Lifestyle Factors in Cancer Survivorship: Where We Are and Where We Are Headed

Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.

Navigating the crossroads: cardiometabolic risks in cancer survivorship - a comprehensive review

The landscape of cancer survivorship is increasingly populated by individuals facing a spectrum of cardiometabolic risks, attributed to both their oncological history and treatment regimens. This manuscript synthesizes findings from various studies, highlighting the prevalence of traditional risk factors-hypertension, dyslipidemia, diabetes-as well as emergent concerns like obesity and metabolic syndrome among survivors. The impact of demographic variables, specific cancer types, and treatment modalities on cardiometabolic health is explored. Through a lens of multidisciplinary management and future research directives, we advocate for an integrative approach to cardiometabolic health in cancer survivors, aiming to ensure their victory over cancer extends into long-term well-being.

Prevalence of health behaviors among cancer survivors in the United States

PURPOSE

We determined the proportion of cancer survivors who met each of five health behavior guidelines recommended by the American Cancer Society (ACS), including consuming fruits and vegetables at least five times/day, maintaining a body mass index (BMI) < 30 kg/m2, engaging in 150 min or more of physical activity weekly, not currently smoking, and not excessively drinking alcohol.

METHODS

Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), 42,727 survey respondents who reported a previous diagnosis of cancer (excluding skin cancer) were included. Weighted percentages with 95% confidence intervals (95% CI) were estimated for the five health behaviors accounting for BRFSS' complex survey design.

RESULTS

The weighted percentage of cancer survivors who met ACS guidelines was 15.1% (95%CI: 14.3%, 15.9%) for fruit and vegetable intake; 66.8% (95%CI: 65.9%, 67.7%) for BMI < 30 kg/m2; 51.1% (95%CI: 50.1%, 52.1%) for physical activity; 84.9% (95%CI: 84.1%, 85.7%) for not currently smoking; and 89.5% (95%CI: 88.8%, 90.3%) for not drinking excessive alcohol. Adherence to ACS guidelines among cancer survivors generally increased with increasing age, income, and education.

CONCLUSIONS

While the majority of cancer survivors met the guidelines for not smoking and limiting alcohol drinking, one-third had elevated BMI, almost half did not meet recommended physical activity levels, and the majority had inadequate fruit and vegetable intake.

IMPLICATIONS FOR CANCER SURVIVORS

Adherence to guidelines was lowest among younger cancer survivors and those with lower income and education, suggesting these may be populations where resources could be targeted to have the greatest impact.

Efficacy and Safety of Laughter Yoga in Cancer Patients: A Scoping Review of Randomized Controlled Trials

The use of laughter yoga as a complementary and alternative medicine (CAM) strategy has recently gained interest as a potential supportive intervention for cancer patients. In this review, we aimed to assess the impact of laughter yoga on the quality of life of cancer patients, with a focus on evidence from randomized controlled trials (RCTs). Our analysis indicates that laughter yoga can significantly improve the quality of life of cancer patients by improving emotional and physical functioning and reducing symptoms of depression and stress. These findings suggest that laughter yoga is a promising CAM practice for enhancing cancer patients' psychological and physical health. Future research should aim to extend these studies to more extensive and more diverse populations to validate and expand upon these findings.

Examining the role of social relationships on health and health behaviors in African American men with prostate cancer: a qualitative analysis

PURPOSE

Cancer survivor cohort studies document the positive impact of health behaviors on cancer survivorship by influencing quality of life, comorbidity burden, and cancer recurrence. Social networks can be instrumental in supporting health behavior changes. This study used qualitative interviews to explore how social networks may impact health and health behaviors of African American Prostate Cancer Survivors (AAPCS) enrolled in Men Moving Forward (MMF), a lifestyle intervention designed with and for AAPCS. Specifically, we sought to understand how different relationships within social networks influence health and health behaviors, and to identify potential mechanisms for this influence.

METHODS

Eighteen men who completed the MMF intervention participated in a semi-structured interview which explored social connections, health and health behaviors, stress, and the cancer experience. Interviews were recorded and transcribed, and thematic analysis was performed by two coders.

RESULTS

Participants described robust social networks of friends and family. Four distinct yet overlapping themes were identified that described how relationships influence health and health behaviors among AAPCS: (1) provision of knowledge, (2) health and behavior history, (3) encouragement and support, and (4) shared behavior.

CONCLUSIONS

These results provide initial insight into the types of relationships that influence health, and the intersecting and multifaceted mechanisms through which this influence occurs.

Perceived importance of weight loss and exercise among endometrial cancer survivors with overweight or obesity: Implications for lifestyle modification interventions

Objective

Type 1 endometrial cancer (EC) survivors who are overweight or obese are at increased risk of comorbidities and reduced quality of life. Lifestyle modification interventions (e.g., healthy eating, exercise) may help these women reduce excess weight and improve their quality of life. However, existing interventions have shown limited success. Guided by Self-Determination Theory, the proposed study sought to identify factors associated with perceived importance of weight loss and exercise as well as interest in lifestyle modification interventions (components of extrinsic and intrinsic motivation) among EC survivors with overweight or obesity to inform future intervention development.

Methods

One hundred type 1 EC survivors [body mass index (BMI) ≥ 25 kg/m2] completed a cross-sectional survey assessing sociodemographics, medical factors, exercise, risk perceptions and provider communication, quality of life, barriers to dieting and exercise, perceived importance of healthy lifestyles, and desired intervention content.

Results

EC survivors who were aware obesity is a risk factor for EC were significantly more likely to perceive weight loss as important and were interested in weight loss programs and receiving information about exercise (ps < 0.05). Additionally, EC survivors who reported their provider discussed the importance of a healthy weight after their diagnosis were significantly more likely to perceive exercise as important and were interested in receiving dieting information.

Conclusions

EC survivors expressed interest in lifestyle modification interventions. Increasing awareness about the risk of obesity and provider discussions about healthy weight during routine appointments may motivate EC survivors to engage in lifestyle modification interventions.

Comparing survival rates for clusters of depressive symptoms found by Network analysis' community detection algorithms: Results from a prospective population-based study among 9774 cancer survivors from the PROFILES-registry

OBJECTIVES

Previous studies have shown that depression is associated with mortality in patients with cancer. Depression is however a heterogeneous construct and it may be more helpful to look at different (clusters) of depressive symptoms than to look at depression as a discrete condition. The aim of the present study is to investigate whether clusters of depressive symptoms can be identified using advanced statistics and to investigate how these symptom clusters are associated with all-cause mortality in a large group of patients with cancer.

METHOD

Data from a large population-based cohort study (PROFILES) including various cancer types were used. Eligible patients completed self-report questionnaires (i.e. Fatigue assessment scale, Hospital anxiety and depression scale, EORTC QOL-C30) after diagnosis. Survival status was determined on 31 January 2022.

RESULTS

In total, 9744 patients were included. Network analyses combining different community detection algorithms showed that clusters of depressive symptoms could be detected that correspond with motivational anhedonia, consummatory anhedonia and negative affect. Survival analyses using the variables that represented these clusters best showed that motivational and consummatory anhedonia were associated with survival. Even after controlling for clinical and sociodemographic variables items assessing motivational anhedonia were significantly associated with mortality over time.

