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Mao YJ, Lai HJ, Liu YM, Liao MN, Tung TH, Lin YC, Beaton RD, Jane SW, Huang HP. Unmet Care Needs of Colorectal Cancer Survivors in Taiwan and Related Predictors. J Nurs Res 2025; 33:e391. [PMID: 40358116 DOI: 10.1097/jnr.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Despite advancements in medical technology and early cancer detection, many colorectal cancer (CRC) survivors report unmet care needs after completion of their cancer treatment that compromise their quality of life (QoL). Previous studies on the care needs of cancer survivors have yielded inconsistent results, and few studies have been conducted on survivors of CRC in Taiwan or on predictors of their unmet care needs. PURPOSE The purpose of this study was to examine the unmet care needs, psychological distress, and QoL of Taiwanese CRC survivors ( n = 100) as well as to assess the mean differences by sociodemographic characteristics in their unmet care needs and other related predictors after treatment completion. METHODS This cross-sectional study using a purposive sampling method was conducted at a regional hospital in northern Taiwan between October 2019 and February 2020. The measurements used in this study included Chinese Cancer Survivors' Unmet Needs, Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Colorectal Cancer Module 29. The independent t test and one-way analysis of variance were employed to assess sociodemographic differences in unmet care needs, and multivariate linear regression was used to identify significant predictors. RESULTS More than half of the participants (63.2%) reported at least one unmet care need, with the highest categories including information needs ("signs and symptoms of cancer recurrence" 31.7% and "information related to health promotion" 31.7%), "medical care needs" ("managing health with the medical team" 13.9%), and "physical/psychological effect needs ("concerns about cancer recurrence" 23.8%). Also, 7%-57% of the participants experienced differing degrees of distress symptoms including fatigue, intestinal and urogenital dysfunctions, and anxiety or depression. The results of the univariate analyses showed unmet needs to differ significantly by age ( p = .021), employment status ( p = .007), and chronic disease status ( p = .025). The findings revealed being of older age (β = 0.23, p = .049), being employed (β = 0.26, p = .014), and having a lower functional level (β = -0.31, p = .012) to be associated with significantly higher levels of unmet care needs, collectively accounting for nearly 27.3% of the variance (adjusted R2 = .273). CONCLUSIONS/IMPLICATIONS FOR PRACTICE CRC survivors continue to experience unmet care needs and various forms of physical-psychological distress for an average of almost 2 years after their completion of CRC treatment. The findings of this study may assist healthcare providers in identifying the major risk factors that interfere with survivor care needs following treatment, thus facilitating the development of timely interventions to mitigate the impact of cancer on this vulnerable population.
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Affiliation(s)
- Yu-Ju Mao
- Department of Nursing, Landseed International Hospital, Taoyuan, Taiwan
| | - Huang-Jen Lai
- Division of Colorectal Surgery, Department of Surgery, Landseed International Hospital, Taoyuan, Taiwan
| | | | - Mei-Nan Liao
- Executive Office, Chang Gung Medical Foundation Administration Center, Taoyuan, Taiwan
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yung-Chang Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Kou, Taiwan
| | - Randal D Beaton
- Child, Family and Population Health Nursing and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle, USA
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Chao CR, Zhou H, Shalman DM, Pak KJ, Armenian S, Xu L, Gu Z, Hechter RC. Chronic opioid use and incident opioid use disorders in survivors of adolescent and young adult cancer after cancer treatment. Cancer 2025; 131:e35866. [PMID: 40359220 DOI: 10.1002/cncr.35866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 03/21/2025] [Accepted: 03/24/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND The use of opioids and its benefits and harms among cancer survivors are poorly understood. The authors examined opioid use and related outcomes among adolescent and young adult (AYA) cancer survivors after cancer treatment. METHODS The authors identified 2-year cancer survivors diagnosed between 15 to 39 years of age at Kaiser Permanente Southern California (2000-2012, followed through 2019). Individuals without cancer were matched to survivors on age, sex, and calendar year for comparison. The authors used robust Poisson regression to compare long-term (≥90 days) opioid use during follow-up and Fine-Gray hazard models to compare incident long-term high-dose use (≥50 morphine milligram equivalents daily dose ≥90 days), benzodiazepine co-use, opioid use disorder (OUD), opioid overdose, and opioid-related hospitalization. We also restricted analyses to individuals on long-term opioid therapy, and evaluated risk factors for opioid-related outcomes within cancer survivors. RESULTS Of 5908 AYA cancer survivors and 81,833 noncancer individuals, 5.2% and 1.8% had long-term opioid use during follow-up, respectively (prevalence ratio = 1.8, 95% confidence interval, 1.6-2.0). Cancer survivors had higher incidence of long-term high dose opioid use (hazard ratio [HR] = 2.2 [1.8-2.8]), benzodiazepine co-use (HR = 1.4 [1.3-1.5]), and opioid-related hospitalization (HR = 1.5 [1.1-2.2]) compared with noncancer individuals. Among those on long-term opioid therapy, cancer survivors had elevated risk for long-term high dose use (HR = 1.4 [1.1-1.8]) and benzodiazepine co-use (HR = 1.6 [1.2-2.1]), but lower OUD risk (HR = 0.6 [0.4-0.9]). Opioid use during cancer treatment phase most strongly predicted long-term high dose use and OUD/overdose during survivorship. CONCLUSION Findings call for risk-stratified patient monitoring and better understanding of the differential OUD risk in AYA cancer survivors.
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Affiliation(s)
- Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Dov M Shalman
- Department of Geriatric, Palliative, and Continuing Care, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Katherine J Pak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Saro Armenian
- Department of Pediatrics, City of Hope, Duarte, California, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc, Sugarland, Texas, USA
| | - Zheng Gu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Kc O, Ellithi M, Herdman E, Westmark D, Wildes TM, Peters ES, Bills SE, Alonso W, Bhatt VR. Exercise interventions and physical activity in adults living with and beyond blood cancer: a scoping review. J Cancer Surviv 2025:10.1007/s11764-025-01822-4. [PMID: 40335873 DOI: 10.1007/s11764-025-01822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 05/02/2025] [Indexed: 05/09/2025]
Abstract
PURPOSE Adults living with and beyond cancer (survivors) often face physical and psychological challenges, including pain, fatigue, sleep disturbances, and depression, which impair quality of life (QOL). While exercise interventions are demonstrated to benefit survivors of solid tumors, their impact on survivors of blood cancer remains underexplored. This review evaluates the evidence regarding exercise interventions in survivors of blood cancer, focusing on intervention types, study participant characteristics, and reported outcomes. METHODS A literature search was conducted using Embase (Elsevier), Medline (EBSCO), CINAHL (EBSCO), and Scopus (Elsevier) to identify studies on exercise interventions in survivors of blood cancer published through March 15, 2024. Articles were screened based on inclusion criteria, including adults aged 18 or older who completed cancer treatment and underwent exercise interventions. Exclusion criteria included pediatric populations, active cancer treatment, study protocols, incomplete results, or non-English publications. RESULTS Seventeen studies were identified, including nine feasibility studies and eight randomized controlled trials. Participants, predominantly white, had a median age range of 31.5-63.5 years. Interventions, often combining aerobic and resistance exercises, were delivered three times weekly over 8-12 weeks. Feasibility studies reported adherence rates of 66-87% and retention rates of 70-95%, with improvements in QOL and physical function. Randomized controlled trials similarly demonstrated benefits in fatigue, QOL, and physical function. CONCLUSIONS: Exercise interventions improve QOL for survivors of blood cancer, though long-term effectiveness and adherence require further study. IMPLICATIONS FOR CANCER SURVIVORS Future research should focus on diverse populations and long-term outcomes to develop tailored, accessible exercise interventions for survivors of blood cancer.
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Affiliation(s)
- Ojbindra Kc
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Moataz Ellithi
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E 74 th Street, New York, NY, 10021, USA.
| | - Emily Herdman
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danielle Westmark
- McGoogan Library of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tanya M Wildes
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edward S Peters
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara E Bills
- Physical Therapy Program, Department of Health & Rehabilitation Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Windy Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vijaya R Bhatt
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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McErlean G, Hui H, Crawford-Williams F, Hart NH, Krishnasamy M, Koczwara B, Walwyn T, Iddawela M, McIntosh R, Chan RJ, Jefford M. Quality cancer survivorship care: a modified Delphi study to define nurse capabilities. J Cancer Surviv 2025:10.1007/s11764-025-01804-6. [PMID: 40316870 DOI: 10.1007/s11764-025-01804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2025] [Accepted: 04/03/2025] [Indexed: 05/04/2025]
Abstract
PURPOSE To establish capabilities required by nurses to deliver quality cancer survivorship care in Australia. METHODS A two-round online modified Delphi involving Australian cancer nurses. Initial domains and capability statements were based on the Quality of Cancer Survivorship Care Framework and supplemented by national and international nursing frameworks. In Round 1 (R1), experts categorised the applicability of 53 capabilities for cancer nurses, across eight domains, in relation to Australian National Professional Development Framework for Cancer Nursing (EdCaN) groups: 'All', 'Many', 'Some', and 'Few' nurses, or not relevant. In Round 2 (R2), experts rated agreement with capabilities allocated to the nurse groups. A priori consensus was set at ≥ 80%. RESULTS Surveys were distributed to 51 experts, with a response rate of 92% (47/51) for R1 and 75% (38/51) for R2. Following R1, ten capabilities were added, resulting in 63 capabilities for R2 to establish consensus allocation to EdCaN groupings. Fifty-seven capabilities reached consensus; four capabilities were moved from 'many' to 'some' nurses; one capability was moved from 'some' to 'few' nurses; and one capability was retained in 'all' nurses following Delphi feedback and research team discussion. CONCLUSIONS Sixty-three capabilities across eight cancer survivorship care domains were identified and allocated to different nursing groupings. This study provides important foundational work by identifying the capabilities of cancer nurses to deliver quality cancer survivorship care in Australia. IMPLICATIONS FOR CANCER SURVIVORS The identification of clearly defined capabilities may improve the quality of cancer survivorship care through the enrichment and standardisation of educational curricula and continuing professional education, and through improved workforce planning.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, University of Wollongong, Sydney, NSW, Australia.
- Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia.
- Health Innovations Research Centre, Faculty of Science, Medicine & Health, University of Wollongong, Sydney, NSW, Australia.
| | - Heidi Hui
- Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- McGrath Foundation, Sydney, NSW, Australia
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Sydney, NSW, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Meinir Krishnasamy
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, VIC, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Thomas Walwyn
- Oncology-Haematology (Paediatric), Royal Hobart Hospital, Hobart, TAS, Australia
- Division of Paediatrics, Medical School, University of Western Australia, Perth, WA, Australia
| | - Mahesh Iddawela
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca McIntosh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Healthability, Box Hill, VIC, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Huizinga F, Westerink NDL, Walenkamp AM, Berendsen AJ, de Greef MH, de Boer MR, de Bock GH, Berger MY, Brandenbarg D. Patient outcomes from a physical activity programme for cancer survivors in general practice: an intervention implementation study. Br J Gen Pract 2025; 75:e366-e374. [PMID: 40044182 PMCID: PMC12040372 DOI: 10.3399/bjgp.2024.0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 01/10/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND Physical activity (PA) benefits cancer survivors' health, yet no PA programmes are incorporated in Dutch general practice. AIM To evaluate cancer survivors' outcomes following a PA programme in general practice. DESIGN AND SETTING A single-arm PA intervention implementation study among cancer survivors in 15 Dutch general practices. METHOD Patients aged ≥18 years who completed primary cancer treatment ≥6 months prior were eligible. The 9-month intervention comprised counselling sessions with a primary care practitioner (PCP) aimed at increasing daily PA. Reach, Effectiveness, and Implementation of the RE-AIM framework were evaluated among participants. Primary health outcomes included self-reported symptoms of fatigue, depression, and anxiety; secondary outcomes included step count, caloric expenditure, weight, physical function, self-reported quality of life, and PA. Outcomes were assessed at time (T)0-T3 (0, 3, 6, and 9 months) or at PCPs' sessions S1-S6 (0, 3, 6 weeks, and 3, 6, 9 months). Non-participants completed a single baseline questionnaire. The study used (non-)parametric independent tests and linear mixed models for analyses. RESULTS Of 564 invited patients, 149 (26%) participated. Participants had less formal education, higher unemployment, less PA, and more fatigue and psychological symptoms than non-participants. All primary and most secondary health outcomes improved over time, with clinically relevant changes in step count and physical function. In total, 11% (n = 16/149) dropped out before and 26% (n = 35/133) during the programme. Counselling session adherence and PA goal achievement were 98% (n = 647/661) and 73% (n = 81/111), respectively. CONCLUSION The programme reached long-term cancer survivors with poorer health status, and showed positive health changes particularly on PA and physical function. Such PA programmes may benefit the health of a rising number of cancer survivors visiting primary care.
