Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors

Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.

Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State

We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients' access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.

A Population-Based Feasibility Study of Occupation and Thoracic Malignancies in New Mexico

Background

Occupational exposures in mining and oil/gas extraction are known risk factors for thoracic malignancies (TMs). Given the relatively high proportion of these industries in New Mexico (NM), we conducted a feasibility study of adult lifetime occupational history among TM cases. We hypothesized a higher proportion of occupational TM in NM relative to the estimated national average of 10-14%.

Methods

We identified incident TM cases through the population-based New Mexico Tumor Registry (NMTR), from 2017-2018. Cases completed a telephone interview. An adjudication panel reviewed case histories and classified cancers as probable, possible, or non-occupational related, taking into account the presence, duration, and latency of exposures. We characterized recruitment and describe job titles and exposures among those with occupational TMs. We also compared the distributions of industry between those with and without occupational TM.

Results

The NMTR identified 400 eligible TM cases, 290 of which were available to be recruited (n=285 lung/bronchial cancer; n=5 mesotheliomas). Of the latter, 60% refused and 18% were deceased, 9% had invalid addresses, 11% were unable to be reached by telephone, and 3% were too ill to participate. The 43 cases who completed an interview held 236 jobs. A total of 33% of cases were classified as probable occupational TM and 5% as possible occupational TM.

Conclusions

High rates of early mortality and refusals were significant barriers to study participation. Nonetheless, the proportion of probable occupational TMs greatly exceeded the estimated national average, highlighting the need for further study of occupational TM in the state.

Combined oral contraceptive use before the first birth and epithelial ovarian cancer risk

Background:

Combined oral contraceptive (COC) use reduces epithelial ovarian cancer (EOC) risk. However, little is known about risk with COC use before the first full-term pregnancy (FFTP).

Methods:

This Canadian population-based case–control study (2001–2012) included 854 invasive cases/2139 controls aged ⩾40 years who were parous and had information on COC use. We estimated odds ratios (aORs) and 95% confidence intervals (CI) adjusted for study site, age, parity, breastfeeding, age at FFTP, familial breast/ovarian cancer, tubal ligation, and body mass.

Results:

Among parous women, per year of COC use exclusively before the FFTP was associated with a 9% risk reduction (95% CI=0.86–0.96). Results were similar for high-grade serous and endometrioid/clear cell EOC. In contrast, per year of use exclusively after the FFTP was not associated with risk (aOR=0.98, 95% CI=0.95–1.02).

Conclusions:

Combined oral contraceptive use before the FFTP may provide a risk reduction that remains for many years, informing possible prevention strategies.

Hormone Contraception before the First Birth and Ovarian Cancer Risk

Introduction: Combined oral contraceptive (OC) use strongly and consistently reduces the risk for epithelial ovarian cancer (EOC); longer durations of use and more recent use are associated with the strongest reductions in risk. However, it is unknown if exclusive OC use before the first birth is associated with a reduction in EOC risk many years later. Therefore, we investigated the risk for EOC among parous women associated with exclusive OC use before the first birth. Methods: From a population-based case-control study in Alberta and British Columbia, Canada, 2001–2011, we included 1144 invasive EOC cases and 2513 controls who were &gt;40 years at diagnosis/reference date. Participants reported OC use and all pregnancies via a telephone interview or self-administered questionnaire (in the early years of the study). Duration of OC use was evaluated as a continuous variable and by categories: non-users (never use or &lt;6 months of use), &lt;5, 5–&lt;10, &gt;10 years, unknown. Using logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CI), controlling for study site, age, parity, breastfeeding, first degree family history of breast/ovarian cancer, tubal ligation, and BMI. Results: OC use at any time during reproductive life was associated with a 42% reduced risk for EOC relative to non-users (aOR = 0.58, 95% CI, 0.49–0.69). Among parous women, each additional year of exclusive OC use before the first birth conferred an 11% risk reduction relative to non-users (aOR = 0.89 95% CI, 0.86–0.94, linear trend p-value &lt;0.01). Results were similar when we restricted to cases with high grade serous cancers (aOR = 0.90 95% CI, 0.84–0.95, linear trend p-value &lt;0.01) and for cases with endometrioid/clear cell cancer (aOR 0.88 95% CI, 0.80–0.95, linear trend p-value &lt; 0.01). Discussion: Among parous women, exclusive use of OCs before the first birth was associated with a strong reduction in EOC risk many years later. Because OCs stop ovulation, this reduced risk may be due to a reduction in lifetime ovulatory cycles. However, it is also possible that OC use at younger ages, before the first birth, represents a window of opportunity to have a substantial impact on reducing risk that remains for many years, informing possible prevention strategies.