CONCLUSION

Separate clusters of symptoms that correspond with motivational and consummatory anhedonia and negative affect can be distinguished and anhedonia may be associated with mortality more than negative affect. Looking at particular (clusters of) depressive symptoms may be more informative and clinically relevant than using depression as a single construct (i.e. syndrome).

U-shaped association between body mass index and health-related quality of life impairment in Korean cancer survivors: a nationwide representative cross-sectional survey

PURPOSE

Although obesity is an important risk factor for cancer incidence, the effect of body mass index (BMI) on health-related quality of life (HRQoL) after cancer treatment remains unknown. This population-based cross-sectional study assessed different levels of BMI as an important factor associated with impaired HRQoL in long-term cancer survivors.

METHODS

The study enrolled 1104 cancer survivors from the fourth to seventh Korea National Health and Nutrition Examination Surveys (KNHANES 2007-2018) who were alive at least 5 years after their cancer diagnoses. The BMI was classified into four categories: < 20 (underweight), 20-22.9 (healthy weight), 23-24.9 (overweight), and ≥ 25 kg/m2 (obese). Impaired HRQoL was defined as the lowest quartile of European Quality of Life 5-Dimensions (EQ-5D) questionnaire scores.

RESULTS

Cancer survivors who were underweight or obese were more likely to report health problems on each dimension of the EQ-5D compared to the other BMI groups. In multivariate logistic regression analysis, the two extreme BMI categories were significantly associated with impaired HRQoL (BMI < 20 kg/m2: odds ratio [OR] = 1.73, 95% confidence interval [CI] = 1.08-2.86; BMI ≥ 25 kg/m2: OR = 2.14, 95% CI = 1.41-3.25; P trend = 0.049), especially in the gastrointestinal cancer group (P heterogeneity = 0.007). Moreover, the association between underweight/obese and impaired HRQoL showed a significant sex difference (P heterogeneity = 0.019).

CONCLUSIONS

The results of this study suggest that deviations from normal BMI, such as being underweight or obese, are negatively associated with HRQoL in long-term cancer survivors; to some extent, this may depend on cancer type and sex.

IMPLICATIONS FOR CANCER SURVIVORS

Reaching or maintaining a healthy weight should be emphasized for cancer survivors as a long-term goal even after cancer treatment.

Health-Promoting Lifestyle among the Survivors of Colorectal Cancer: An Integrative Review

Introduction

Health-promoting lifestyle (HPL) among the survivors of colorectal cancer (CRC) is essential to reduce CRC complications, prevent its recurrence, and improve survival. Nonetheless, there is no comprehensive definition for the concept of HPL in CRC survivors. This study aimed to define the concept of HPL among CRC survivors based on the existing literature.

Methods

This integrative review was conducted in 2021 using Whittemore and Knafl's method. The national and international databases of SID, Magiran, ProQuest, Medline, ScienceDirect, Web of Science, and Scopus were searched. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT) and the data were analyzed using the four-step approach proposed by Whittemore and Knafl.

Results

After data evaluation, 167 documents were included in final analysis. In total, 1863 codes were generated and categorized into eighteen main categories and the three main themes of antecedents, attributes, and consequences. Accordingly, HPL among CRC survivors was defined as "a set of behaviors in the areas of health responsibility, physical activity, nutrition, spiritual growth, psychological management, and interpersonal relations which are affected by socio-demographic characteristics, clinical characteristics, psychological status, physical conditions, time and place limitations, and patient education, and lead to better disease prognosis, better general health status, better bio-psycho-social status, and better quality of life".

Conclusion

The definition of HPL among CRC survivors provided in the present study can be used in counseling, educational, supportive, and care programs for CRC survivors in order to improve their quality of life and survival.

Real-world evidence research in metastatic colorectal cancer: raising awareness of the need for patient contributions

Real-world evidence (RWE) research helps determine whether outcomes observed in clinical trials happen in real-life clinical practice. RWE research may help patients receive more appropriate treatment, closer to their needs and wishes. RWE for metastatic colorectal cancer is currently limited. The PROMETCO RWE study is an important example of an ongoing initiative that focuses on patient-reported outcomes in metastatic colorectal cancer. Patients play an active role throughout the RWE research process, including study design, participation and results dissemination. This involvement can encourage greater patient empowerment through active engagement, potentially resulting in various benefits that can lead to improved clinical outcomes. Greater patient engagement can increase involvement in RWE, helping more patients to access the benefits of RWE research. Clinical Trial Registration: NCT03935763 (ClinicalTrials.gov).

Protocol: Can coronary artery calcium score identified on thoracic planning CT scans be used and actioned to identify cancer survivors at high risk of cardiac events: A feasibility study in cancer survivors undergoing radiotherapy in Australia

INTRODUCTION

A coronary artery calcium (CAC) CT scan can identify calcified plaque and predict risk of future cardiac events. Cancer survivors undergoing thoracic radiotherapy routinely undergo a planning CT scan, which presents a unique opportunity to use already obtained medical imaging to identify those at the highest risk of cardiac events. While radiation therapy is an important modality for many cancer treatments, radiation dose to the heart in thoracic radiotherapy leads to cardiotoxicity and may accelerate pre-existing atherosclerosis. The primary aims of this study are to investigate the feasibility of using CAC scores calculated on thoracic radiotherapy planning CT scans to identify a subset of cancer survivors at an increased risk of future cardiac events, and to establish and evaluate a referral pathway for assessment and management in a cardio-oncology clinic. An optional substudy aims to investigate using abdominal aortic calcification (AAC) as a practical, low-radiation alternative to CAC to evaluate and monitor vascular health.

METHODS AND ANALYSIS

This is an observational, prospective study in a minimum of 100 cancer survivors commencing radiotherapy. Participants will have CAC scored from thoracic radiotherapy planning CT scans. Those identified as high risk (CAC score>0) will be referred to a cardio-oncology clinic. Feasibility, determined by adherence to the recommended pathway, and impact on quality of life and anxiety measured via questionnaire, will be assessed. Participants in Western Australia will be invited to participate in a 12-month observational pilot substudy, investigating lifestyle behaviours and the use of a dual-energy X-ray absorptiometry machine to measure musculoskeletal health and AAC.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from St Vincent's Hospital, Sydney (Project number 2021/ETH11847), GenesisCare and Edith Cowan University (2022-03326-DALLAVIA). Study results will be reported in peer-reviewed academic journals, at scientific conferences, and at clinical forums, irrespective of the results observed.

TRIAL REGISTRATION NUMBER

ACTRN12621001343897.

Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non-Small Cell Lung Cancer

Importance

Lung cancer remains the leading cause of cancer-related death globally; non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases, and cigarette smoking is the factor most significantly associated with its risk. However, little is known about the association of years since prediagnosis smoking cessation and cumulative smoking with overall survival (OS) following a lung cancer diagnosis.

Objective

To characterize the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with OS in patients with NSCLC in a lung cancer survivor cohort.