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Affiliation(s)
- Famke Huizinga
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
| | - Nico-Derk L Westerink
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
| | - Annemiek Me Walenkamp
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen
| | - Annette J Berendsen
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
| | - Mathieu Hg de Greef
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen
| | - Michiel R de Boer
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
| | - Daan Brandenbarg
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen
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Wang S, Xia W, Zhang J, Wu M, Tian L. Effects of internet-based mindfulness interventions on anxiety and depression symptoms in cancer patients: A meta-analysis. Gen Hosp Psychiatry 2025; 94:126-141. [PMID: 40073752 DOI: 10.1016/j.genhosppsych.2025.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 11/21/2024] [Accepted: 02/26/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate the effectiveness of internet-based mindfulness interventions on anxiety and depression symptoms in patients with cancer. METHODS Eight databases (Cochrane Library, PubMed, Embase, and PsycINFO CNKI, Wanfang, VIP, and CBM) were systematically searched from the inception of databases to August 2023 for randomized controlled trials (RCTs). Two independent reviewers rigorously assessed the risk of bias and extracted data using a pre-established form. The meta-analysis, conducted using Stata version 16, calculated pooled effect sizes and 95% confidence intervals (CIs). Sensitivity analysis was employed to find the source of heterogeneity, and potential publication bias was evaluated through funnel plot analysis and the Egger test. RESULTS This study included 10 studies, involving a total of 1314 patients. The results of the meta-analysis showed that Internet-based mindfulness interventions were effective in reducing anxiety [SMD = -0.38, 95% CI (-0.51, -0.25), P < 0.01] and depression [SMD = -0.36, 95% CI (-0.49, -0.23), P < 0.01], particularly when the duration of the program was within 8 weeks and each session lasted <45 min. Interventions guided by therapists proved to be more effective than those without therapist guidance in improving anxiety and depression in cancer patients, and synchronous online interaction with therapists were found to yield the most noticeable improvements in anxiety and depression. CONCLUSION Internet-based mindfulness interventions, especially synchronous online interaction with therapists, contribute to alleviating anxiety and depression symptoms in cancer patients. The effectiveness is more pronounced when the intervention duration per session is limited to 45 min and the overall intervention duration is within 8 weeks. The medium to long-term efficacy of the intervention needs further validation through more high-quality research.
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Affiliation(s)
- Shizhen Wang
- The First Affiliated Hospital of Soochow University, Suzhou 215006, China; School of Nursing, Medical College of Soochow University, Suzhou 215006, China
| | - Wangjie Xia
- The First Affiliated Hospital of Soochow University, Suzhou 215006, China; School of Nursing, Medical College of Soochow University, Suzhou 215006, China
| | - Jian Zhang
- The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Mengru Wu
- School of Nursing, Medical College of Soochow University, Suzhou 215006, China
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou 215006, China; School of Nursing, Medical College of Soochow University, Suzhou 215006, China.
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Mbous YPV, Mohamed R, Osahor U, LeMasters TJ. Direct Economic Burden of Post-Cancer Treatment Pain Among Cancer Survivors in the United States: A Population-Based Retrospective Longitudinal Study. Int J Health Plann Manage 2025. [PMID: 40186739 DOI: 10.1002/hpm.3932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 01/25/2025] [Accepted: 03/24/2025] [Indexed: 04/07/2025] Open
Abstract
PURPOSE Post-cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long-term incremental healthcare expenditures (total, third-party, and out-of-pocket) and out-of-pocket burden among cancer survivors. METHODS A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self-Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log-link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted. RESULTS 2125 cancer survivors had PCTP. Post-cancer treatment, 10.5%-24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%-5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1-year post-cancer treatment), and severe chronic PCTP, (≥ 5 years post-cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out-of-pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain. CONCLUSION These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient-reported outcomes for pain among cancer survivors.
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Affiliation(s)
- Yves Paul Vincent Mbous
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Rowida Mohamed
- Biological Sciences Division, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Uche Osahor
- Lane Department of Computer Science and Electrical Engineering, School of Engineering, West Virginia University, Morgantown, West Virginia, USA
| | - Traci J LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
- OPEN Health, Parsippany, New Jersey, USA
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Amani O, Mazaheri MA, Malekzadeh Moghani M, Zarani F. Prediction of Sleep Quality in Cancer Survivors Based on Arousal, Pain, and Worry: The Mediating Role of Dysfunctional Beliefs and Attitudes About Sleep. Cancer Med 2025; 14:e70773. [PMID: 40166817 PMCID: PMC11959300 DOI: 10.1002/cam4.70773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 02/14/2025] [Accepted: 03/07/2025] [Indexed: 04/02/2025] Open
Abstract
PURPOSE Our study explores the prevalence, severity, and psychological correlates of insomnia in cancer survivors, aiming to predict sleep quality based on pre-sleep arousal, pain, and worry, while examining the mediating role of dysfunctional beliefs and attitudes about sleep (DBAS). METHODS A descriptive-correlational design was employed, with 200 cancer survivors from Tehran, Iran, selected through convenience sampling in 2022. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Chronic Pain Grade (CPG), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pennsylvania Worry Questionnaire (PSWQ), and Pre-Sleep Arousal Scale (PSAS). The data were analyzed using correlation and multiple regression through SPSS-23 software. RESULTS On average, 37.07 months post-treatment, 95% of survivors reported delayed sleep onset, 88.5% frequent awakenings, 72% reduced sleep duration, and 67% morning dysfunction. Significant positive associations were found between pre-sleep arousal, chronic pain (r = 0.552), worry (r = 0.161), DBAS (r = 0.363), and poor sleep quality (r = 0.607). Regression analysis indicated that physical arousal (B = 0.29, p = 0.01) and DBAS (B = 0.14, p < 0.05) were significant predictors of sleep quality, with DBAS mediating the relationship between physical arousal and sleep quality. CONCLUSIONS Persistent sleep problems after cancer treatment highlight the need for targeted interventions in survivorship care. Sleep-focused strategies may improve sleep quality and reduce the burden of insomnia-related issues. IMPLICATIONS FOR CANCER SURVIVORS Addressing pre-sleep arousal, pain, worry, and DBAS through targeted interventions is crucial for improving sleep quality and overall quality of life in cancer survivors.
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Affiliation(s)
- Omid Amani
- Department of PsychologyShahid Beheshti UniversityTehranIran
| | | | | | - Fariba Zarani
- Department of PsychologyShahid Beheshti UniversityTehranIran
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Yao P, Zhong Y, Wei Z. Association between sedentary behavior, depressive symptoms, and the risk of all-cause and cause-specific mortality among U.S. cancer survivors. BMC Cancer 2025; 25:570. [PMID: 40155883 PMCID: PMC11954221 DOI: 10.1186/s12885-025-13578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 01/21/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Sedentary behavior and depressive symptoms are commonly observed in cancer survivors. However, the combined impact of these factors on the mortality outcomes of cancer survivors remains unknown. METHODS Cancer survivors from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were selected. Multivariate-adjusted Cox regression analyses were employed to examine the intendent and joint prognostic effects of sedentary behavior and depressive symptoms on the mortality outcomes of cancer survivors. RESULTS A total of 2,460 US adult cancer survivors (men = 1,143 and women = 1,317) were included. Severe sedentary behavior (≥ 8 h/day) was linked to higher all-cause [hazard ratio (HR) = 1.68, 95% confidence interval (CI): 1.36-2.09, p < 0.001] and noncancer mortality (HR = 1.80, 95% CI: 1.35-2.40, p < 0.001) in cancer survivors. Each additional hour of sedentary time increased the risk of all-cause (HR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and noncancer mortality (HR = 1.07, 95% CI: 1.04-1.11, p < 0.001). Depressive symptoms (PHQ-9 ≥ 5) were also associated with higher all-cause (HR = 1.22, 95% CI: 1.01-1.48, p = 0.040) and noncancer mortality (HR = 1.27, 95% CI: 1.01-1.61, p = 0.045). In the joint analysis, cancer survivors with both depressive symptoms and severe sedentary behavior had the highest risk of all-cause mortality (HR = 2.06, 95% CI: 1.47-2.88, p < 0.001). Survivors with no depressive symptoms but severe sedentary behavior also had a higher risk (HR = 1.44, 95% CI: 1.10-1.88, p = 0.008). Additionally, the combination of depressive symptoms and severe sedentary behavior increased risks of cancer-specific (HR = 1.56, 95% CI: 1.04-2.34, p = 0.001), noncancer (HR = 1.86, 95% CI: 1.34-2.57, p < 0.001), and CMD-related mortality (HR = 1.74, 95% CI: 1.04-2.93, p = 0.037). In subgroup analysis, cancer survivors with endocrine-related and gastrointestinal cancers were more sensitive to these effects. CONCLUSION Our study highlighted the importance of considering both sedentary behavior and mental health in making effective long-term follow-up recommendations for cancer survivors.
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Affiliation(s)
- Ping Yao
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Ying Zhong
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China.
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Zhang Y, Yu J, Liu T, Kuang L, Bi X. Core preoperative symptoms and patients' symptom experiences in oral cancer: a mixed-methods study. Support Care Cancer 2025; 33:319. [PMID: 40133556 PMCID: PMC11937163 DOI: 10.1007/s00520-025-09370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/17/2025] [Indexed: 03/27/2025]
Abstract
AIMS Patients with oral cancer frequently experience a substantial symptom burden, especially during the preoperative phase, which is typically marked by increased anxiety, pain, and functional impairments. This study aimed to construct contemporaneous symptom networks and investigate symptom experiences of patients with preoperative oral cancer in China. METHODS This study employed a mixed-methods design that integrated a cross-sectional study with qualitative research. Data were collected from 527 patients with oral cancer at the Department of Head and Neck Oncology in a tertiary hospital between September 2023 and May 2024 in China. The MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-H&N) was used to assess the prevalence and severity of the cancer-related symptoms. Symptom networks were constructed using the networktools, qgraph, and Bootnet packages in R, with centrality indices calculated to identify core symptoms within the network. Qualitative data were analyzed using content analysis with NVivo software to extract themes, thereby providing a comprehensive understanding of patients' symptom experiences. RESULTS Distress (89.56%) and sadness (63.95%) were the most prevalent and severe symptoms, respectively. Two distinct symptom clusters emerged: the Emotional-Sleep Symptoms Cluster (Cluster 1) and Eating Disorder Symptoms Cluster (Cluster 2). Difficulty swallowing or chewing (rs = 0.87, rb = 102) and disturbed sleep (rs = 0.64, rb = 77) exhibited the highest centrality indices, indicating that these symptoms were more likely to co-occur with others within the network. Additionally, fatigue had the most significant negative impact on quality of life (r = - 0.16). CONCLUSION This study identified core symptoms through preoperative symptom network analysis and offered valuable insights into the lived experiences of patients with oral cancer regarding their symptoms. These findings serve as a foundation for personalized targeted treatment strategies designed to improve symptom management and enhance quality of life in oral cancer care.
