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Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group. Cancers (Basel) 2021; 13:cancers13215270. [PMID: 34771435 PMCID: PMC8582416 DOI: 10.3390/cancers13215270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Adolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Abstract Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.
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Velasco R, Besora S, Argyriou AA, Santos C, Sala R, Izquierdo C, Simó M, Gil-Gil M, Pardo B, Jiménez L, Clapés V, Calvo M, Palmero R, Bruna J. Duloxetine against symptomatic chemotherapy-induced peripheral neurotoxicity in cancer survivors: a real world, open-label experience. Anticancer Drugs 2021; 32:88-94. [PMID: 33332891 DOI: 10.1097/cad.0000000000001005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this observational study was to evaluate the efficacy and safety of duloxetine in a cohort of 100 cancer survivors with chemotherapy-induced peripheral neurotoxicity (CIPN). CIPN was graded employing the TNSc and the NCI-CTCv4. The Patient Global Impression of Change (PGIC) scale measured the efficacy of duloxetine (1: no benefit; to 7: excellent response). A clinically meaningful response was considered a PGIC > 4. Median age was 62 (29-81) years and 42% were male. CIPN was graded as grades 1, 2 and 3 in 20, 66, and 14% of patients, respectively. Median time to duloxetine initiation was 6 (1-63) months after chemotherapy. Fifty-seven patients early dropped out from duloxetine, due to lack of efficacy (20%) or side effects (37%). Male patients more frequently discontinued duloxetine due to lack of efficacy (35.7 vs. 8.6% P = 0.001). PGIC scores were higher in female patients (4 vs. 1, P = 0.001), taxane-treated patients (4 vs. 1, P = 0.042) and with short-lasting (<6 months) CIPN (4 vs. 1, P = 0.008). Patients with long-lasting CIPN had a higher rate of adverse events (47 vs. 27%, P = 0.038) and discontinuation (54.8 vs. 45.1%, P = 0.023). In the multivariate analysis, female gender and short-lasting CIPN were independently associated with a favorable response to duloxetine. Low tolerability, male gender, and long-lasting CIPN significantly limited duloxetine use in daily practice setting. A minority of cancer survivors with CIPN treated with duloxetine had a meaningful CIPN improvement, and tolerability was overall low. Female gender and short-term CIPN were independently associated with a favorable response to duloxetine.
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Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra
| | - Sarah Besora
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Hospital Universitari Mútua de Terrassa, Terrassa
| | | | | | - Rosó Sala
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Cristina Izquierdo
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Marta Simó
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
| | - Miguel Gil-Gil
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Beatriz Pardo
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Laura Jiménez
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Victoria Clapés
- Department of Clinical Hematology, ICO L'Hospitalet, Barcelona, Spain
| | - Mariona Calvo
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Ramón Palmero
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Jordi Bruna
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra
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