Design, Setting, and Participants

The cohort study involved patients with NSCLC who were recruited to the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital (Boston, Massachusetts) between 1992 and 2022. Patients' smoking history and baseline clinicopathological characteristics were prospectively collected through questionnaires, and OS following lung cancer diagnosis was regularly updated.

Exposures

Duration of smoking cessation before a lung cancer diagnosis.

Main Outcomes and Measures

The primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis.

Results

Of 5594 patients with NSCLC (mean [SD] age, 65.6 [10.8] years; 2987 men [53.4%]), 795 (14.2%) were never smokers, 3308 (59.1%) were former smokers, and 1491 (26.7%) were current smokers. Cox regression analysis suggested that former smokers had 26% higher mortality (hazard ratio [HR], 1.26; 95% CI, 1.13-1.40; P < .001) and current smokers had 68% higher mortality (HR, 1.68; 95% CI, 1.50-1.89; P < .001) compared with never smokers. Log2-transformed years since smoking cessation before diagnosis were associated with significantly lower mortality among ever smokers (HR, 0.96; 95% CI, 0.93-0.99; P = .003). Subgroup analysis, stratified by clinical stage at diagnosis, revealed that former and current smokers had even shorter OS among patients with early-stage disease.

Conclusions and Relevance

In this cohort study of patients with NSCLC, quitting smoking early was associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with OS may have varied depending on clinical stage at diagnosis, potentially owing to the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. Detailed smoking history collection should be incorporated into future epidemiological and clinical studies to improve lung cancer prognosis and treatment selection.

Evaluation of health behaviors and overall quality of life in younger adult African American cancer survivors

BACKGROUND

Epidemiological studies of cancer survivors have predominantly focused on non-Hispanic White, elderly patients, despite the observation that African Americans have higher rates of mortality. Therefore, we characterized cancer survivorship in younger African American survivors using the Detroit Research on Cancer Survivors (ROCS) study to assess health behaviors and quality of life.

METHODS

Five hundred and seventeen patients diagnosed with any cancer between the ages of 20-49 (mean age: 42 years; SD: 6.7 years) completed a survey to identify important clinical, behavioral, and sociodemographic characteristics, measures of health literacy, and experiences of discrimination. Quality of life outcomes were evaluated in patients using FACT-G, FACT-Cog, and PROMIS® Anxiety and Depression scales. Stepwise linear and logistic regression were used to assess the association between quality of life measures and participant characteristics.

RESULTS

The mean FACT-G score was 74.1 (SD: 21.3), while the FACT-Cog was 55.1 (SD: 17.1) (FACT-G range 0-108 with higher scores indicating better function; elderly cancer patient mean: 82.2; FACT-Cog 18-item range 0-72 points with higher scores indicating better perceived cognitive functioning; scores <54 indicating cognitive impairment). In addition, 27.1% and 21.6% of patients had a score indicative of moderate or severe anxiety and depression, respectively. Perceived discrimination and the number of discriminatory events were significantly associated with reductions in three of the four quality of life measures. Health literacy was positively associated with all four health measures, while total comorbidity count was negatively associated with three of the four measures.

CONCLUSION

Younger adult African American cancer survivors who report experiencing discrimination and suffer from multiple comorbid conditions have poorer mental and overall health. Understanding the unique clinical and socioeconomic stressors that influence this patient population is essential for reducing health disparities and improving long-term survivorship.

Diet and exercise advice and referrals for cancer survivors: an integrative review of medical and nursing perspectives

Purpose

To examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals.

Methods

An integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators.

Results

Twenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice.

Conclusion

Although medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07152-w.

A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries

Cancer incidence and mortality rates continue to rise globally, a trend mostly driven by preventable cancers occurring in low-and middle-income countries (LMICs). There is growing concern that many LMICs are ill-equipped to cope with markedly increased burden of cancer due to lack of comprehensive cancer control programs that incorporate primary, secondary, and tertiary prevention strategies. Notably, few countries have allocated budgets to implement such programs. In this review, we utilize a socio-ecological framework to summarize primary (risk reduction), secondary (early detection), and tertiary (treatment and survivorship) strategies to reduce the cancer burden in these countries across the individual, organizational, community, and policy levels. We highlight strategies that center on promoting health behaviors and reducing cancer risk, including diet, tobacco, alcohol, and vaccine uptake, approaches to promote routine cancer screenings, and policies to support comprehensive cancer treatment. Consistent with goals promulgated by the United Nations General Assembly on Noncommunicable Disease Prevention and Control, our review supports the development and implementation of sustainable national comprehensive cancer control plans in partnership with local communities to enhance cultural relevance and adoption, incorporating strategies across the socio-ecological framework. Such a concerted commitment will be necessary to curtail the rising cancer and chronic disease burden in LMICs.

Phytotherapy in Integrative Oncology-An Update of Promising Treatment Options

Modern phytotherapy is part of today's conventional evidence-based medicine and the use of phytopharmaceuticals in integrative oncology is becoming increasingly popular. Approximately 40% of users of such phytopharmaceuticals are tumour patients. The present review provides an overview of the most important plants and nature-based compounds used in integrative oncology and illustrates their pharmacological potential in preclinical and clinical settings. A selection of promising anti-tumour plants and ingredients was made on the basis of scientific evidence and therapeutic practical relevance and included Boswellia, gingko, ginseng, ginger, and curcumin. In addition to these nominees, there is a large number of other interesting plants and plant ingredients that can be considered for the treatment of cancer diseases or for the treatment of tumour or tumour therapy-associated symptoms. Side effects and interactions are included in the discussion. However, with the regular and intended use of phytopharmaceuticals, the occurrence of adverse side effects is rather rare. Overall, the use of defined phytopharmaceuticals is recommended in the context of a rational integrative oncology approach.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Assessment and management of a person experiencing pain from pancreatic cancer ascites: a case study

The most common type of pancreatic cancer is pancreatic adenocarcinoma, which affects the exocrine ducts. There are many risk factors associated with pancreatic cancer, including smoking, obesity, poor diet, diabetes, inactivity and genetics. In the UK, pancreatic cancer is the 10th most common cancer with a poor prognosis, with only 24% of people surviving the first year after diagnosis and 7% surviving for 5 years. The lives of those with the condition are impacted in a number of ways. This case study of a patient with pancreatic cancer explores the nursing assessment, management and evaluation of care provided from a student nurse perspective under the supervision of a qualified nurse.

ADP-ribosylation factor 6 expression increase in oesophageal adenocarcinoma suggests a potential biomarker role for it

ADP-ribosylation factor 6 small GTPase plays an important role in cell migration, invasion and angiogenesis, which are the hallmarks of cancer. Although alterations in ARF6 expression and activity have been linked to metastatic cancer in one or two tissues, the expression of ARF6 in cancers over a wide range of tissues has not been studied so far. In this report, we analysed the expression of ARF6 mRNA in cancers and corresponding healthy controls from 17 different tissues by real-time qualitative polymerase chain reaction (RT-qPCR). We further evaluated ARF6 protein expression in oesophageal adenocarcinoma (EAC) tissue microarray cores by immunohistochemistry. The ARF6 gene expression levels are highly variable between healthy and cancer tissues. Our findings suggest that the ARF6 gene expression is up-regulated highest in oesophageal cancer. In EAC TMAs, ARF6 protein expression increase correlated with EAC progression. This is the first study to investigate ARF6 gene expression in a wide array of cancer tissues and demonstrate that ARF6 expression, at both mRNA and protein levels, is significantly upregulated in higher grades of EAC, which may be useful in targeting ARF6 for cancer diagnostic and therapeutic purposes.