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Affiliation(s)
- Yu Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dep. Of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, 610041, China
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jingya Yu
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Tingting Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases &, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lixia Kuang
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Xiaoqin Bi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dep. Of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section Three, Ren Min Nan Road, Chengdu, Sichuan, 610041, China.
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11
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Ryding HG, Rigby RR, Johnston EA, Kruger R, Mitchell LJ. Dietitians' practices and perspectives of the delivery of nutritional care to cancer survivors in the primary care setting. Support Care Cancer 2025; 33:290. [PMID: 40095197 PMCID: PMC11913905 DOI: 10.1007/s00520-025-09330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/03/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE The number of people living longer after a cancer diagnosis is increasing. Guidelines for cancer survivorship recommend a healthy diet and maintaining a healthy weight post-treatment. While cancer survivors often express the need for professional support for nutrition management, few report seeing a dietitian. This study aimed to explore primary care dietitians' experiences, practices, and perspectives in providing nutritional care to cancer survivors in Australia. METHODS This qualitative study used in-depth, semi-structured interviews with primary care dietitians working in private practice and community care. Interviews were recorded and transcribed. A qualitative descriptive methodological approach integrated with a working analytical framework was utilized for coding and data analysis. RESULTS Twenty-four dietitians working in primary care participated. Four themes and 13 sub-themes were identified: (1) diversity in dietetic practice and cancer-related care interactions; (2) accessing referral pathways and funding sources in a complex healthcare system; (3) the application of nutrition education, and upskilling in cancer care; (4) client barriers and dietitians' challenges and factors influencing confidence in cancer care. CONCLUSION Dietitians in this study highlighted the need for clear referral pathways to primary care particularly as a continuation of cancer-related care following the acute setting. There is a need for tailored support for dietitians supporting people diagnosed with cancer in the primary care setting, including opportunities to upskill in cancer care.
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Affiliation(s)
- Henriette G Ryding
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Roshan R Rigby
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Elizabeth A Johnston
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Rozanne Kruger
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Lana J Mitchell
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia.
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12
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Caldiroli CL, Sarandacchi S, Tomasuolo M, Diso D, Castiglioni M, Procaccia R. Resilience as a mediator of quality of life in cancer patients in healthcare services. Sci Rep 2025; 15:8599. [PMID: 40075138 PMCID: PMC11904231 DOI: 10.1038/s41598-025-93008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 03/04/2025] [Indexed: 03/14/2025] Open
Abstract
Quality of life is a critical outcome in oncology, influencing treatment adherence and patient satisfaction. Haematology patients face psychological challenges, including emotional distress, depression and PTSD, which can affect their quality of life. Resilience and social support are protective factors that help patients cope with these challenges. This study aimed to assess the psychological adjustment of haematology patients by examining psychological outcomes (PTSD and depression), psychological resources (resilience and perceived social support), and quality of life. It also examined correlations between demographic variables, psychological outcomes and resources to identify predictors of quality of life and whether resilience mediates these effects. A sample of 110 haematology patients from three hospital centers in central/southern Italy participated. Data were collected using self-report questionnaires measuring PTSD, depression, resilience, social support and quality of life. Correlational analyses and hierarchical multiple regression were used to explore the relationships between variables, followed by a mediation analysis to examine the role of resilience. Results indicated that QOL was negatively associated with gender, age, PTSD and depression, but positively associated with resilience. Regression analyses showed that quality of life was significantly predicted by resilience, age, depressive symptoms and gender. The mediation model showed that resilience partially mediated the effects of age, gender and depression on QoL. These findings highlight the protective role of resilience in improving quality of life in haematology patients. Despite limitations related to sample size and the use of self-report questionnaires, this study provides valuable insights into the psychological adjustment of haematology patients and highlights the importance of considering psychological resources in oncology care.
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Affiliation(s)
- Cristina Liviana Caldiroli
- Department of Human Sciences for Education "Riccardo Massa", University of Milano-Bicocca, Milan, Italy.
| | - Silvia Sarandacchi
- Department of Human Sciences for Education "Riccardo Massa", University of Milano-Bicocca, Milan, Italy
| | - Miriam Tomasuolo
- Department of Economics, Management and Statistics, University of Milano Bicocca, Milan, Italy
| | - Deborah Diso
- Department of Human Sciences for Education "Riccardo Massa", University of Milano-Bicocca, Milan, Italy
| | - Marco Castiglioni
- Department of Human Sciences for Education "Riccardo Massa", University of Milano-Bicocca, Milan, Italy
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Bhimani N, Dieng M, Kelly PJ, Hugh TJ. Colorectal liver metastasis resection results in excellent long-term quality of life and low symptom burden. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109751. [PMID: 40086219 DOI: 10.1016/j.ejso.2025.109751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 01/19/2025] [Accepted: 03/05/2025] [Indexed: 03/16/2025]
Abstract
INTRODUCTION Prognostic factors in patients who undergo liver resection for colorectal liver metastases (CRLM) have been investigated, but limited research exists on health-related quality of life (HRQoL), functional status, and ongoing symptoms. This study aimed to assess the long-term HRQoL of life and examine the factors associated with HRQoL, functional status, and ongoing symptoms. MATERIALS AND METHODS This was a cross-sectional study of patients who had curative resection between 2010 and June 2021. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 (a generic questionnaire) and QLQ-LMC21 (CRLM-specific) questionnaires. RESULTS In total, 121 patients underwent liver resection, of which 85 were alive. There was a 61 % response rate (n = 52). The median postoperative time when the survey was completed was 4.0 years (1-13.1). Overall, most patients were doing well, with a median global HRQoL score of 83 and scores >80 in all domains. Most symptoms were assigned a median score of "0". There were no clinical factors that significantly impacted HRQoL and only trivial differences in relation to physical symptoms. CONCLUSION This study demonstrates excellent long-term HRQoL and functional status in patients who undergo liver resection for CRLM and have long-term survival.
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Affiliation(s)
- Nazim Bhimani
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Mbathio Dieng
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
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14
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Bakalis VI. Evaluating Quality of Life of Prostate Cancer Patients After Radical Prostatectomy. Cureus 2025; 17:e79973. [PMID: 40177457 PMCID: PMC11964286 DOI: 10.7759/cureus.79973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2025] [Indexed: 04/05/2025] Open
Abstract
Background Prostate cancer is the second most commonly diagnosed cancer globally and has a significant impact on patients' quality of life (QoL). The treatment of prostate cancer, particularly through radical prostatectomy, offers curative benefits but often results in adverse effects such as urinary incontinence and erectile dysfunction. These issues can persist long after treatment, affecting both physical and mental well-being. Beyond these complications, patients may also experience emotional distress, anxiety, and social implications, such as changes in relationships and self-perception. As such, evaluating QoL post-treatment is essential in understanding the comprehensive impact of prostate cancer care. Methodology This study involved 110 prostate cancer patients who underwent radical prostatectomy. QoL was assessed using the Short-Form Health Survey Questionnaire (SF-36) at the following three points: before treatment and at six and 12 months post-treatment. The evaluation focused on physical, emotional, and social aspects of health. Patients with psychiatric disorders or those unable to understand Greek were excluded from the study. Results The study participants' average age ranged from 67 to 82 years (mean = 74.2 years). A significant improvement in social functioning was observed between the first and second assessments. Improvements were also seen in physical functionality, emotional well-being, and general health, but these changes were not statistically significant. By the third assessment (12 months post-surgery), significant improvements were noted in vitality, though other changes, including in physical, emotional, and role functioning, were not significant. Conclusions Radical prostatectomy is effective for cancer control but often results in persistent QoL issues such as erectile dysfunction and urinary incontinence. While there are improvements in certain areas such as vitality and social functioning, managing the full spectrum of physical and psychosocial impacts requires a holistic approach. Incorporating psychological support and sexual rehabilitation into treatment plans is essential to enhance the QoL of prostate cancer patients. The integration of patient-reported outcomes in clinical care is crucial for ensuring comprehensive and effective treatment.
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Schubel LC, Rivera Rivera J, Pratt-Chapman ML, Astorino J, Taylor T, Littlejohn R, Smith JL, Sabatino SA, White A, O Buckley B, King C, Mandelblatt J, Gallagher C, Arem H. Social risk factors screening preferences among breast and prostate cancer survivors: A qualitative study. J Psychosoc Oncol 2025:1-19. [PMID: 39946244 DOI: 10.1080/07347332.2025.2463389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
OBJECTIVES This project aimed to understand the experiences and preferences for social risk factor screening among racially, ethnically, and linguistically diverse cancer survivors in the Washington, DC, region. METHODS Semi-structured interviews were conducted with English, Spanish, and Amharic-speaking breast and prostate cancer survivors. Data were inductively coded to identify themes, and differences by race and preferred language were evaluated. FINDINGS Twenty-two interviews in English (n = 14), Spanish (n = 7), and Amharic (n = 1) among participants who identified as Black (n = 8), White (n = 5), Asian (n = 1), Other (n = 6), and multiracial (n = 2) were completed. Participants reported unresolved needs during treatment including transportation, healthful food, mental health care, financial help, and employment assistance. COVID-19 exacerbated many needs. Most participants did not recall discussing needs with oncology teams, but all participants were open to having these conversations. CONCLUSION(S) This research reveals that cancer survivors might benefit from culturally appropriate strategies that address social needs.
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Affiliation(s)
- Laura C Schubel
- National Center for Human Factors in Healthcare, Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
- Implementation Science; Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
| | - Jessica Rivera Rivera
- Implementation Science; Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
| | - Mandi L Pratt-Chapman
- The George Washington University Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Joseph Astorino
- The George Washington University Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Teletia Taylor
- Howard University College of Medicine, Department of Medicine, Howard University, Washington, DC, USA
| | - Robin Littlejohn
- National Center for Human Factors in Healthcare, Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryan O Buckley
- MedStar Institute for Quality and Safety, Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
| | - Christopher King
- School of Health at Georgetown University, Washington, DC, USA; Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | | | | | - Hannah Arem
- Implementation Science; Healthcare Delivery Research, MedStar Health Research Institute, Washington, DC, USA
- Department of Oncology, Georgetown University, Washington, DC, USA
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Tian Q, Xue M, Chen L, Zhang M, Zhu W, Wu B. Analysis of physical activity levels and influencing factors in cancer survivors after pancreaticoduodenectomy. Front Oncol 2025; 14:1428884. [PMID: 39886671 PMCID: PMC11779614 DOI: 10.3389/fonc.2024.1428884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/16/2024] [Indexed: 02/01/2025] Open
Abstract
Introduction Physical activity is becoming more important in cancer patient care. However, there are limited studies investigating physical activity levels in cancer survivors after pancreaticoduodenectomy. This study aims to assess the present status of physical activity levels in cancer survivors after pancreaticoduodenectomy and whether perioperative metrics and length of follow-up have an impact on physical activity levels in survivorship. Methods This is a cross-sectional study. The study included cancer survivors who were treated at a tertiary general teaching hospital for pancreaticoduodenectomy from December 2019 to January 2022 following surgery. We quantified physical activity frequency, duration, and intensity using the International Physical Activity Questionnaire-Short Form. Patient demographic and clinical characteristics were obtained via an electronic medical record system. Postoperative complication data were obtained from our survival cohort. Variables univariately associated with the physical activity level at an alpha level of less than 0.1 were included in the logistic regression analysis of factors influencing physical activity in cancer survivors after pancreaticoduodenectomy. Results A total of 223 patients who met the eligibility criteria completed a telephone survey. The main form of physical exercise is walking, 69.5% of participants' physical activity belongs to the active category, but only 16.6% of participants met the aerobic guideline. Logistic regression showed that cancer survivors without pancreatic fistula were 2.453 times more likely to perform active physical activity in survival than those with pancreatic leakage (p = 0.041). For a one-unit increase in operation duration, there is approximately a 0.5% reduction in the level of active physical activity participation among cancer survivors after pancreaticoduodenectomy (p = 0.015). For each unit increase in follow-up time, post-pancreaticoduodenectomy patients were 1.046 times more likely to participate in active physical activity (p = 0.030). Conclusion Although half of the cancer survivors after pancreaticoduodenectomy experienced active physical activity, only a small percentage of individuals met the guideline-recommended level of aerobic exercise. More physical activity support should be provided to cancer survivors after pancreaticoduodenectomy. Moreover, operation duration, postoperative pancreatic fistula, and follow-up time should be taken into consideration when giving exercise instructions to postoperative survivors of pancreaticoduodenectomy.
