Differences in cancer patients' work-cessation risk, based on gender and type of job: Examination of middle-aged and older adults in super-aged Japan

Psychosocial challenges among Asian adolescents and young adults with cancer: a scoping review

BACKGROUND

Most of the landmark cohorts and reviews that assessed the psychosocial outcomes among adolescent and young adult (AYA) cancer survivors have focused on Western populations. This scoping review summarizes the existing evidence on psychosocial challenges experienced by AYAs with cancer in Asia, specifically work- and school-related outcomes, financial distress, social relationships, and concerns with infertility.

METHODS

A literature search was conducted on Embase and Medline for studies that (1) were published in English between 2000 and 2023, (2) recruited AYAs diagnosed with cancer between the age of 15 and 39 years, (3) were conducted in Asia, and (4) assessed outcomes related to (i) work or/and school performance, (ii) financial distress, (iii) romantic relationship or/and relationship with family and peers, and (iii) concerns with childbirth and infertility. Titles, abstracts, and full texts were screened independently by two reviewers to identify eligible studies. Information of included studies was summarized and aggregated using structured forms based on Joanna Briggs Institute's (JBI) data extraction form. Both quantitative and qualitative studies were assessed for methodological validity using JBI Critical Appraisal Checklist.

RESULTS

Thirteen studies, enrolling a total of 1,108 survivors, reported outcomes related to work or school performance (n = 8), relationships with families and peers (n = 5), and desires or concerns regarding childbirth or infertility (n = 5). Although no differences in resignation rates between AYA survivors of cancer and non-cancer controls or other age groups were reported in three studies, 21%-40% of AYAs expressed concerns regarding employment or impaired work outcomes after cancer diagnosis. Studies identified health concerns and socioenvironmental factors that affected family functioning and romantic relationships. The uncertainty and the lack of information on fertility preservation were consistently reported by participants.

CONCLUSIONS

Our review demonstrated differences in concerns and disparities in social support and interventions available to AYA cancer survivors among various Asian countries/regions. We found Asian studies have focused more on family relationships than peers, likely due to sociocultural nuances when compared with Western societies. Given the variability in economic development and healthcare infrastructure across Asia, region-specific healthcare policies and services are required for AYA survivors.

Cancer treatment-related financial toxicity in Japan: a scoping review

Financial toxicity during cancer survival has been studied mainly in the United States; 47-49% of cancer survivors reported financial hardships and 12-63% reported debt owing to treatment costs. Financial toxicity is influenced by each country's economic status and healthcare system. We aimed to review the evidence on financial toxicity in Japan. A systematic search was performed using PubMed and Ichushi databases. We included English or Japanese peer-reviewed articles that (1) explored the experiences of cancer patients facing financial toxicity due to cancer diagnosis and treatment, (2) were specific to Japan, and (3) focused on the experiences of financial toxicities among cancer patients. Data were extracted focusing on the experiences of patients, families, and healthcare providers. The main themes were synthesized based on a previous study. The search yielded 632 citations from PubMed and 21 from Ichushi, and non-duplicates were identified. Of these, 31 articles were selected for full-text review. Literature was divided into studies describing the following elements: (a) risk factors for financial toxicity, (b) description of financial toxicity, (c) psychological reactions, (d) coping strategies for financial toxicity, and (e) impact on treatment outcomes. Only three studies reported comprehensive financial toxicity scores. Furthermore, treatment costs influenced physicians' treatment decisions, and patients and their families adopted various strategies to cope with treatment costs. Two studies showed that low current income and younger age were high-risk factors. As for utilization of the support system, approximately 70% of the patients used the high-cost medical expense system, 20% used the sickness benefit system, and 40% used the medical expense deduction system. Many cancer patients in Japan suffer from financial toxicity during cancer survival. One reason for this is that the awareness of the system supporting financial toxicity is insufficient and actual utilization is low. It is necessary to actively encourage patients to ask healthcare providers questions, improve the link between patients and the support system, reconstruct the support system design, and improve the method of publicizing the system.

Exploring the independent association of employment status to cancer survivors' health-related quality of life

BACKGROUND

Having a job has been associated with better Health-Related Quality of Life (HRQOL) in cancer survivors. However, the sociodemographic and disease-related profiles characterizing the survivors being employed and those having better HRQOL largely overlap. The present study aims to discern the degree to which employment status is independently associated with cancer survivors' HRQOL or if it mainly reflects the impact of other sociodemographic and cancer-related variables.

METHODS

Cross-sectional study on a heterogeneous sample of 772 working-age survivors of adult-onset cancer. An instrument specifically designed to assess HRQOL in cancer survivors and Multivariate Variance Analysis (MANOVA) were used.

RESULTS

Survival phase, cancer type, and employment status showed the main effects on cancer survivors' HRQOL. In particular, being employed (vs unemployed) had the greatest positive association with HRQOL, affecting ten of the twelve HRQOL domains considered. Also, interaction effects highlighted the role of age (younger) and marital status (single) as risk factors for a greater negative impact of variables affecting the survivor's HRQOL.

CONCLUSIONS

The application of a multivariate methodology sheds new light on two relevant issues for the cancer survivor's HRQOL: (i) the existence of differences between diagnostic groups that are not attributed to other variables such as sex, and (ii) the important and independent role that employment status plays. Comprehensive cancer survivorship care should focus more on high-risk groups and include having a job as an essential aspect to consider and prompt. The fact that the employment status is susceptible to change represents a valuable opportunity to care for the wellbeing of this population.

Quality of life in cancer survivorship: Sociodemographic and disease-related moderators

RATIONALE

To identify high-risk survivors in order to provide appropriate care.

PURPOSE

To analyse the quality of life (QOL) of cancer survivors using an instrument designed specifically for this population and considering different sociodemographic and disease-related characteristics as possible modulating variables.

METHODS

The Quality of Life in Adult Cancer Survivors (QLACS) was filled out by a large and heterogeneous sample of disease-free post-treatment Spanish cancer survivors (N = 1862).

RESULTS

QLACS scores were comparable to those obtained in other studies and indicative of worse QOL as a function of shorter elapsed time since the end of primary treatment. The best QOL was shown by prostate, and the worst by hematologic cancer survivors. Both systemic treatments (chemotherapy and hormone therapy) and the combination of radiotherapy and chemotherapy were associated with worse QOL. Likewise, younger age, female sex, unemployment status and not having a stable partner were associated with worse QOL.

CONCLUSION

Greater understanding of the QOL experienced by the already large and continuously growing population of cancer survivors is relevant for guiding both clinical practice and health policy. In addition, knowing the risk factors associated with worse QOL facilitates the development of targeted prevention programmes for those survivors who need it the most.