Diet/Nutrition: Ready to Transition from a Cancer Recurrence/Prevention Strategy to a Chronic Pain Management Modality for Cancer Survivors?

Evidence for the relationship between chronic pain and nutrition is mounting, and chronic pain following cancer is gaining recognition as a significant area for improving health care in the cancer survivorship population. This review explains why nutrition should be considered to be an important component in chronic pain management in cancer survivors by exploring relevant evidence from the literature and how to translate this knowledge into clinical practice. This review was built on relevant evidence from both human and pre-clinical studies identified in PubMed, Web of Science and Embase databases. Given the relationship between chronic pain, inflammation, and metabolism found in the literature, it is advised to look for a strategic dietary intervention in cancer survivors. Dietary interventions may result in weight loss, a healthy body weight, good diet quality, systemic inflammation, and immune system regulations, and a healthy gut microbiota environment, all of which may alter the pain-related pathways and mechanisms. In addition to being a cancer recurrence or prevention strategy, nutrition may become a chronic pain management modality for cancer survivors. Although additional research is needed before implementing nutrition as an evidence-based management modality for chronic pain in cancer survivors, it is already critical to counsel and inform this patient population about the importance of a healthy diet based on the data available so far.

Adoption of healthy lifestyles among Chinese cancer survivors during the first five years after completion of treatment

Objectives: The number of cancer survivors is increasing as a result of advances in detection and treatment. Lifestyle is a significant modifiable factor in the development of cancer. Most studies on healthy lifestyles have been conducted in Western countries. Cultural influences on the pursuit of healthy lifestyles among Chinese cancer survivors remain largely unexplored. The objectives of this qualitative study are to explore the experiences of Chinese cancer survivors in adopting healthy lifestyles, with a focus on their goals, the challenges they face, and the influences of Chinese culture.Design: Thirty-two Chinese breast and colorectal cancer survivors in their first five years after treatment were recruited from a hospital in Hong Kong to participate in eight focus groups. Qualitative content analysis was adopted to analyse the data.Results: The adoption of a healthy lifestyle was a strategy through which the participants exercised choice to restore balance in their health after developing cancer. Diet, exercise, psychological well-being, the use of traditional Chinese medicine (TCM) and health/dietary supplements, and attending medical consultations/follow-up visits were the behaviours adopted by the participants, with the goal of improving their health, controlling their cancer and preventing relapse, and managing the residual physical symptoms of their illness. In adopting a healthy lifestyle, the participants encountered challenges such as a lack of reliable and practical instructions from healthcare professionals. Chinese cultural beliefs concerning the nature of food, TCM, minimizing social disturbances, and collaborative control influenced their lifestyle.Conclusions: The cancer survivors adopted a range of healthy lifestyles but encountered challenges. Clarifying the principles of food choice while addressing Chinese beliefs regarding therapeutic food and the use of TCM, clarifying queries about conflicting information, and developing plans according to the needs, and competing demands of survivors can facilitate collaborative control between healthcare professionals and cancer survivors.

Health-Promoting Lifestyle in Colorectal Cancer Survivors: A Qualitative Study on the Experiences and Perspectives of Colorectal Cancer Survivors and Healthcare Providers

OBJECTIVE

Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors.

METHODS

This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data.

RESULTS

Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL.

CONCLUSIONS

CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.

The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review

Simple Summary

It is unclear what the risk of negative health outcomes is after cancer during adolescence and young adulthood. We conducted a review to understand the risk of second cancers, chronic conditions, and death in adolescent and young adult (AYA) cancer survivors and found factors that increase the risk. In total, 652 studies were identified, of which 106 were included in the review: 23 for second cancers, 34 for chronic conditions, and 54 for deaths. The number of included studies increased over time, from four studies in 2010 to 17 in 2020. The studies found that AYA cancer survivors are at an increased risk of second cancers, chronic conditions, and deaths. In particular, the following factors increased risk: radiation exposure for second cancers; younger attained age and earlier calendar period of diagnosis for chronic conditions; and non-Hispanic Black or Hispanic, low socioeconomic status, and earlier calendar period of diagnosis for deaths.

Abstract

Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.

Feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors: a systematic review

OBJECTIVE

This study aimed to systematically identify and synthesize evidence on the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors.

METHODS

A total of 14 electronic databases and three trial registries were searched. Experimental studies that examined the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors and published in English or Chinese peer-reviewed journals or protocols were considered eligible. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool. Data were extracted and synthesized narratively.

RESULTS

Six studies, with a sample size ranging from 50 to 3088, were included. The studies had a high overall risk of bias. Six studies reported feasibility data, and the average eligibility, recruitment, and retention rates at post-intervention were 60.7%, 66.7%, and 90.7%, respectively. Only one study measured the acceptability and reported that 66.6% of participants were satisfied with the intervention. Five out of the six studies that measured fruit and vegetable consumption reported statistically significant positive intervention effects. Two studies reported inconsistent intervention effects on wholegrain consumption. Only one study measured the consumption of processed meat, sugar, and alcohol, which had statistically nonsignificant intervention effect.

CONCLUSIONS

Behavior change interventions for improving multiple dietary behaviors might be feasible and effective to increase fruit and/or vegetable consumption among cancer survivors. Further research is needed to examine the acceptability and effects of the intervention for modifying other dietary behavior.

The Evaluation of a Health-Based Education and Behavioral Change Retreat on Quality of Life, Physical Activity and Psychosocial Health in Adult Cancer Survivors: An Exploratory Analysis

Knights Cabin Cancer retreats may represent an ideal opportunity and environment to fill the gap in health education and behavioral change. It is unknown, however, whether the program improves quality of life, physical activity, and psychosocial health. Cancer survivors who enrolled in a retreat completed online questionnaires prior to and 3 months post to assess health-related quality of life, physical activity, and psychosocial variables; perceived stress, depression, and self-esteem. Paired t tests were utilized to compare changes pre and 3 months post the retreat. The majority of the 51 cancer survivors were female with a mean age of 53. The mental component summary of health-related quality of life (p < 0.016) and physical activity score (p = 0.048) was significantly improved at follow-up, while the physical component summary of health-related quality of life was not (p = 0.139). In addition, participants showed an improvement in psychosocial variables of self-esteem (p = 0.016) and depression (p = 0.016) after 3 months but did not show a significant improvement in perceived stress (p = 0.054). Improvements were seen following a Knights Cabin Cancer retreat in mental health-related quality of life and physical activity as well as some psychosocial variables. Further research is needed to evaluate the individual program components and the sustainability of the program in the community.