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Affiliation(s)
- Qiuju Tian
- Gastrointestinal Surgery Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meiqin Xue
- Nursing Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leying Chen
- Pancreatic Surgery Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Min Zhang
- Pancreatic Surgery Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiyi Zhu
- Nursing Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Beiwen Wu
- Nursing Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Marker RJ, Kittelson AJ, Scorsone JJ, Moran IA, Quindry JC, Leach HJ. A Novel Telehealth Exercise Program Designed for Rural Survivors of Cancer With Cancer-Related Fatigue: Single-Arm Feasibility Trial. JMIR Cancer 2025; 11:e59478. [PMID: 39793972 PMCID: PMC11759908 DOI: 10.2196/59478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 11/01/2024] [Accepted: 12/09/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural survivors of cancer, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs. OBJECTIVE The purpose of this investigation was to assess the feasibility of a novel telehealth exercise program designed specifically for rural survivors of cancer with CRF. METHODS A single-arm clinical trial of the BfitBwell Telehealth Program was performed. Based on an established clinical program, this adapted 12-week program addressed barriers previously reported by rural survivors by providing synchronous videoconference exercise sessions (2 per program), asynchronous exercise sessions using a personal training smartphone or internet app (3-5 per week), and regular symptom (CRF) monitoring using automated emailed surveys (every 2 weeks). Personalized exercise prescriptions containing aerobic and resistance activities were implemented by cancer exercise specialists. Symptom-triggered synchronous sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements observed during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by objective measures of recruitment, data collection, intervention acceptability and suitability, and preliminary evaluations of participant responses. CRF was the primary clinical outcome (assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale [FACIT-Fatigue]) and was measured before, after, and 6 months after program completion. RESULTS In total, 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. A total of 14 participants were recruited through internet advertisements, and the total recruitment rate peaked at 5 participants per month. Participants completed 100% of initial and final assessments (30 assessments across all participants) and 93% (70/75 possible surveys across all participants) of emailed surveys and attended 97% (29/30 possible sessions across all participants) of synchronous exercise sessions. In total, 6 participants initiated symptom-triggered sessions, with 6 of 7 initiated sessions attended. The mean FACIT-Fatigue scores significantly improved (P=.001) by 11.2 (SD 6.8) points following the completion of the program. A total of 13 participants demonstrated at least a minimal clinically important difference in FACIT-Fatigue scores (≥ +3 points) at this time. FACIT-Fatigue scores did not significantly change from program completion to 6-month follow-up (n=13; mean change -1.1, SD 3.4 points; P=.29). CONCLUSIONS Results from this investigation support the feasibility of the BfitBwell Telehealth Program and a subsequent efficacy trial. Novel program components also provide potential models for improving exercise program efficacy and efficiency through asynchronous exercise prescription and symptom monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT04533165; https://clinicaltrials.gov/study/NCT04533165.
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Affiliation(s)
- Ryan J Marker
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, United States
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, United States
| | - Jared J Scorsone
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ian A Moran
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - John C Quindry
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, United States
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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Singh A, Jain AG, Hamilton BK, Adjei A. Care Models for Cancer Survivors. Annu Rev Med 2025; 76:225-241. [PMID: 39661552 DOI: 10.1146/annurev-med-042423-044004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2024]
Abstract
The population of cancer survivors is on the rise due to an increase in cancer incidence and a decline in cancer mortality. This growing survivor population creates a number of challenges. Although there have been improvements in care planning for cancer survivors, our healthcare system still lacks the delivery of coordinated care between primary care physicians and specialists. Understanding the needs of cancer survivors can help improve the current care models. In this review we describe existing survivorship care models. We also describe emerging models using some programs at the Cleveland Clinic to highlight various potential approaches.
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Affiliation(s)
- Abhay Singh
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA;
| | - Akriti G Jain
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA;
| | | | - Alex Adjei
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA;
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Kittel JA, Seplaki CL, van Wijngaarden E, Richman J, Magnuson A, Conwell Y. Fatigue, impaired physical function and mental health in cancer survivors: the role of social isolation. Support Care Cancer 2024; 33:16. [PMID: 39661200 DOI: 10.1007/s00520-024-09075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 12/06/2024] [Indexed: 12/12/2024]
Abstract
PURPOSE Cancer survivors experience an array of physical, psychological, and social problems after treatment has ended. Perceived social isolation may exacerbate the effects of physical problems on mental health. We examined the association between physical health (cancer-related fatigue and physical function) and mental health (depression and anxiety symptoms) in cancer survivors in the first year of survivorship (i.e., up to one year after the end of treatment with curative intent), as well as the moderating role of perceived social isolation. METHODS Survey data were collected from 118 cancer survivors who completed treatment with curative intent in the last year. We assessed mental and physical health symptoms, as well as perceived social isolation. RESULTS In multivariable analyses, fatigue was significantly associated with both depression (β = 0.279, 95% CI: 0.193,0.362) and anxiety symptoms (β = 0.189, 95% CI: 0.106,0.272). Social isolation moderated the effect of fatigue on depression and anxiety such that higher social isolation exacerbated the association of fatigue with mental health. CONCLUSIONS Cancer survivors who continue to experience fatigue after curative treatment are at risk for mental health problems, including depression and anxiety symptoms. For cancer survivors who feel socially isolated, the association between fatigue and mental health may be stronger. The current standard of care for survivorship does not sufficiently address psychosocial needs. Future research should evaluate the inclusion of social support interventions in early-term survivorship care.
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Affiliation(s)
- Julie A Kittel
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU 420644, Rochester, NY, 14642, USA.
| | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU 420644, Rochester, NY, 14642, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU 420644, Rochester, NY, 14642, USA
| | - Jennifer Richman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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20
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Pritlove C, Capone G, Ramasamy M, Avery L, Fierini D, Ferguson SE, Han K, Jones JM. Eliminating Digestive Irregularities Caused by Late Effects: A Pilot Study of an Innovative Culinary Nutrition Intervention for Reducing Gastrointestinal Toxicity in Gynecologic Cancer Patients Who Have Undergone Pelvic Radiotherapy. Nutrients 2024; 16:4227. [PMID: 39683620 DOI: 10.3390/nu16234227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 11/30/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES Pelvic radiotherapy (RT) improves survival in gynecologic cancer patients but often results in gastrointestinal (GI) toxicity, affecting quality of life. Standard nutrition guidance lacks specificity for these survivors, complicating dietary choices. To address this gap, the EDIBLE intervention was developed to offer structured dietary self-management skills to alleviate RT-induced GI toxicity. METHODS We conducted a single-arm mixed-methods pilot of the EDIBLE intervention among post-treatment gynecologic cancer survivors to assess its feasibility, acceptability, and preliminary effects on GI symptoms, knowledge, and self-efficacy, with measures at baseline (T1), post-intervention (T2), and after 3 months (T3). RESULTS Qualitative interviews supported strong perceptions of intervention feasibility; however, the recruitment (32%) and retention (72%) rates were modest, indicating that alternate formats for program delivery may be needed to make it more accessible. The acceptability of the EDIBLE intervention garnered especially high ratings on measures of satisfaction and utility, with program improvements largely rallying around a desire for increased in-class sessions and program expansion. Statistically significant improvements were observed at the three-month mark (T3), such as enhanced confidence in culinary practices, increased knowledge and skills with regard to managing GI side effects, and improvements in bowel and GI symptoms. CONCLUSIONS The results suggest EDIBLE is acceptable, improving GI symptoms and self-efficacy; however, moderate recruitment rates indicate refinement is needed. A randomized control trial and cost-effectiveness analysis is needed to confirm effectiveness and scalability.
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Affiliation(s)
- Cheryl Pritlove
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A, Canada
| | - Geremy Capone
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
| | - Mathankki Ramasamy
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A, Canada
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
| | - Daniela Fierini
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, University Health Network/Sinai Health Systems, Toronto, ON M5G 1X5, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5S 1A, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A, Canada
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21
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Villinger K, Berli C, Scholz U. App-based interventions to improve cancer outcomes rely on informational support from professionals: a systematic review. Health Psychol Rev 2024; 18:767-789. [PMID: 38755755 DOI: 10.1080/17437199.2024.2349617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
The importance of social support for cancer patients is well-established, and mobile applications hold promise for implementation. This systematic review examines app-based interventions with social support components for cancer patients, investigating the use of different support functions from different sources and the impact on cancer-related symptoms and psychological outcomes. A systematic search across five databases (EMBASE, Scopus, PsycINFO, PubMed, Web of Science) yielded 449 records, of which 17 studies (12 controlled designs) were included. Two independent reviewers extracted data and assessed study quality, revealing a high risk of bias across studies. Social support was implemented through different app functions, including contact/chat functions (n = 9), automatic alerts based on app input (n = 6) and discussion forums (n = 5). Social support predominantly focused on informational support (n = 17), mostly from healthcare professionals. Emotional support was less common (n = 7). Results indicated some promising intervention effects for pain, fatigue, nausea/vomiting, insomnia, constipation and overall symptom distress, but heterogeneous effects for health-related quality of life. Overall, results were mixed, but indicate that mobile apps incorporating social support may hold promise for cancer patients. However, future studies should focus on measuring and reporting social support as an intervention mechanism to systematically investigate its specific impact and improve effectiveness.
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Affiliation(s)
| | - Corina Berli
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Urte Scholz
- Department of Psychology, University of Zurich, Zurich, Switzerland
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22
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Bilc MI, Pollmann N, Eisenmann C, Buchholz A, Pokhrel B, Lauche R, Cramer H. Yoga intervention for colorectal cancer survivors: a qualitative study exploring participants' expectations and experiences. Ann Med 2024; 56:2397571. [PMID: 39212243 DOI: 10.1080/07853890.2024.2397571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) survivors often struggle with side effects following treatment such as reduced quality of life, fatigue and psychological distress and need therefore efficient comprehensive interventions. The aim of this qualitative study was to explore CRC survivors' expectations before the yoga intervention as well as their unique experiences beyond those reported with standard questionnaires. METHODS Interpretative phenomenological approach was used in this qualitative study. Semi-structured interviews were conducted before and after a 10-week yoga program (90 min once a week, Hatha Yoga) with CRC survivors enrolled in a randomized controlled trial. Thematic analysis was used to uncover themes present in participants' accounts. RESULTS Nine patients participated in the interviews, mean interview duration was 27.49 min (SD = 7.71) before and 38.41 min (SD = 15.93) after the intervention. Our analysis identified following themes: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention; (4) differences between the study yoga intervention and other physical activities. The superordinate theme regarding effects of intervention included aspects of intervention at multiple levels such as emotional, physical, behavioral and spiritual. CONCLUSIONS This qualitative study provides valuable insight regarding CRC survivors' expectations and experiences following a 10-week yoga intervention. While expectations varied from skepticism to specific symptom improvement, the majority of participants had a positive, open attitude towards yoga. Consistent with participants' experiences, yoga may represent a promising intervention for CRC survivors if the groups' specific concerns are taken into account.
