause mortality risk among participants performing PA 10 min to 1 h/week (hazard ratio [HR] = 0.75, 95% confidence interval [CI] = 0.67-0.85), a 28% lower risk among those performing PA 1-2.5 h/week (HR = 0.72, 95% CI = 0.67-0.78), a 34% lower risk among those performing PA 2.5-5 h/week (HR = 0.66, 95% CI = 0.60-0.72), a 37% lower risk among those performing PA 5-7.5 h/week (HR = 0.63, 95% CI = 0.56-0.70), a 47% lower risk among those performing PA 7.5-13.3 h/week (HR = 0.53, 95% CI = 0.47-0.61), and a 43% lower risk among those performing PA 13.3-24 h/week (adjusted HR = 0.53, 95% CI = 0.49-0.66). In cancer survivors, leisure-time PA was associated with a lower all-cause mortality. Inactive cancer survivors should be encouraged to perform more PA to reduce the risk of all-cause mortality.
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Affiliation(s)
- Qiguang Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xueqiang Pan
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiao Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Wei Huang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410017, China
- Research Center of Carcinogenesis and Targeted Therapy, Xiangya Hospital, Central South University, Changsha 410017, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Changsha 410017, China
- Correspondence: ; Tel.: +86-0731-84328888
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Application of the Updated WCRF/AICR Cancer Prevention Score as an Outcome for Cancer Survivors Participating in a Tailored and Intensive Dietary and Physical Activity Intervention. Nutrients 2022; 14:nu14224751. [PMID: 36432442 PMCID: PMC9699073 DOI: 10.3390/nu14224751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has defined evidence-based guidelines for cancer prevention. These recommendations have been operationalized into a quantitative index for individual assessment. Survivors of cancer are increasingly desiring guidance for diet and lifestyle, and in the absence of research in survivors, are often instructed to follow cancer prevention and public health guidelines. In this study, we examine the utility of the quantitative updated WCRF/AICR scoring criteria to assess change among cancer survivors with overweight/obesity (OW/OB) following an intensive behavioral intervention. We applied the WCRF/AICR scoring criteria (range 0−7) to examine changes over the duration of the study by paired t-tests. Two cancer survivor cohorts with OW/OB (n = 91) completed a six-month phase II clinical trial designed to improve dietary and physical activity patterns. At enrollment and post-intervention, participants completed assessments including anthropometrics, food frequency questionnaires, and objective evaluation of physical activity. Participants improved adherence to all scored recommendations, with a significant increase in mean score from enrollment (3.22 ± 1.06) to post-intervention (4.28 ± 1.04) (p < 0.001). Mean BMI and waist circumference improved (both p < 0.001). The greatest improvements were noted for fruit and non-starchy vegetable intakes (+39%, p < 0.001); the greatest decreases were observed for processed meat consumption (−70%, p < 0.001). The updated WCRF/AICR Score can be applied to cancer survivor intervention studies and provides a tool to compare trials in regard to the baseline status of populations enrolled and the success of the intervention. Future interventions incorporating standardized assessments will help guide effective strategies to improve the health and quality of life for cancer survivors.
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Zhang J, Su M, Cheng J, Zhou S, Liu L, Yao NA. A nationally representative study of aerobic activity and strength training in older cancer survivors and their psychological distress and sleep difficulties. Support Care Cancer 2022; 30:9597-9605. [PMID: 36171399 DOI: 10.1007/s00520-022-07370-2] [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: 05/24/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the prevalence of different levels of aerobic activity and strength training in older cancer survivors and their associations with psychological distress and sleep difficulties. METHODS We used cross-sectional data from the 2016-2018 National Health Interview Survey on 3,425 survivors aged ≥ 65 years. Individuals were classified into active, insufficiently active, and inactive categories, and by whether they reported strength training at least twice per week. The outcome variables were self-reported psychological distress, trouble falling asleep, trouble staying asleep, and trouble waking up feeling rested. Multivariate logistic models were used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs). RESULTS Only 35.2% of older survivors reached the recommended aerobic activity guidelines, and 12% had strength training at least twice per week. A total of 626 (18.3%) reported at least moderate psychological distress, and 1,137 (33.2%) had trouble staying asleep. For survivors who reported strength training less than two times per week, being insufficiently active or inactive was associated with worse psychological distress (OR 1.52, 95% CI 1.17-1.97; OR 1.30, 95% CI 1.02-1.64) and more sleep difficulties (OR ranging from 1.33 to 2.07). Among active survivors, strength training two or more times per week was associated with more trouble staying asleep (OR 1.67, 95% CI 1.06-2.58). CONCLUSIONS Most older cancer survivors did not meet the recommended physical activity guidelines and suffered from psychological distress and sleep difficulties. Additional research may be needed to examine the effects of frequent muscle strength training on sleep quality.
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Affiliation(s)
- Jiajun Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China
- Center for Cancer Control and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China
- Center for Cancer Control and Policy Research, Shandong University, Jinan, China
| | - Joyce Cheng
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shengyu Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China
- Center for Cancer Control and Policy Research, Shandong University, Jinan, China
| | - Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Nengliang Aaron Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China.
- Center for Cancer Control and Policy Research, Shandong University, Jinan, China.
- Home Centered Care Institute, Schaumburg, IL, USA.
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Liang Q, Hong S, Peng L, Liao J, Wen W, Sun W. Impact of prior cancer history on survival of patients with hypopharyngeal cancer. Cancer Med 2022; 12:2929-2936. [PMID: 36057955 PMCID: PMC9939181 DOI: 10.1002/cam4.5208] [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: 03/28/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The impact of prior cancer history on survival of hypopharyngeal cancer patients remains unknown. The present study assessed the impact of prior cancer history on survival of patients with hypopharyngeal cancer. METHODS Patients with primary hypopharyngeal cancer diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. One-to-one PSM, Kaplan-Meier method, and log-rank test were performed for survival analysis. RESULTS We included 5017 patients with hypopharyngeal cancer. Prior cancer history had no significant impact on overall survival of hypopharyngeal cancer patients in comparison with those without prior cancer history (p = 0.845, after PSM). Subgroup analysis showed that prior cancer history had no significant effect on overall survival of hypopharyngeal cancer patients. CONCLUSION More hypopharyngeal cancer patients with prior cancer history should be considered for clinical trials. However, further prospective studies are needed.
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Affiliation(s)
- Qi‐Wei Liang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of Otorhinolaryngology Head and Neck SurgeryDepartment of Thyroid Center/Thyroid Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of Otorhinolaryngology of Longgang Center Hospital, the Ninth People's Hospital of ShenzhenShenzhenChina
| | - Shu‐Yi Hong
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of Otorhinolaryngology Head and Neck SurgeryDepartment of Thyroid Center/Thyroid Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Liang Peng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jing Liao
- Department of Otorhinolaryngology Head and Neck SurgeryDepartment of Thyroid Center/Thyroid Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Wei‐Ping Wen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of Otorhinolaryngology Head and Neck SurgeryDepartment of Thyroid Center/Thyroid Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Wei Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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