Chronic medical conditions and late effects after acute myeloid leukaemia in adolescents and young adults: a population-based study

BACKGROUND

Curative-intent treatment of acute myeloid leukaemia (AML) can lead to multiple chronic medical conditions ('late effects'). Little is known about the burden of late effects in adolescent and young adult (AYA, 15-39 years) survivors of AML. We aimed to estimate the cumulative incidence and investigate the main predictors of late effects among these patients.

METHODS

During 1996-2012, 1168 eligible AYAs with AML who survived ≥2 years after diagnosis were identified in the California Cancer Registry. Late effects were reported from State hospital discharge data, and patients were followed through 2014. Hazard ratios and 95% confidence intervals of late effects occurrence were estimated using Cox proportional hazard models, adjusted for sociodemographic and clinical factors.

RESULTS

The most common late effects at 10 years after diagnosis were: endocrine (26.1%), cardiovascular (18.6%) and respiratory (6.6%), followed by neurologic (4.9%), liver/pancreatic (4.3%), renal (3.1%), avascular necrosis (2.7%) and second primary malignancies (2.4%). Of 1168 survivors, 547 (46.8%) received a haematopoietic stem cell transplant (HSCT). After multivariable adjustments, AYAs who underwent HSCT or had a non-favourable risk AML experienced ∼2-fold or higher increased likelihood of all late effects. Additionally, AYAs of Hispanic, Black or Asian/Pacific Islander (vs non-Hispanic White) race/ethnicity and those who resided in lower socio-economic neighbourhoods were at higher risk of numerous late effects.

CONCLUSIONS

Our findings underscore the need for long-term surveillance for the prevention, early detection and treatment of late effects, and can inform the development of AYA-focused consensus-based guidelines that will ultimately improve the quality of life and survival of these young vulnerable patients.

Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey

Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.

The effect of exercise and nutrition interventions on physical functioning in patients undergoing haematopoietic stem cell transplantation: a systematic review and meta-analysis

PURPOSE

Haematopoietic stem cell transplantation (HSCT) is potentially lifesaving. However, it comes with negative consequences such as impaired physical functioning, fatigue and poor quality of life. The aim of this systematic review and meta-analysis is to determine the effect of exercise and nutrition interventions to counteract negative consequences of treatment and improve physical functioning in patients receiving HSCT.

METHODS

This systematic review and meta-analysis included randomised controlled trials from three electronic databases between 2009 and 2020. The trials included adult patients receiving HSCT and an exercise or nutrition intervention. Study selection, bias assessment and data extraction were independently performed by two reviewers. Physical functioning outcomes were meta-analysed with a random-effects model.

RESULTS

Thirteen studies were included using exercise interventions (n = 11) and nutrition interventions (n = 2); no study used a combined intervention. Meta-analysis of the trials using exercise intervention showed statistically significant effects on 6-min walking distance (standardised mean difference (SMD) 0.41, 95% CI: 0.14-0.68), lower extremity strength (SMD 0.37, 95% CI 0.12-0.62) and global quality of life (SMD 0.27, 95% CI: 0.08-0.46).

CONCLUSION

Our physical functioning outcomes indicate positive effects of exercise interventions for patients receiving HSCT. Heterogeneity of the exercise interventions and absence of high-quality nutrition studies call for new studies comparing different types of exercise studies and high quality studies on nutrition in patients with HSCT.

Lifestyle Behavioral Factors and Integrative Successful Aging Among Puerto Ricans Living in the Mainland United States

BACKGROUND

Few studies have assessed multidimensional models for predicting successful aging that incorporate both physical and cognitive-psychosocial elements among minority populations. This study aimed to establish a comprehensive lifestyle behavioral factors (cLBF) score and an integrative successful aging (ISA) score and explore their associations among older Puerto Rican adults.

METHODS

Data were assessed from 889 adults (45-75 years) participating in the longitudinal (baseline and 2-year follow-up) Boston Puerto Rican Health Study. Higher cLBF score (range 0-10) indicates healthier behaviors (nonsmoking, lack of sedentarism, physical activity, high diet quality, and adequate sleep). The physical domain score of ISA included 8 components (functional impairment, hypertension, diabetes, cancer, cardiovascular disease, respiratory disease, arthritis, osteoporosis) and ranged 0-11. The cognitive-psychosocial domain of ISA included 5 components (cognitive impairment, depressive symptoms, social support, perceived stress, and self-rated health) and ranged 0-10. The sum of both domains comprised the ISA score, ranging 0-21. Higher scores of ISA and its domains indicate more successful aging.

RESULTS

At 2 years, the mean ± SD of cLBF score was 4.9 ± 1.8, and ISA was 10.1 ± 3.3. In multivariable-adjusted models, cLBF score was significantly and positively associated with 2-year change in overall ISA (β [95% CI]: 0.15 [0.07, 0.24] points), in physical domain (0.09 [0.04, 0.13] points), and in cognitive-psychosocial domain (0.08 [0.02, 0.14] points).

CONCLUSIONS

Maintaining healthier lifestyle behaviors may contribute to successful aging through both physical and cognitive-psychosocial domains. The results support using a multidimensional definition of successful aging in Puerto Ricans and evaluating it in other populations.

Second primary malignancies in patients with melanoma in situ: Insights from the surveillance, epidemiology, and end results program

BACKGROUND

Melanoma in situ (MIS) is among the most frequently diagnosed cancers in the United States. Emerging data suggest that MIS is associated with an increased risk of developing a second primary malignancy (SPM).

OBJECTIVES

To determine trends in MIS-associated SPMs and identify MIS-specific features that increase SPM risk.

METHODS

In this retrospective population-based study, we identified 90,075 patients who were diagnosed with MIS between 1973 and 2015 from the Surveillance, Epidemiology, and End Results database. The risk of developing an SPM among these individuals was compared to individuals without a diagnosis of MIS. The risk of developing an SPM among patients with a diagnosis of MIS was also increased over time.

RESULTS

Patients with a diagnosis of MIS had an increased relative risk (RR) of developing an SPM as compared to the general population with an identical age, sex, race, and follow-up period. The RR of a metachronous malignancy in MIS patients also increased over time, as follows: 1.16 (95 % CI: 1.07-1.26), 1.19 (95 % CI: 1.14-1.23), 1.30 (95 % CI: 1.27-1.33), and 1.52 (95 % CI: 1.49-1.56) in 1973-1982, 1983-1992, 1993-2002, and 2003-2015, respectively (P < 0.05). In addition, there was a direct correlation between the number of MIS lesions and SPM risk; ≥1, ≥2, and ≥3 tumors portended a 1.5-2, 2-3, and 4-5-fold increased risk of developing an SPM, respectively.

CONCLUSIONS

MIS is associated with an increased risk of developing an SPM and therefore individuals with a history of MIS may benefit from close medical surveillance.