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Affiliation(s)
- Mirela-Ioana Bilc
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Nina Pollmann
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | | | - Analena Buchholz
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Bijay Pokhrel
- Medical Care Center of Recura Clinics, Beelitz-Heilstätten, Germany
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
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23
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Wei Y, Cheng W, Lu Y, Zhu Z, Xu G, Wu H, Lin S, Xiao H. Features and Differences in Core Symptom Clusters in Home-Based Hospice Patients With Advanced Cancer: A Network Analysis. Cancer Med 2024; 13:e70370. [PMID: 39494586 PMCID: PMC11532887 DOI: 10.1002/cam4.70370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/15/2024] [Accepted: 10/16/2024] [Indexed: 11/05/2024] Open
Abstract
INTRODUCTION Patients with terminal-stage cancer frequently experience multiple symptoms simultaneously. Little is known about how core symptom clusters differ in advanced-cancer patients with different survival expectancies receiving hospice care. To identify the core symptom clusters of hospice-care cancer patients with different survival expectancies and compare the features of their symptom networks. METHODS In this retrospective study, secondary data analysis was conducted. Records of 6946 patients with advanced cancer who received home-based hospice care service in a hospice center from April 2001 to December 2020 were collected and analyzed using network analysis. RESULTS This analysis included 6946 patients with advanced cancer receiving hospice care. In patients with survival expectancies of 0-6 months, loss of appetite was identified as the core symptom (rs = 4.03, rb = 5.21, rc = 2.63), and five symptom clusters were identified. Malnutrition was the core symptom in patients with survival expectancies of 6-12 months (rs = 2.83, rb = 2.43, rc = 0.93), and nine symptom clusters were identified. Wasting syndrome was the core symptom cluster in two groups. The network density of symptoms in patients with < 6 months of survival expectancy (91.99) was higher than in patients with 6-12 months (28.39). CONCLUSIONS Nutrition impact symptoms are the core symptoms for home-hospice care cancer patients with a survival period of 1 year or below. Moreover, hospice cancer patients with short survival expectancies have greater inter-symptom impact.
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Affiliation(s)
- Yitao Wei
- School of NursingFujian Medical UniversityFuzhouChina
| | - Wan Cheng
- School of NursingFujian Medical UniversityFuzhouChina
| | - Yuanfeng Lu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Zheng Zhu
- School of NursingFudan UniversityShanghaiChina
| | - Guiru Xu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Hong Wu
- Department of Hospice CareFujian Provincial HospitalFuzhouChina
| | - Shaowei Lin
- School of Public HealthFujian Medical UniversityFuzhouChina
| | - Huimin Xiao
- School of NursingFujian Medical UniversityFuzhouChina
- Research Center for Nursing HumanityFujian Medical UniversityFuzhouChina
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24
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Luo H, Li Q, Xu R, Han S, Yang J. Reliability and Validity of the Chinese Version of the Nurses' Cancer Pain Management Competency Scale. Pain Manag Nurs 2024; 25:e375-e380. [PMID: 38734526 DOI: 10.1016/j.pmn.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The Nurses' Cancer Pain Management Competency Scale (NCPMCS) is a tool to explore nurses' competencies and subjective experiences in cancer pain management, and to help nurses understand their current shortcomings in cancer pain management. The scale, currently available only in English and translated into Chinese for wider adoption abroad, provides a tool for Chinese nurses to assess their level of cancer pain management. Furthermore, based on the scale's specific score, they can evaluate their lack of understanding about cancer pain management, advance research into this area, and enhance their capacity to control cancer pain while providing patient care. OBJECTIVE The purpose of this study was to translate and localize the new scale, and to measure its reliability and validity. The study was also to provide a way to quickly and accurately measure the competency of cancer pain management among nursing staff in China. METHODS The Bristling translation approach was used to translate, translate back, and culturally modify the English version of the cancer pain management competency scale for nurses to create the Chinese version. A convenience sample was used for the study, 220 clinical nurses from three Grade III hospitals in Zhengzhou, Henan Province, China, were chosen by convenience sampling. The Chinese version of the scale was used for this investigation. RESULTS The Cancer Pain Management Competency Scale for Nurses has 14 items over 4 dimensions in its Chinese form. From the exploratory factor analysis, four common components were recovered; the cumulative variance rate was 81.994%, the scale's Cronbach's α coefficient was 0.902, and the Cronbach's α coefficient for each dimension ranged from 0.800 to 0.938. Retest reliability was 0.915, scale content validity was 0.865, and Spearman-Brown's broken half reliability was 0.808. CONCLUSION Nurses' cancer pain management competency in clinics can be assessed using the Chinese version of the Nurses' Cancer Pain Management Competency Scale, which has strong validity and reliability.
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Affiliation(s)
- Haoyue Luo
- School of Nursing and Health, Zhengzhou University (ZZU), Zhengzhou City, Henan Province, China
| | - Qiufang Li
- School of Nursing and Health, Zhengzhou University (ZZU), Zhengzhou City, Henan Province, China.
| | - Rui Xu
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Shuangrong Han
- School of Nursing and Health, Zhengzhou University (ZZU), Zhengzhou City, Henan Province, China
| | - Jiayin Yang
- School of Nursing and Health, Zhengzhou University (ZZU), Zhengzhou City, Henan Province, China
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25
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Van den Broecke M, de Jong S, Vanthomme K, Mbengi RK, Vanroelen C. Factors related to the return to work of head and neck cancer patients diagnosed between 2004-2011 in Belgium: a multivariate Fine-Gray regression model analysis. Arch Public Health 2024; 82:155. [PMID: 39267126 PMCID: PMC11391679 DOI: 10.1186/s13690-024-01373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/13/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND This study aims to identify the key factors that underlie the return to work (RTW) of head and neck cancer (HNC) patients in Belgium. METHODS We used data from the EMPCAN database linking data from the Belgian Cancer Registry and the Crossroads Bank for Social Security. We selected HNC patients aged 18-60 at diagnosis who became inactive on the labour market during the follow-up time observed (n = 398). Fine-Gray regression models were used to examine associations between clinical, socio-demographical and work-related factors and RTW over a follow-up of almost 8 years (2004-2011). RESULTS The overall RTW was 21.6%. Stage IV at diagnosis and the use of chemoradiation were associated with a decreased RTW probability but this effect was attenuated by age-adjusted analyses. Multivariate analysis shows that the probability of RTW decreases with age and depends on the household composition. Patients who live alone (SHR 2.2, 95% CI 1.0 - 4.5) and patients who live with another adult and child(ren) (SHR 2.1, 95% CI 1.1 - 4.0) are more likely to RTW than patients who live with another adult without children. CONCLUSIONS The cumulative incidence of RTW in HNC patients is associated with age and household composition but not with treatment modalities or stage. In future research, this model could be applied to larger cancer patient groups for more accurate estimations. These insights are of importance to better support patients and for informing tailored policy measures which should take into account the sociodemographic profile of HNC patients to tackle societal and health-related inequities and burden of work inactivity.
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Affiliation(s)
- Maxim Van den Broecke
- Belgian Cancer Center, Belgian National Institute of Public Health (Sciensano), Brussels, Belgium.
- Brussels Institute for Social and Population Studies, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Sarah de Jong
- Belgian Cancer Center, Belgian National Institute of Public Health (Sciensano), Brussels, Belgium
- METICES Research Group, Faculty of Sociology, Université Libre de Bruxelles, Brussels, Belgium
| | - Katrien Vanthomme
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Régine Kiasuwa Mbengi
- Belgian Cancer Center, Belgian National Institute of Public Health (Sciensano), Brussels, Belgium
| | - Christophe Vanroelen
- Brussels Institute for Social and Population Studies, Vrije Universiteit Brussel, Brussels, Belgium
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26
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Romeiser JL, Chen Z, Nanavati K, Williams AA. Correlates and patterns of using complementary health approaches among individuals with recent and longer-term cancer diagnoses: a US national cross-sectional study. J Cancer Surviv 2024:10.1007/s11764-024-01665-5. [PMID: 39249689 DOI: 10.1007/s11764-024-01665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/16/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To (1) describe and compare the prevalence of using of complementary health approaches, focusing on mind and body practices, and reasons for use among cancer survivors, and (2) examine characteristics associated with use among those with a recent and non-recent diagnosis of cancer compared to those without a previous cancer diagnosis. METHODS Using data from the 2022 US National Health Interview Survey, prevalence estimates were derived for using any complementary health approach, by category (manipulative body-based [chiropractor, acupuncture, massage], creative [music therapy, art therapy], and mind-body [meditation, guided imagery, yoga]), and reasons for use. Regression models identified correlates of use among all participants and within cancer diagnosis subgroups. RESULTS Among 26,523 adult participants, overall prevalence of using any complementary approach was similar amongst individuals with recent cancer (40.17%), non-recent cancer (37.75%), and no cancer diagnosis (37.93%). However, odds of use were higher amongst recent (OR = 1.37) and relatively long term (OR = 1.14) cancer survivors compared to those without a history of cancer in adjusted models (both p < 0.05). In cancer survivors, mind-body approaches were mostly used for general health purposes, whereas manipulative approaches were used for general health and pain management. Female sex, younger age, higher education and income were among the prominent variables associated with using complementary approaches. CONCLUSION We present an important snapshot of the landscape of using complementary approaches, specifically mind and body practices, in adult cancer survivors in the US. Inequalities in access to these therapies may exist, as use remains highest amongst those with higher socioeconomic conditions. IMPLICATIONS FOR CANCER SURVIVORS Given the prevalence and potential benefits of complementary approaches among cancer survivors, there is a need to better understand their effectiveness, optimal use, and integration into cancer care. Further research is needed to understand and address access barriers that might exist amongst some cancer survivors.
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Affiliation(s)
- Jamie L Romeiser
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA.
| | - Zhi Chen
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Kaushal Nanavati
- Upstate Cancer Center, Upstate Medical University, Syracuse, NY, USA
- Department of Family Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Augusta A Williams
- Department of Public Health and Preventive Medicine, Upstate Medical University, Syracuse, NY, USA
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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 PMCID: PMC11572702 DOI: 10.1200/op.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Bachman SL, Gomes E, Aryal S, Cella D, Clay I, Lyden K, Leach HJ. Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis. JMIR Cancer 2024; 10:e53180. [PMID: 39008350 PMCID: PMC11287100 DOI: 10.2196/53180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. OBJECTIVE In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. METHODS Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. RESULTS Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps≥.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps≤.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps≤.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps≥.08). CONCLUSIONS In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154.
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Affiliation(s)
| | - Emma Gomes
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ieuan Clay
- VivoSense, Inc, Newport Coast, CA, United States
| | - Kate Lyden
- VivoSense, Inc, Newport Coast, CA, United States
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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29
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Oliva G, Giustiniani A, Danesin L, Burgio F, Arcara G, Conte P. Cognitive impairment following breast cancer treatments: an umbrella review. Oncologist 2024; 29:e848-e863. [PMID: 38723166 PMCID: PMC11224991 DOI: 10.1093/oncolo/oyae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/16/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES Cancer-related cognitive impairment (CRCI) refers to a cognitive decline associated with cancer or its treatments. While research into CRCI is expanding, evidence remains scattered due to differences in study designs, methodologies, and definitions. The present umbrella review aims to provide a comprehensive overview of the current evidence regarding the impact of different breast cancer therapies on cognitive functioning, with a particular focus on the interplay among objective cognitive deficits (ie, measured with standardized tests), subjective cognitive concerns, (ie, self-reported), and other mediating psycho-physical factors. METHODS The search was made in Pubmed, Embase, and Scopus for articles published until July 2023, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol. RESULTS Chemotherapy and endocrine therapy appear consistently associated with CRCI in patients with breast cancer, primarily affecting memory, attention/concentration, executive functioning, and processing speed. Subjective cognitive concerns were often found weakly or not associated with neuropsychological test results, while overall CRCI seemed consistently associated with psychological distress, fatigue, sleep quality, and inflammatory and biological factors. CONCLUSION Current evidence suggests that CRCI is common after chemotherapy and endocrine therapy for breast cancer. However, heterogeneity in study designs and the scarcity of studies on more recent treatments such as targeted therapies and immunotherapies, highlight the need for more systematic and harmonized studies, possibly taking into account the complex and multifactorial etiology of CRCI. This may provide valuable insights into CRCI's underlying mechanisms and potential new ways to treat it.
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Affiliation(s)
- Giulia Oliva
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35124 Padova, Italy
- IRCCS San Camillo Hospital, 30126 Venice, Italy
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Hernández-Hernández S, Heredia-Ciuró A, Martín-Núñez J, Calvache-Mateo A, Navas-Otero A, López-López L, Valenza MC. The Impact of Pain Education Interventions for Cancer Survivors and Caregivers: A Systematic Review with Meta-Analysis. Cancers (Basel) 2024; 16:2468. [PMID: 39001530 PMCID: PMC11240398 DOI: 10.3390/cancers16132468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Cancer-related pain is a global health-related problem associated with functional impairment, anxiety, depression, and reduced quality of life. The use of educational interventions for patients and their caregivers has been proposed as a promising tool for overcoming pain in cancer. The aim of this study was to summarize by means of a standardized methodological systematic revision the actual pain education intervention used in cancer patients and their caregivers and to analyze its effects on pain. METHODS A search was conducted through PubMed, Web of Science, Scopus and Cinhal from their inception to September 2022. Randomized controlled trials which included pain education interventions were identified. Two reviewers performed independent data extraction and methodologic quality assessments of these studies. RESULTS A total of seven studies was included in the study. The meta-analysis showed that pain education interventions have a significant effect on the worst pain; however, there was no effect on average pain. CONCLUSIONS Pain education interventions addressed to patients and their caregivers could have positive effects on cancer-related pain. It is recommended that a minimum of three sessions of about one hour's duration be held once a week. Further research needs to be carried out and analyzed on the effects over the long term. Pain education interventions show positive results in improving pain in cancer patients regardless of etiology or extent of the cancer. Studies with better methodological quality should be carried out to address specific components related to education interventions.
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Affiliation(s)
- Sofía Hernández-Hernández
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Alba Navas-Otero
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración 60, 18016 Granada, Spain
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Agbejule OA, Hart NH, Ekberg S, Chan RJ. Development of a self-management support practice framework for addressing cancer-related fatigue: a modified Delphi study. J Cancer Surviv 2024; 18:972-982. [PMID: 36826459 PMCID: PMC11082027 DOI: 10.1007/s11764-023-01348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Managing cancer-related fatigue requires individuals to adopt a range of self-management behaviours. However, clinicians report the lack of clear guidance on self-management support practices hinders their provision of supportive care. To develop consensus on a framework of core practices required by health professionals to deliver effective self-management support to cancer patients and survivors experiencing cancer-related fatigue. METHODS A preliminary framework of 47 practice items (14 Key Practices, 33 Practice Components) was derived from a systematic review, and a self-management support capability outline for primary care professionals. This preliminary framework was presented for consensus rating and comment in a two-round modified Delphi study conducted with a panel of health professionals, research academics, and cancer consumers. RESULTS Fifty-two panel participants comprising consumers (n = 25), health professionals (n = 19), and researchers (n = 16) were included in Round 1 of the modified Delphi study. Feedback from the panel produced consensus on retaining 27 of 47 original practice items without change. Seventeen items (including 12 modified, and 5 newly created practice items) were sent to the panel for rating in Round 2. Thirty-six experts produced consensus on retaining all 17 practice items in Round 2. The final framework comprised 44 items (13 Key Practices, 31 Practice Components). CONCLUSIONS The practice framework offers an evidence- and consensus-based model of best practice for health professionals providing self-management support for cancer-related fatigue. IMPLICATIONS FOR CANCER SURVIVORS This framework is the first to focus on quality provision of self-management support in managing cancer-related fatigue, one of the most prevalent symptoms experienced by cancer patients and survivors.
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Affiliation(s)
- Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
- Centre for IMPACCT, Faculty of Health, University of Technology, NSW, Sydney, 2007, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
- School of Psychology & Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
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Schoenberg P, Wulff-Burchfield E, Schlundt D, Bonnet K, Dietrich M, Murphy B. Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors. Cancers (Basel) 2024; 16:2106. [PMID: 38893225 PMCID: PMC11172150 DOI: 10.3390/cancers16112106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors' (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors' experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community.
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Affiliation(s)
- Poppy Schoenberg
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Mary Dietrich
- Department of Biostatistics, School of Nursing, Vanderbilt University, Nashville, TN 37240, USA
| | - Barbara Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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Li Y, Zhu K, Wang L, Zhang Y, Hou S, Wang W. Effectiveness of web-based intervention on reducing symptom burden, improving self-management capabilities and self-efficacy among prostate cancer survivors: a systematic review and meta-analysis protocol. BMJ Open 2024; 14:e082709. [PMID: 38821569 PMCID: PMC11149145 DOI: 10.1136/bmjopen-2023-082709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/22/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Prostate cancer is the most common malignant disease within the male genitourinary system. Advances in cancer screening and treatment have significantly ameliorated the survival rates of patients with prostate cancer. Nonetheless, prostate cancer survivors report various degrees of cancer-related symptoms. These symptoms cause physiological and psychological suffering, leading to a deterioration of quality of life. Web-based interventions may facilitate the management of symptoms due to their flexibility, accessibility and convenience. However, the efficacy of web-based interventions in reducing symptom burden remains to be confirmed. Consequently, this systematic review and meta-analysis aims to comprehensively synthesise existing evidence, evaluate the effectiveness of web-based interventions in reducing symptom burden among patients and furnish a reference for clinical practice. METHODS AND ANALYSIS This protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines. We will comprehensively search six databases (PubMed, Web of Science, Cochrane, Embase, CINAHL and PsycINFO) from their inception to March 2024 in order to identify clinical trials on the efficacy of web-based interventions for prostate cancer survivors. Two reviewers will independently conduct study selection, data extraction and quality assessment. The risk bias of included studies will be assessed using the Cochrane Risk of Bias Tool for randomised trials 2.0, and the strength of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) guideline. Meta-analysis will be performed using STATA V.16.0, and the effect size will be calculated using the standardised mean difference and its 95% CI. Heterogeneity will be assessed using Cochran's Q statics and inconsistency will be measured using the I2 statistics. Potential sources of bias will be evaluated. ETHICS AND DISSEMINATION Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference. PROSPERO REGISTRATION NUMBER CRD42023457718.
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Affiliation(s)
- Yaqin Li
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Keping Zhu
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lijuan Wang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Zhang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sijia Hou
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Wang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Song D, Bai Y, Liu Y, Li Y. Patterns and predictors of symptom burden and posttraumatic growth among patients with cancer: a latent profile analysis. Support Care Cancer 2024; 32:363. [PMID: 38758452 DOI: 10.1007/s00520-024-08577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/14/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE The study identified different patterns of symptom burden and posttraumatic growth (PTG) among patients with cancer and to explored the effects of sociodemographic, disease-related, and family resilience factors, which could provide reference for the development of personalized nursing measures. METHODS A questionnaire survey was conducted with 329 patients with cancer who were undergoing treatment. Latent profile analysis (LPA) was used to explore the patterns of symptom burden and PTG among patients with cancer, and multiple logistic regression analysis was used to explore the influencing factors of different patterns. RESULTS Based on the fit indicators of LPA, a three-class pattern model of posttraumatic responses was shown to be optimal, including resisting, struggling, and growth groups. In the resisting group (34.34%), patients reported low symptom burden and low PTG; in the struggling group (19.15%), patients showed a high symptom burden and moderate PTG; in the growth group (46.51%), patients showed low symptom burden and high PTG. Moreover, patients with cancer with high levels of family resilience were more likely to fall into the struggling and growth groups. Specifically, those with lower scores in the optimistic attitude and higher scores in the family and social support dimension of family resilience were more likely to fall into the struggling group, whereas those with lower scores in the transcendence and spiritual belief dimensions of family resilience were more likely to fall into the resisting group. Additionally, patients with at least three children were more likely to fall into the struggling group. CONCLUSIONS This study showed heterogeneity in symptom burden and PTG patterns among patients with cancer. Patients' growth must include both psychological growth and the mitigated symptom burden. Family factors may be intervention targets to improve the growth patterns.
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Affiliation(s)
- Dongyu Song
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yongfang Bai
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yuzhou Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuli Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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Voskanyan V, Marzorati C, Sala D, Grasso R, Pietrobon R, van der Heide I, Engelaar M, Bos N, Caraceni A, Couspel N, Ferrer M, Groenvold M, Kaasa S, Lombardo C, Sirven A, Vachon H, Velikova G, Brunelli C, Apolone G, Pravettoni G. Psychosocial factors associated with quality of life in cancer survivors: umbrella review. J Cancer Res Clin Oncol 2024; 150:249. [PMID: 38727730 PMCID: PMC11087342 DOI: 10.1007/s00432-024-05749-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/10/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Viktorya Voskanyan
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Diana Sala
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Iris van der Heide
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Merel Engelaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Nanne Bos
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Augusto Caraceni
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
| | | | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Mogens Groenvold
- Department of Public Health, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Claudio Lombardo
- OECI-EEIG Organisation of European Cancer Institutes-European Economic Interest Grouping, Brussels, Belgium
| | | | | | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Cinzia Brunelli
- Scientific Directorate, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Zhang Z, Lao J, Liu M, Zheng S, Zhao M, Zhang M. Symptom cluster among cancer survivors from a nationally representative survey: a network analysis. Support Care Cancer 2024; 32:333. [PMID: 38713314 DOI: 10.1007/s00520-024-08531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To identify the symptom cluster among cancer survivors and examine their subgroup differences via network analysis based on nationally representative data. METHODS This cross-sectional study included 2966 survivors participating in the 2020 National Health Interview Survey (NHIS). Participants self-reported the presence of 14 symptoms capturing four clusters (physical, somatic, sleep, and psychologic problems). Network analysis models were used to reveal the relationships between symptoms and those interactions. Network comparison tests were applied to compare subgroups. RESULTS The core symptoms of the symptom cluster were fatigue (Bet = 33, Clo = 0.0067, Str = 0.9397), pain (Bet = 11, Clo = 0.0060, Str = 0.9226), wake up well rested (Bet = 25, Clo = 0.0057, Str = 0.8491), and anxiety (Bet = 5, Clo = 0.0043, Str = 0.9697) among cancer survivors. The core symptoms, network structure, and global strength were invariant between time since diagnoses (< 2 years vs. ≥ 2 years) or between numbers of cancers (1 vs. ≥ 2), yet varied between the comorbidity group and non-comorbidity group (≥ 1 vs. 0). CONCLUSIONS Fatigue would be a potential target for alleviating other symptoms through a negative feedback loop of other related symptoms of cancer survivors. In particular, cancer survivors with other chronic diseases should be the focus of attention and strengthen targeted intervention.
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Affiliation(s)
- Zhen Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jiahui Lao
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Mingming Liu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Shenglong Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ming Zhao
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Min Zhang
- Department of Nursing, Qilu Hospital, Shandong University, Jinan, China.
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Zhang X, Wu Z, Wang X, Xin B, Hu P, Yin Y, He S, Ren M. Causal associations between dietary factors and colorectal cancer risk: a Mendelian randomization study. Front Nutr 2024; 11:1388732. [PMID: 38751740 PMCID: PMC11094808 DOI: 10.3389/fnut.2024.1388732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Background Previous epidemiological studies have found a link between colorectal cancer (CRC) and human dietary habits. However, the inherent limitations and inevitable confounding factors of the observational studies may lead to the inaccurate and doubtful results. The causality of dietary factors to CRC remains elusive. Methods We conducted two-sample Mendelian randomization (MR) analyses utilizing the data sets from the IEU Open GWAS project. The exposure datasets included alcoholic drinks per week, processed meat intake, beef intake, poultry intake, oily fish intake, non-oily fish intake, lamb/mutton intake, pork intake, cheese intake, bread intake, tea intake, coffee intake, cooked vegetable intake, cereal intake, fresh fruit intake, salad/raw vegetable intake, and dried fruit intake. In our MR analyses, the inverse variance weighted (IVW) method was employed as the primary analytical approach. The weighted median, MR-Egger, weighted mode, and simple mode were also applied to quality control. Heterogeneity and pleiotropic analyses were implemented to replenish the accuracy of the results. Results MR consequences revealed that alcoholic drinks per week [odds ratio (OR): 1.565, 95% confidence interval (CI): 1.068-2.293, p = 0.022], non-oily fish intake (OR: 0.286; 95% CI: 0.095-0.860; p = 0.026), fresh fruit intake (OR: 0.513; 95% CI: 0.273-0.964; p = 0.038), cereal intake (OR: 0.435; 95% CI: 0.253-0.476; p = 0.003) and dried fruit intake (OR: 0.522; 95% CI: 0.311-0.875; p = 0.014) was causally correlated with the risk of CRC. No other significant relationships were obtained. The sensitivity analyses proposed the absence of heterogeneity or pleiotropy, demonstrating the reliability of the MR results. Conclusion This study indicated that alcoholic drinks were associated with an increased risk of CRC, while non-oily fish intake, fresh fruit intake, cereal intake, and dried fruit were associated with a decreased risk of CRC. This study also indicated that other dietary factors included in this research were not associated with CRC. The current study is the first to establish the link between comprehensive diet-related factors and CRC at the genetic level, offering novel clues for interpreting the genetic etiology of CRC and replenishing new perspectives for the clinical practice of gastrointestinal disease prevention.