Narrative Review of Web-based Healthy Lifestyle Interventions for Cancer Survivors

This narrative review of web-delivered weight management, diet quality, and physical activity interventions for cancer survivors relies on a systematic search of PubMed, Psych Info, and EBSCOhost which identified 19 unique web-delivered lifestyle interventions for cancer survivors. The sample sizes for these studies ranged from 11–492. Intervention duration ranged from 1–12 months; however, most interventions were 6–12 weeks in length. Ten studies were randomized controlled trials (RCTs), two were two-arm quasi RCTs, and seven employed a single-arm pre/post-test design. Many (N= 15) of the interventions were well-grounded in behavioral theory, which may have led to favorable behavior change. Most studies (15-of-19) targeted and reported increases in physical activity, while only a few targeted and reported improvements in diet quality (36.9% and 15.8%, respectively) and weight management (26.3% and 10.5%, respectively). A notable limitation was that most studies were conducted among populations that were primarily White and female. Future directions for Internet-based lifestyle interventions for cancer survivors include increasing: (a) focus on multiple behavior change, (b) representation of male and minority populations to improve generalizability of findings, (c) extended intervention duration and follow-up to evaluate long-term efficacy of web-based lifestyle interventions, and (d) sample size to allow for adequate statistical power.

Provider Discussion about Lifestyle by Cancer History: A Nationally Representative Survey

BACKGROUND

Providers are uniquely positioned to encourage health-promoting behaviors, particularly among cancer survivors where patients develop trust in providers.

METHODS

We utilized the National Health Interview Survey to identify adults who reported a visit to a provider in the prior year (44,385 individuals with no cancer history and 4,792 cancer survivors), and reported prevalence of provider discussions on weight loss, physical activity, diet, and smoking. We used generalized linear mixed models to examine predicted prevalence of provider lifestyle discussions by cancer history overall, and among those who do not meet body mass index (BMI), activity, or smoking guidelines.

RESULTS

Among those with a BMI of 25-<60 kg/m², 9.2% of those with a cancer history and 11.6% of those without a cancer history reported being told to participate in a weight loss program (P < 0.001). Overall, 31.7% of cancer survivors and 35.3% of those with no cancer history were told to increase their physical activity (P < 0.001). Only 27.6% of cancer survivors and 32.2% of those with no cancer history reported having a general discussion of diet (P < 0.001). Among smokers, 67.3% of cancer survivors and 69.9% of those with no cancer history reported counseling on smoking (P = 0.309).

CONCLUSIONS

Fewer cancer survivors, who are at increased risk for health complications, are reporting provider discussions about critical lifestyle issues than those with no cancer history.

IMPACT

Our nationally representative results suggest that providers are missing an opportunity for influencing patient lifestyle factors, which could lead to mitigation of late and long-term effects of treatment.

Discussions About Lifestyle Risk Factors Following a Cancer Diagnosis: Findings from a Sample of Australian Cancer Outpatients

Individuals with a previous cancer diagnosis are at risk of cancer recurrence. However, many cancer survivors do not adhere to lifestyle recommendations to reduce cancer risk. Little is known about the extent to which cancer patients are asked about lifestyle risk factors by healthcare providers following diagnosis. The aim of this study is to determine among Australian cancer survivors the (1) proportion asked about smoking, alcohol consumption, nutrition and physical activity; (2) total number of lifestyle risk factors asked about; and (3) factors associated with being asked about fewer risk factors. A cross-sectional survey was conducted with cancer patients attending outpatient clinics. Eligible patients completed a baseline survey and a second survey 4 weeks later. Data about demographic and disease characteristics, and whether participants had been asked about smoking, alcohol, physical activity and diet since being diagnosed with cancer, was collected. A total of 144 patients were included in the analyses. Following diagnosis, most had been asked about smoking (86%), alcohol consumption (85%), physical activity (80%) and diet (69%) by a healthcare provider. Sixty-one percent of participants reported being asked about all four risk factors; only 6% recalled being asked about none. After controlling for age, participants with a high school or lower education were more likely to be asked about fewer risk factors (OR 2.16; 95%CI 1.0 to 4.6; p = 0.04) compared with those with a trade, vocational or university-level education. Just over one-third of a sample of Australian cancer patients were not asked about all assessed lifestyle risk factors following their diagnosis of cancer. These findings suggest there is scope to improve identification of lifestyle risk factors among cancer survivors.

Cancer survivorship needs in Brazil: Patient and family perspective

Introduction

Cancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develop a comprehensive approach to cancer survivorship.

Objectives

Identify the needs of cancer survivors and their relatives, specifically those of individuals with breast, cervical or prostate cancer, and with acute lymphocytic leukemia (ALL).

Methods

A qualitative, exploratory study conducted in two referral institutions in Brazil, located in Rio de Janeiro (Southeast region) and Fortaleza (Northeast region). The study included 47 patients of public and private health services and 12 family members. We used script-based semi-structured interviews. The discursive material obtained was categorized and analyzed using the Thematic Analysis approach.

Results

The analysis identified three central themes: 1) consequences of cancer treatment; 2) Changes in daily life associated with cancer survivorship; and 3) Unmet structural needs in cancer survivorship.

Conclusion

Social and cancer control policies in Brazil should provide resources, specific care standards and clinical, psychological and social support. Cancer survivors should also receive rehabilitation and work reintegration guidelines. This matter requires broader access to qualified cancer information, development of an integrated patient-centered care and care model, and more research resources for the country's post-treatment cancer period.

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project

BACKGROUND

Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program.

METHODS

In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata.

RESULTS

Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor.

CONCLUSIONS

This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Self-rated health in relation to fruit and vegetable consumption and physical activity among older cancer survivors

PURPOSE

We aimed to investigate associations of self-rated health with fruit and vegetable consumption (FVC) and physical activity (PA) among older cancer survivors.

METHODS

We used the 2017 Behavioral Risk Factor Surveillance System to identify cancer survivors ≥ 65 years (N = 2663). Self-reported FVC and PA were categorized as ordinal variables to approximate quartiles. Low general health (LGH) was defined as fair or poor self-rated health. A multivariable logistic regression treating LGH as the outcome was used to calculate adjusted odd ratios (aORs) and 95% confidence intervals (CIs) for FVC and PA. Restricted cubic spline depicted non-linear dose-response curves for FVC and PA. In comparative analysis, we used the same logistic regression and dose-response model to calculate ORs of FVC and PA in 73,134 people ≥ 65 years without cancer history.

RESULTS

Overall, 470 (17.7%) survivors had LGH. Survivors' mean age was 73.3 years (SD = 5.2), 55.1% of them were female, and 95.4% self-reported as white. In cancer survivors, FVC was not associated with LGH (≥ 28 vs. < 14 times/week: aOR = 1.02, 95% CI = 0.75-1.39, p-trend = 0.50), whereas PA was inversely associated with LGH (≥ 30 vs. < 7 MET-hours/week: aOR = 0.55, 95% CI = 0.41-0.75, p-trend < 0.01). Dose-response curves demonstrated consistent association patterns. In comparative analysis, ORs of PA did not change substantially but we observed inverse association for FVC.

CONCLUSIONS

An inverse association between PA and LGH was observed among older cancer survivors, but no significant association was obtained for FVC among them. Regular PA may maintain or indicate a favorable health in older cancer survivors, whereas impacts of FVC deserve further investigations.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern reduces the risk of colorectal cancer: A systematic review and meta-analysis

BACKGROUND & AIMS

Colorectal cancer (CRC) has become a major concern due to industrialization and dietary changes generated by it. Many of the components of the DASH (Dietary Approach to Stop Hypertension) diet are associated with the risk of CRC. However, the relationship between DASH dietary pattern and CRC has not been studied yet in a systematic review and meta-analysis. The present study was conducted to review the studies investigating the relationship between DASH diet and the risk of CRC.