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Affiliation(s)
- Xu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
| | - Zhimeng Wu
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Xiangrui Wang
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Binglong Xin
- Shanxi Institute of Science and Technology, Jincheng, China
| | - Ping Hu
- Department of Surgery, Dangtu Central Health Center, Ma’anshan, China
| | - Yan Yin
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
| | - Mudan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Shannxi Clinical Research Center of Digestive Disease (Cancer Division), Xi’an, China
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Onyedibe MCC, Blickle P, Schmidt ME, Steindorf K. Posttraumatic growth and health-related quality of life in cancer survivors: Does fatigue moderate the link? Stress Health 2024; 40:e3299. [PMID: 37547957 DOI: 10.1002/smi.3299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
Interest in post-traumatic growth (PTG) as a predictor of health-related quality of life (HRQoL) is currently gaining attention. However, current evidence is still inconclusive on the nature of this relationship. The first objective of this study was to investigate the relationship between PTG and global HRQoL among cancer survivors. We further investigated the moderating role of fatigue in the association between PTG and global HRQoL. In the FiX study (Fatigue in Germany - Examination of prevalence, severity, and state of screening and treatment) cancer-related fatigue (EORTC QLQ-FA12), PTG inventory and global HRQoL (EORTC QLQ-C30) were assessed four years after cancer diagnosis in 1316 cancer-free survivors (mean age = 67.28, SD = 11.05, 51.4% female). Multiple linear regression analysis and moderation analysis were performed. The results showed that PTG had a convex quadratic relationship with global HRQoL (p < 0.001). Contrary to our hypothesis, fatigue did not moderate the relationship between PTG (linear and quadratic terms) and global HRQoL, neither when considering the overall PTG score nor for any PTG subdimension. In conclusion, PTG has a convex quadratic relationship with long-term global HRQoL that was not modified by persisting fatigue. Future statistical models investigating PTG and global HRQoL should take this non-linear relationship into account. Aiming to increase PTG might contribute to, but is likely not sufficient for high levels of global HRQoL in cancer survivors in the long run.
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Affiliation(s)
- Maria-Chidi C Onyedibe
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Patricia Blickle
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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Naeimabadi Z, Bana Derakhshan H, Rassouli M, Ebadi A. Health-related quality of life and related factors in patients with colorectal cancer in Iran: a systematic review. Ann Med Surg (Lond) 2024; 86:2088-2097. [PMID: 38576919 PMCID: PMC10990301 DOI: 10.1097/ms9.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/02/2023] [Indexed: 04/06/2024] Open
Abstract
Introduction This systematic review aims to examine the health-related quality of life (QOL) in Iranian patients with colorectal cancer (CRC) and its related factors. Methods A thorough, systematic search was conducted in different international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords such as "Colorectal neoplasm", "Colorectal tumors", "Colorectal cancer", "Quality of life", and "Life quality" from the earliest to 17 October 2022. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Results There were 820 CRC patients in the five cross-sectional studies that made up this systematic review. The mean score of QOL in patients with CRC was 61.99 (SD=15.87) out of 100 based on EORTC-QLQ-C30, which indicates a moderate to good level of QOL. Factors such as age, gender, living conditions, level of education, occupation, monthly income, health insurance, physical activity, performance status, and comorbidities had a significant relationship with QOL in patients with CRC. Conclusion In sum, the findings of the five studies that were a part of this systematic review revealed that Iranian patients with CRC had a moderate to good QOL. Therefore, managers and health policymakers can create psychological counseling programs with an emphasis on the factors affecting the QOL of patients in light of how crucial it is to raise patients' understanding of the long-term impacts of CRC and how they affect their QOL.
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Affiliation(s)
- Zahra Naeimabadi
- Student Research Committee, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Science
| | - Homayoon Bana Derakhshan
- Assistant Professor of Medical Education, Head of Anesthesia & Operating Room Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences
| | - Maryam Rassouli
- Professor, Cancer Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences
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Sandager MT, Rossen S, Hofland DT, Nielsen CV, Maribo T. Health-related quality of life, needs, and concerns among cancer survivors referred to rehabilitation in primary healthcare setting. Acta Oncol 2024; 63:76-82. [PMID: 38482717 PMCID: PMC11332470 DOI: 10.2340/1651-226x.2024.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND PURPOSE There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs. MATERIAL AND METHODS This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions 'what concerns you the most?' and 'what matters to you?' Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease. INTERPRETATION CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs' challenges.
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Affiliation(s)
- Mette T Sandager
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark.
| | - Dorte T Hofland
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Claus V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark; Social Medicine and Rehabilitation, Region Hospital Goedstrup, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark
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Jun HS, Lee K. Association Between Fear of Cancer Recurrence, Fatigue, and Healthy Lifestyle Behaviors Among Breast Cancer Survivors in South Korea. Cancer Nurs 2024; 47:E134-E141. [PMID: 36648326 DOI: 10.1097/ncc.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Improving healthy lifestyle behaviors in breast cancer survivors can promote their physical and mental health, thereby reducing the risk of cancer recurrence. Therefore, it is crucial to identify and control the factors affecting healthy lifestyle behaviors among breast cancer survivors. OBJECTIVE This study aimed to examine the effects of physiological, psychological, and situational factors and symptoms on healthy lifestyle behaviors in breast cancer survivors. METHODS Data were collected from August to September 2021, and a questionnaire was administered through an online breast cancer patient community's bulletin board. Finally, 162 questionnaires were included in the analysis. RESULTS The model was statistically significant, explaining 33.2% of the variance. A decrease in healthy lifestyle behaviors in breast cancer survivors was influenced by an age of 40 years or younger, 5 years or more since a breast cancer diagnosis, low income, fear of cancer recurrence, and fatigue. CONCLUSIONS Intervention strategies, such as easily accessible online content that accounts for age and survival period after cancer diagnosis, should be used to promote healthy lifestyle behaviors among breast cancer survivors. Healthcare providers should be given appropriate guidelines on managing patients' fear of cancer recurrence and reducing fatigue to ensure timely access to clinical interventions. Adequate financial support from local communities and governments is needed to promote healthy lifestyle behaviors. IMPLICATIONS FOR PRACTICE To improve breast cancer survivors' healthy lifestyle behaviors, an understanding of the influencing factors and a multidimensional approach are required. Nurses play a role in developing and implementing interventions to improve healthy lifestyle behaviors.
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Affiliation(s)
- Hye Suk Jun
- Author Affiliations: Department of Nursing, Hallym University, Kangdong Sacred Heart Hospital, South Korea (Dr Jun); and College of Nursing, Baekseok University, Cheonan, South Korea (Dr Lee)
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Hartup S, Briggs M. Managing chronic pain after breast cancer treatments: are web-based interventions the future? Curr Opin Support Palliat Care 2024; 18:47-54. [PMID: 38170201 DOI: 10.1097/spc.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF THE REVIEW Chronic post-treatment pain in breast cancer affects a high proportion of patients. Symptom burden and financial costs are increasingly impacting patients and healthcare systems because of improved treatments and survival rates. Supporting long-term breast cancer symptoms using novel methodology has been examined, yet few have explored the opportunity to utilise these interventions for prevention. This review aims to explore the need for, range of, and effectiveness of such interventions. RECENT FINDINGS Three papers describe risk factors for chronic pain, with six recent papers describing the use of interventions for acute pain in the surgical setting. The evidence for the effectiveness of these interventions to improve pain management in this setting is limited but tentatively positive. The results have to take into account the variation between systems and limited testing. SUMMARY Multiple types of intervention emerged and appear well accepted by patients. Most assessed short-term impact and did not evaluate for reduction in chronic pain. Such interventions require rigorous effectiveness testing to meet the growing needs of post-treatment pain in breast cancer. A detailed understanding of components of web-based interventions and their individual impact on acute pain and chronic pain is needed within future optimisation trials. Their effectiveness as preventative tools are yet to be decided.
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Affiliation(s)
- Sue Hartup
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Michelle Briggs
- Pain Research Institute, School of Health Sciences, Faculty of Health and Life Science University of Liverpool
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Choe YH, Lee S, Lim Y, Kim SH. Machine learning-derived model for predicting poor post-treatment quality of life in Korean cancer survivors. Support Care Cancer 2024; 32:143. [PMID: 38315224 DOI: 10.1007/s00520-024-08347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE A substantial number of cancer survivors have poor quality of life (QOL) even after completing cancer treatment. Thus, in this study, we used machine learning (ML) to develop predictive models for poor QOL in post-treatment cancer survivors in South Korea. METHODS This cross-sectional study used online survey data from 1,005 post-treatment cancer survivors in South Korea. The outcome variable was QOL, which was measured using the global QOL subscale of the European Organization of Cancer and Treatment for Cancer Quality of Life Questionnaire, where a global QOL score < 60.4 was defined as poor QOL. Three ML models (random forest (RF), support vector machine, and extreme gradient boosting) and three deep learning models were used to develop predictive models for poor QOL. Model performance regarding accuracy, area under the receiver operating characteristic curve, F1 score, precision, and recall was evaluated. The SHapely Additive exPlanation (SHAP) method was used to identify important features. RESULTS Of the 1,005 participants, 65.1% had poor QOL. Among the six models, the RF model had the best performance (accuracy = 0.85, F1 = 0.90). The SHAP method revealed that survivorship concerns (e.g., distress, pain, and fatigue) were the most important factors that affected poor QOL. CONCLUSIONS The ML-based prediction model developed to predict poor QOL in Korean post-treatment cancer survivors showed good accuracy. The ML model proposed in this study can be used to support clinical decision-making in identifying survivors at risk of poor QOL.
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Affiliation(s)
- Yu Hyeon Choe
- Department of Nursing, Inha University, Incheon, Republic of Korea
| | - Sujee Lee
- Department of Industrial and Information Systems Engineering, Soongsil University, Seoul, Republic of Korea
| | - Yooseok Lim
- Department of Industrial and Information Systems Engineering, Soongsil University, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Nursing, Inha University, Incheon, Republic of Korea.