METHODS

PubMed and Scopus search engines were searched to find relevant publications from inception up to September 2019. All the observational studies that addressed the association between DASH diet and CRC were included in the systematic review and meta-analysis. All the steps including data base search, screening, and data extraction were carried out by two researchers, independently.

RESULTS

Eight studies included in this systematic review and 5 studies (out of 8 studies included in the systematic review) were included in the meta-analysis. Combining 12 effects sizes from 5 studies, a significant inverse association between adherence to the DASH diet and risk of CRC was found (RR: 0.80; 95% CI: 0.74, 0.85). Based on the result of this study, individuals with greater adherence to DASH diet had 20% lower risk of CRC.

CONCLUSION

The current study demonstrates that the risk of CRC is negatively associated with the adherence to the DASH dietary pattern.

Health and lifestyle behaviors in colorectal cancer survivors with and without Lynch syndrome

Lynch syndrome (LS), a hereditary cancer syndrome, accounts for approximately 3% of colorectal cancers (CRC). Positive health behaviors and surveillance are preventive strategies, but research on whether recommended behavioral guidelines are followed by individuals with LS is limited. Additional health education and promotion could be beneficial to the improved survivorship of CRC survivors. Explore health and lifestyle behaviors in CRC survivors with and without LS. We conducted a case-control study of CRC survivors with and without LS using a mailed questionnaire. Recruitment was conducted via patient registries at The University of Texas MD Anderson Cancer Center (cases n = 33; controls n = 75) and through social media (cases n = 42). CRC survivors with and without LS in our study had substantially lower smoking prevalence (5.5% and 2.7%) compared to national prevalence (18.0%). However, they had higher levels of alcohol consumption (36.8% and 10.3% for male and female LS survivors, respectively, and 35.8% and 22.0% for male and female sporadic survivors, respectively) compared to national prevalence of 13.88% for males and 6.02% for females. Both groups of CRC survivors participate in negative health behaviors that impact survivorship. More research is needed to examine the relationship between personal engagement in preventive behaviors and patient-provider relationships to improve health behaviors and explore strategies for intervention. Additionally, better health education and lifestyle change recommendations would promote and reinforce positive health outcomes in the CRC population and especially in LS survivors.

Prognostic associations of circulating phytoestrogens and biomarker changes in long-term survivors of postmenopausal breast cancer

Lignans are associated with improved postmenopausal breast cancer (BC) survival, but whether these associations, particularly with enterolactone (major lignan metabolite), persist over time is unclear. Little is known about other phytoestrogens on prognosis in long-term survivors. The study examines associations of prognosis with 1) circulating postdiagnosis enterolactone, 2) eight circulating phytoestrogen metabolites, and 3) changes in enterolactone and genistein. In a German cohort of 2,105 postmenopausal BC patients with blood samples collected at recruitment 2002-2005 (baseline) and re-interview in 2009 (follow-up), delay-entry Cox proportional hazards regression was used. Landmark analysis showed that circulating enterolactone (log2) associations with 5-year survival changed over time, with strongest hazard ratios of 0.89 (95% CI, 0.80-0.99) at blood draw (BD) and 0.86 (0.77-0.97) at 2 years post-BD for BC mortality, and 0.87 (0.80-0.95) at BD and 0.84 (0.76-0.92) at 3 years post-BD for all-cause mortality, which attenuated thereafter. In long-term survivors, increasing concentrations of genistein (1.17, 1.01-1.36), resveratrol (1.19, 1.02-1.40), and luteolin (1.96, 1.07-3.58) measured in follow-up blood samples were associated with poorer subsequent prognosis. Neither enterolactone at follow-up nor changes in enterolactone/genistein were associated with prognosis. Large long-term longitudinal studies with multiple phytoestrogen measurements are required to understand long-term effects of phytoestrogens after BC.

Factors associated with the use of diet and the use of exercise for prostate cancer by long-term survivors

Objective

To assess the use of diet and the use of exercise for prostate cancer (and/or its treatments’ side effects) by long-term survivors and whether such use is associated with selected socio-demographic, clinical, health-related quality-of-life (HRQOL) and psychological factors.

Design, setting and participants

Population-based cohort study in New South Wales, Australia of prostate cancer survivors aged <70 years at diagnosis and who returned a 10-year follow-up questionnaire.

Methods

Validated instruments assessed patient’s HRQOL and psychological well-being. Poisson regression was used to estimate adjusted relative proportions (RRs) of prostate cancer survivor groups who were currently eating differently (‘using diet’) or exercise differently (‘using exercise’) to help with their prostate cancer.

Results

996 (61.0% of 1634) participants completed the 10-year questionnaire of whom 118 (11.8%; 95%CI[9.8–13.9]) were using diet and 78 (7.8%; 95%CI[6.2–9.5]) were using exercise to help with their prostate cancer. Men were more likely to use diet or use exercise for prostate cancer if they were younger (p-trend = 0.020 for diet, p-trend = 0.045 for exercise), more educated (p-trend<0.001, p-trend = 0.011), support group participants (p-nominal<0.001, p-nominal = 0.005), had higher Gleason score at diagnosis (p-trend<0.001, p-trend = 0.002) and had knowledge of cancer spread (p-nominal = 0.002, p-nominal = 0.001). Use of diet was also associated with receipt of androgen deprivation therapy (RR = 1.59; 95%CI[1.04–2.45]), a greater fear of cancer recurrence (p-trend = 0.010), cognitive avoidance (p-trend = 0.025) and greater perceived control of cancer course (p-trend = 0.014). Use of exercise was also associated with receipt of prostatectomy (RR = 2.02; 95%CI[1.12–3.63]), receipt of androgen deprivation therapy (RR = 2.20; 95%CI[1.34–3.61]) and less satisfaction with medical treatments (p-trend = 0.044).

Conclusions

Few long-term prostate cancer survivors use diet or exercise to help with their prostate cancer. Survivors may benefit from counselling on the scientific evidence supporting healthy eating and regular exercise for improving quality-of-life and cancer-related outcomes.

Food Label Literacy and Use among US Adults Diagnosed with Cancer: Results from a National Representative Study

For those diagnosed with cancer, lifestyle factors including diet can be more important than ever. However, lack of nutrition-related knowledge can pose a significant barrier to healthy eating. Food labels guide consumers in selecting appropriate portion sizes-that is, caloric content-and ensuring adequate intake of nutrients. Data from the 2013-2014 HINTS were used to examine (a) differences in food label use and food label literacy between respondents ever had a cancer diagnosis and those never had a diagnosis; (b) sociodemographic correlates and health-related correlates of food label use and literacy, in a context of cancer diagnosis; and (c) potential association between food label use/literacy and each of two dietary choices, eating vegetables and fruits and limiting intake of sugary drinks, again, in a context of cancer diagnosis. Data was analyzed via SPSS version 24.0, and cross tabulations using Pearson's Chi-square test and logistic regressions. Income, gender and non-participation in support groups were associated with food label literacy (p<.05). Confidence to take care of self was associated with food label use (p<.05). Relationships were observed between using food labels and curtailing soda intake (b = -.368, p<.05), eating relatively more fruits (b = .558, p<.05), and eating relatively more vegetables (b = .558, p<.05). The overall models predicting consumption of soda [x2 (2) = 13.70, p = .001, Nagelkerke R-square = .059], of fruits [x2 (2) = 33.87, p < .001, Nagelkerke R-square = .136], and of vegetables [x2 (2) = 36.08, p < .001, Nagelkerke R-square = .144] was statistically significant. Implications for research and practice can be found in results linking food label use to better quality diets. They include the usefulness of nutrition education interventions targeting lower-income men with cancer diagnoses; one lesson should be the use of food labels.

Are cancer survivors following the national comprehensive cancer network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic

PURPOSE

Engaging in positive health behaviors post-treatment is important for cancer survivors' health. However, little is known about whether survivors are practicing health promoting behaviors. We aimed to explore whether survivors are meeting the recent health behavior guidelines set forth by the National Comprehensive Cancer Network (NCCN) and to examine associations between health behaviors and distress.

METHODS

Sixty-six survivors completed a cross-sectional questionnaire assessing health behaviors prior to an initial appointment at a survivorship care clinic. Information about sociodemographic, clinical, and psychosocial variables and six health behavior recommendations, including physical activity, sunscreen use, tobacco use, alcohol consumption, weight management, and annual primary care provider visits, was collected.

FINDINGS

Only 7.6% of survivors met all six NCCN health behavior guidelines. One in ten (10.6%) survivors had smoked a cigarette in the previous 30 days, and half did not use sunscreen regularly (50%), had an unhealthy body mass index (53%), and did not engage in >10 MET-h/week of physical activity (50%). Approximately 1 in 6 (15.1%) survivors reported drinking beyond the recommended limit, and a similar proportion had not seen a PCP in the previous year (27.3%). Clinically significant levels of distress (>5; range 0-10) on the NCCN distress scale were reported by 64.6% of survivors. Participants with clinical levels of distress were less likely to adhere to health behavior guidelines than those who were not distressed (p = .002).

CONCLUSIONS

Overall, survivors engaged at a survivorship clinic did not meet the NCCN recommended health behavior guidelines. Implications for Psychosocial Providers or Policy: Survivors' health behaviors and distress should be assessed and intervened upon during survivorship care. Survivorship clinics may provide a unique forum in which to provide ongoing behavioral health counseling and psychosocial support for these patients.

Association between Cigarette Smoking and Histotype-Specific Epithelial Ovarian Cancer: A Review of Epidemiologic Studies

Many studies have demonstrated that smoking can influence ovarian cancer risk and survival; however, the number of studies investigating this relationship according to histologic subtypes is limited. We conducted a review of epidemiologic research that assessed the role of smoking on ovarian cancer risk and survival after diagnosis, specifically capturing studies that discerned between various histologic subtypes of this disease. In the majority of studies, current smoking was associated with increased risk of mucinous cancer. There was also evidence of a decreased risk of clear cell and endometrioid histotypes. No significant association was observed between cigarette smoking and serous cancer. In the studies investigating the relationship between smoking and survival, all the studies reported an increased risk of mortality associated with smoking. Smoking appeared to be a risk factor for both ovarian cancer risk and mortality. Future studies need to investigate further a potential link between smoking and ovarian cancer by having a better assessment of exposure to smoking and having a larger number of participants with the ability to detect associations within rare histotypes.

Lifestyle Patterns and Survival Following Breast Cancer in the Carolina Breast Cancer Study

BACKGROUND

Few studies have examined the impact of lifestyle patterns on survival following breast cancer. We aimed to identify distinct lifestyle patterns based on five behavior/dietary exposures among a population-based sample of women diagnosed with breast cancer and to examine their association with subsequent survival.

METHODS

In the Carolina Breast Cancer Study Phases I/II, we interviewed 1,808 women 20-74 years of age following diagnosis of invasive breast cancer. We determined vital status using the National Death Index (717 deaths, 427 from breast cancer; median follow-up 13.56 years). We assessed lifestyle patterns using a latent class analysis based on five behavioral and dietary exposures: current versus never/former smokers; low versus high vegetable and fruit intake; high and low/moderate, versus no alcohol consumption; and no and low/moderate, versus high regular physical activity. We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality, and cause-specific and subdistribution HRs for breast cancer-specific mortality within 5 years and 13 years postdiagnosis conditional on 5-year survival.

RESULTS

We identified three distinct lifestyle patterns: healthy behavior and diet (n = 916); healthy behavior and unhealthy diet (n = 624); and unhealthy behavior and diet (n = 268). The unhealthy (vs. healthy) behavior and diet pattern was associated with a 13-year conditional all-cause mortality HR of 1.4 (95% CI = 1.1, 1.9) and with 13-year conditional breast cancer-specific and subdistribution HRs of 1.2 (95% CI = 0.79, 1.9) and 1.2 (95% CI = 0.77, 1.8), respectively.

CONCLUSIONS

Behavioral and dietary patterns can be used to identify lifestyle patterns that influence survival patterns following breast cancer diagnosis.

Impact of immigration status on health behaviors and perceptions in cancer survivors

Background

Health behaviors including smoking cessation, physical activity (PA), and alcohol moderation are key aspects of cancer survivorship. Immigrants may have unique survivorship needs. We evaluated whether immigrant cancer survivors had health behaviors and perceptions that were distinct from native‐born cancer survivors.

Methods

Adult cancer patients from Princess Margaret Cancer Centre were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5‐year survival, and fatigue. Multivariable models evaluated the association of immigration status and region‐of‐origin on behaviors and perceptions.

Results

Of the 784 patients, 39% self‐identified as immigrants. Median time of survey was 24 months after histological diagnosis. At baseline, immigrants had trends toward not meeting Canadian PA guidelines or being ever‐drinkers; patients from non‐Western countries were less likely to smoke (aOR_current = 0.46, aOR_ex‐smoker = 0.47, P = 0.02), drink alcohol (aOR_current = 0.22, aOR_ex‐drinker = 0.52, P < 0.001), or meet PA guidelines (aOR = 0.44, P = 0.006). Among immigrants, remote immigrants (migrated ≥40 years ago) were more likely to be consuming alcohol at diagnosis (aOR = 5.70, P < 0.001) compared to recent immigrants. Compared to nonimmigrants, immigrants were less likely to perceive smoking as harmful on QoL (aOR = 0.58, P = 0.008) and survival (aOR = 0.56, P = 0.002), and less likely to perceive that PA improved fatigue (aOR = 0.62, P = 0.04) and survival (aOR = 0.64, P = 0.08).

Conclusions

Immigrants had different patterns of health behaviors than nonimmigrants. Immigrants were less likely to perceive continued smoking as harmful and were less likely to be aware of PA benefits. Culturally tailored counselling may be required for immigrants who smoke or are physically sedentary at diagnosis.