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Salz T, Chimonas S, Jinna S, Brens J, Kriplani A, Salner A, Rabinowits G, Currier B, Daly B, Korenstein D. Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis. Pain Manag 2024; 14:87-99. [PMID: 38318666 PMCID: PMC10918509 DOI: 10.2217/pmt-2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of
Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, Department of
Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, Department of
Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Jessica Brens
- Memorial Sloan Kettering Cancer Center, Department of
Advanced Practice Providers, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of
Medicine, New York, NY 10065, USA
| | - Andrew Salner
- Hartford Hospital, Department of Radiation Oncology,
Hartford, CT 06106, USA
| | - Guilherme Rabinowits
- Moffit Cancer Center, Department of Head and
Neck-Endocrine Oncology, Tampa, FL 33612, USA
| | - Beatriz Currier
- Miami Cancer Institute, Department of Medicine,
Miami, FL 33176, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Department of
Medicine, New York, NY 10065, USA
| | - Deborah Korenstein
- Mount Sinai Hospital, Department of Internal
Medicine, New York, NY 10001, USA
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Levinsen AKG, Dalton SO, Thygesen LC, Jakobsen E, Gögenur I, Borre M, Zachariae R, Christiansen P, Laurberg S, Christensen P, Hölmich LR, Brown PDN, Johansen C, Kjær SK, van de Poll-Franse L, Kjaer TK. Cohort Profile: The Danish SEQUEL cohort. Int J Epidemiol 2024; 53:dyad189. [PMID: 38205845 DOI: 10.1093/ije/dyad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter de Nully Brown
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Cancer Late Effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lonneke van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Vande Vyvere T, De Groote A, De Groef A, Haenen V, Tjalma W, Van Dyck P, Meeus M. Morphological and functional brain changes in chronic cancer-related pain: A systematic review. Anat Rec (Hoboken) 2024; 307:285-297. [PMID: 36342941 DOI: 10.1002/ar.25113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to perform a systematic review of the available literature on morphological and functional brain changes measured by modern neuroimaging techniques in patients suffering from chronic cancer-related pain. A systematic search was conducted in PubMed, Embase, and Web of Science using different keyword combinations. In addition, a hand search was performed on the reference lists and several databases to retrieve supplementary primary studies. Eligible articles were assessed for methodological quality and risk of bias and reviewed by two independent researchers. The search yielded only four studies, three of which used MRI and one PET-CT. None of the studies measured longitudinal morphological (i.e., gray or white matter) changes. All studies investigated functional brain changes and found differences in specific brain regions and networks between patients with chronic cancer-related pain and pain-free cancer patients or healthy volunteers. Some of these alterations were found in brain networks that also show changes in non-cancer populations with chronic pain (e.g., the default mode network and salience network). However, specific findings were inconsistent, and there was substantial variation in imaging methodology, analysis, sample size, and study quality. There is a striking lack of research on morphological brain changes in patients with chronic cancer-related pain. Moreover, only a few studies investigated functional brain changes. In the retrieved studies, there is some evidence that alterations occur in brain networks also involved in other chronic non-cancer pain syndromes. However, the low sample sizes of the studies, finding inconsistencies, and methodological heterogeneity do not allow for robust conclusions.
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Affiliation(s)
- Thijs Vande Vyvere
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Amber De Groote
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - An De Groef
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wiebren Tjalma
- Department of Gynecological Oncology, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Wang J, Wang X, Ma T, Lu Y, Yan Z, Wang J, Hao Q. A visualization analysis of hotspots and global trends on pelvic floor dysfunction in cervical cancer. J Cancer Res Clin Oncol 2024; 150:54. [PMID: 38289495 PMCID: PMC10827841 DOI: 10.1007/s00432-023-05531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND/OBJECTIVE Cervical cancer is the major cause of cancer-related mortalities in women globally. It constitutes one of the life-threatening conditions for women in developing countries. The popularization of cervical cancer screening and the improvement of treatment levels has caused the mortality rate of cervical cancer to decrease gradually, but pelvic floor dysfunction before and after cervical cancer treatment has become prominent and attracted more and more attention. Bibliometric analysis has been carried out in this research. The main goal of this research is to provide a comprehensive insight into the knowledge structure and global research hotspots about pelvic floor dysfunction in cervical cancer. METHODS Literature related to cervical cancer and pelvic floor dysfunction as of May 2023 was searched on the Web of Science Core Collection (WOSCC). The visualization and bibliometric analyses of the number and contents of publications were performed to analyze the temporal trends, spatial distribution, collaborative networks, influential references, keyword co-occurrence, and clustering. RESULTS There were 870 publications from 74 countries or regions, with the U.S. publications in a leading position. Since 2020, the number of publications has rapidly increased with the emphasis on the quality of life of cervical cancer patients. Although pelvic floor dysfunction in cervical cancer mainly occurs in developing countries, developed countries have made great contributions to this disease. However, in developing countries such as China and India, the quality of publications needs to be improved. In this field, the studies focused on the sexual dysfunction or urinary incontinence of cervical cancer patients, and the most cited papers discussed the effect of cervical cancer treatment on the sexual activities of females. The frontier keywords were represented by pelvic radiotherapy and risk factors. CONCLUSION This study provides an objective and comprehensive analysis of the literature available on pelvic floor dysfunction in cervical cancer and identifies future trends and current hotspots. It can provide a valuable reference for researchers in this field.
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Affiliation(s)
- Jiawen Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Xinhao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Tianming Ma
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yu Lu
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200092, China
| | - Zehao Yan
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100005, China.
| | - Qiang Hao
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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Marker RJ, Wechsler S, Leach HJ. Cancer-related fatigue is associated with objective measures of physical function before and after a clinical exercise program: A retrospective analysis. REHABILITATION ONCOLOGY 2024; 42:31-38. [PMID: 38774708 PMCID: PMC11104554 DOI: 10.1097/01.reo.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Background:
Cancer-related fatigue (CRF) is a common symptom reported by survivors of cancer. CRF is associated with reduced self-reported physical function, but associations with objective measures of physical function are less robust. Exercise programs have been shown to improve both CRF and objective physical function, but the interaction of exercise, CRF, and function has not been explored.
Methods:
Retrospective data were collected from baseline (n = 420) and final assessments (n = 234) of survivors who participated in a 3-month clinical exercise program. Assessments included measures of CRF (Functional Assessment of Chronic Illness Therapy–Fatigue) and physical function (6-minute walk test, usual and fast gait speed, 30-second sit-to-stand test, and the Timed Up and Go test). Multiple regression analyses investigated associations between CRF and physical function before and after the program. CRF and functional changes following the program were calculated and associations investigated with multiple regressions.
Results:
All measures of CRF and physical function significantly improved following the program (P < .01). CRF was associated with all functional measures at baseline (standardized β = −0.18 to 0.29, P < .01) and final assessments (r = −0.27 to 0.26, P < .01). Changes in CRF were associated with changes in function (standardized β = −0.12 to 0.23, P < .05), except usual gait speed (P = .17).
Conclusion:
This investigation demonstrated associations between CRF and objective physical function before and after participation in an exercise program. The 3-way interaction between CRF, physical function, and exercise can be used clinically to personalize rehabilitation strategies. Future studies should investigate changes in CRF and function during an exercise program.
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Affiliation(s)
- Ryan J Marker
- Assistant Professor, Department of Physical Medicine and
Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Stephen Wechsler
- Post-Doctoral Research Fellow, Department of Occupational
Therapy, MGH Institute of Health Professions
| | - Heather J Leach
- Associate Professor, Department of Health and Exercise
Science, Colorado State University
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Brunet J, Hussien J, Pitman A, Wurz A, Conte E, Polskaia N, Seely D. Yoga Therapy as an Intervention to Improve Patient-Reported Outcomes Among Adults After Treatment for Cancer: Preliminary Findings From a Trial Using Single-Subject Experimental Design. Integr Cancer Ther 2024; 23:15347354241233517. [PMID: 38385326 PMCID: PMC10893844 DOI: 10.1177/15347354241233517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Cancer is a chronic condition associated with a substantial symptom burden, which can impair recovery after treatment. Investigating interventions with potential to improve self-reported disease and/or treatment effects-known as patient-reported outcomes (PROs)-is paramount to inform cancer care. The objective of this study was to evaluate the effects of a yoga therapy (YT) intervention on key PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life [QoL]) among adults after treatment for cancer. METHODS Data from 20 adults (Mage = 55.74 years, 85% female; Mtime since diagnosis = 2.83 years) who had completed treatment for cancer were analyzed for this study. In this single-subject exploratory experimental study, the YT intervention comprised a 1:1 YT session (ie, 1 participant with 1 yoga therapist) followed by 6 weekly small (ie, 2-3 participants) group YT sessions. Group sessions were facilitated by the same yoga therapist who delivered participants' 1:1 session to ensure an in-depth personalized approach. PROs were assessed before (ie, pre-intervention) and after the 1:1 YT session (ie, during the intervention), as well as after the last group YT session (ie, post-intervention). Hierarchical linear modeling was used to analyze the data. RESULTS Participants showed improvements in cancer-related fatigue, state anxiety, trait anxiety, perceived cognitive impairments, impacts of perceived cognitive impairments on QoL, and 1 dimension of QoL (ie, functional wellbeing) over time. Notably, cancer-related fatigue and state anxiety increased immediately after the 1:1 session, but showed greater improvements over time afterward (ie, during the intervention phase). No changes were observed for the remaining PROs. CONCLUSION Although results require confirmation in future trials, this study highlights the importance of continuing to investigate YT as an intervention to enhance important PROs (ie, cancer-related fatigue and state anxiety) after treatment for cancer. More research is needed to identify additional beneficial effects and factors that influence participants' responses to 1:1 and group YT (ie, moderators and mediators). REGISTRATION NUMBER ISRCTN64763228. DATE OF REGISTRATION December 12, 2021. This trial was registered retrospectively. URL OF TRIAL REGISTRY RECORD https://www.isrctn.com/ISRCTN64763228. PUBLISHED PROTOCOL Brunet, J., Wurz, A., Hussien, J., Pitman, A., Conte, E., Ennis, J. K., . . . & Seely, D. (2022). Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol. Integrative Cancer Therapies, 21, 15347354221075576.
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Affiliation(s)
- Jennifer Brunet
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Hôpital Montfort, Ottawa, ON, Canada
| | | | - Anne Pitman
- Centre for Health Innovation, Ottawa, ON, Canada
| | - Amanda Wurz
- University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ellen Conte
- Centre for Health Innovation, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Centre for Health Innovation, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
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50
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De Groef A, Van der Gucht E, Devoogdt N, Smeets A, Bernar K, Morlion B, Godderis L, De Vrieze T, Fieuws S, Meeus M, Dams L. Returning to Work After Breast Cancer Surgery: A Randomised Controlled Trial on the Effect of Pain Neuroscience Education. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:757-765. [PMID: 37171771 DOI: 10.1007/s10926-023-10103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of pain neuroscience education compared to biomedical pain education after breast cancer surgery on (1) work status, (2) time until work resumption, and (3) change in return-to-work expectations up to 18 months post-surgery. METHODS Participants were randomly assigned to either pain neuroscience education (intervention group) or biomedical pain education (control group) in addition to a standard physical therapy program after surgery for breast cancer. The first four months following surgery, one to two physiotherapy sessions and three educational sessions were scheduled. After, two educational sessions and two physiotherapy sessions were held at six and eight months postoperatively. All outcomes were assessed at four, six, eight, 12 and 18 months postoperatively. RESULTS At 12 months, in the intervention group, 71% of the women returned to work compared to 53% in the control group (18% points difference, 95%CI:-0.1 to 35;p = 0.07). At 18 months, the differences decreased to 9% points, 95%CI:-26 to 7;p = 0.35). Neither time until work resumption (p = 0.46) nor change in estimation of own ability to return to work up to 18 months postoperatively (p = 0.21) significantly differed between both groups. CONCLUSION No significant differences were found regarding return to work outcomes between women receiving pain neuroscience education versus biomedical pain education after breast cancer surgery. Further research is warranted to explore the potential role of pain neuroscience education in return-to-work interventions following breast cancer surgery.
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Affiliation(s)
- An De Groef
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
- Pain In Motion International research group. http://www.paininmotion.be, Antwerp, Belgium.
- Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, ON4 - Herestraat 49 - box 1510, Leuven, 3000, Belgium.
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Pain In Motion International research group. http://www.paininmotion.be, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Section Anaesthesiology and Algology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, University of Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Tessa De Vrieze
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, University of Leuven and University of Hasselt, Leuven, Belgium
| | - Mira Meeus
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Pain In Motion International research group. http://www.paininmotion.be, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lore Dams
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Pain In Motion International research group. http://www.paininmotion.be, Antwerp, Belgium
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