Are rural Ohio Appalachia cancer survivors needs different than urban cancer survivors?

Introduction  

Limited information is available about rural cancer survivors’ needs and if they differ from urban cancer survivors.     

Use of fertility drugs in early-onset female cancer survivors—A Finnish register-based study on 8,929 survivors

Advances in multimodality cancer treatments have increased the risk of long-term complications in early-onset cancer survivors. For female cancer survivors, these include diminished reproductive function, often resulting in a narrowed fertile window. The aim of our study was to evaluate the use of fertility treatments in cancer survivors (aged 0–39 years at diagnosis) compared to siblings. Data from Finnish registers on cancer, birth and prescribed medications were merged to identify 8,929 survivors and 9,495 siblings without previous deliveries. Fertility drug purchases from 1993 to 2012 at the age of 16–41 years were included. A Poisson regression model was used to estimate incidence rate ratios (IRRs) for the use of fertility drugs, adjusting for age and calendar time at fertility drug purchase. Fertility treatments were more common in survivors compared to siblings, as 6.1% of survivors compared to 3.8% of siblings had bought fertility drugs (IRR 1.43, 95% confidence interval [CI] 1.25–1.65). A subclassification of fertility treatments into ovulation inductions and assisted reproductive technology (ART), showed increased use of ART (IRR 2.41, 95% CI 1.97–2.96), whereas the use of ovulation induction was similar in survivors and siblings. Analyses by calendar time periods showed the use of ART to be significantly higher in the most recent decade, from 2003 onwards. We conclude that cancer survivors have an increased risk for subfertility, which is why fertility counseling is important. However, our results mirror a more active approach among clinicians towards fertility treatments in cancer survivors during the most recent years.     

Who are the breast cancer survivors in Malaysia?

Introduction: Worldwide, breast cancer is the commonest cause of cancer death in women. However, thesurvival rate varies across regions at averages of 73%and 57% in the developed and developing countries,respectively. Objective: This study aimed to determine the survival rate of breast cancer among the women ofMalaysia and characteristics of the survivors. Method: A retrospective cohort study was conducted on secondarydata obtained from the Breast Cancer Registry and medical records of breast cancer patients admitted toHospital Kuala Lumpur from 2005 to 2009. Survival data were validated with National Birth and Death Registry.Statistical analysis applied logistic regression, the Cox proportional hazard model, the Kaplan-Meier methodand log rank test. Results: A total of 868 women were diagnosed with breast cancer between January 2005 andDecember 2009, comprising 58%, 25% and 17% Malays, Chinese and Indians, respectively. The overall survivalrate was 43.5% (CI 0.573-0.597), with Chinese, Indians and Malays having 5 year survival rates of 48.2% (CI0.444-0.520), 47.2% (CI 0.432-0.512) and 39.7% (CI 0.373-0.421), respectively (p<0.05). The survival rate waslower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese(36%) and Indians (34%). Size of tumor>3.0cm; lymph node involvement, ERPR, and HER 2 status, delayedpresentation and involvement of both breasts were among other factors that were associated with poor survival.Conclusions: The overall survival rate of Malaysian women with breast cancer was lower than the westernfigures with Malays having the lowest because they presented at late stage, after a long duration of symptoms,had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on whythere is delay in diagnosis and treatment of breast cancer women in Malaysia.     

Does psychological adjustment of melanoma survivors differs between genders?

Objective: Survival rates of cancer have significantly increased. However, cancer survivors face physical, psychological and social difficulties, while adjusting to post‐illness status. We examined between‐gender differences in the psychological adjustment (mental well‐being, distress and subjective level of functioning), the putative origin of those differences, and the roles of cognitive appraisal, hardiness and attachment style in the psychological adjustment of melanoma survivors. Methods: Our sample included 300 malignant melanoma survivors (182 women and 118 men). Most were diagnosed in stages IA and IB of the disease, and had no evidence of disease for 5 years or more. Participants completed self‐report questionnaires regarding personal data, adjustment measured by sense of well‐being, distress and subjective functioning, cognitive appraisal (primary and secondary) and personal resources (hardiness and attachment style). Results: Between‐gender differences were revealed in psychological adjustment and in various components of cognitive appraisal and attachment styles. Women revealed more distress, less secondary cognitive appraisal and were more secure in attachment styles. Men showed higher secondary appraisal and were more dismissing‐avoidant in attachment. No between‐group differences were found in mental well‐being, subjective functioning, and primary cognitive appraisal or in the global measure of hardiness. Conclusions: We present social processes that seem to account for gender differences in behavior and response to stress, and psychological explanations for these findings. This study contributes to the field of psycho‐oncology by identifying factors that promote adjustment among melanoma survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Mortality is persistently increased in Hodgkin’s lymphoma survivors

BackgroundNegative health outcomes of chronic fatigue (CF) in disease-free cancer survivors are mainly unexplored. Aims of this study were to examine mortality and causes of death in Hodgkin’s lymphoma survivors (HLSs) compared to controls from the general population, and to explore if CF was associated with increased mortality.MethodsHLSs (n = 557) invited to participate in a survey on late effects in 1994 were divided into three groups: participants without CF (n = 329), participants with CF (n = 113), non-participants (n = 98). Controls matched for gender and age were drawn from the general population (five per HLSs, n = 2785). Observation time was calculated from 1st January 1994 until date of death or cut-off at 1st January 2007. Kaplan–Meier plots were used for univariate analyses and Cox models for multiple covariates.ResultsCompared to controls HLSs had nearly five times higher mortality (HR = 4.93; 95% confidence interval [CI]: 3.91–6.21) and the mortality rate of HLSs was higher than the rate of their controls for the entire observation period. Mortality was increased in all groups: participants with CF: HR = 4.85 (95% CI: 3.02–7.77), participants without CF: HR = 4.35 (95% CI: 3.16–6.00), non-participants: HR = 9.45 (95% CI: 5.44–16.41).Compared to the controls HLSs had over six times increased mortality of cancer (HR: 6.6, 95% CI: 4.7–9.2) and almost five times increased mortality of cardiovascular diseases (HR: 4.9, 95% CI: 3.1–7.9).ConclusionsHLSs had almost five-time increased mortality compared to controls. CF was not associated with increased mortality rate. The high mortality among the non-participating HLSs indicates that serious health problems are underestimated in this group. This has implications for the interpretation of surveys in cancer survivors.     

Second cancer among long-term survivors from Hodgkin’s disease

Purpose: There are limited data on the frequency of second cancer among long-term survivors from Hodgkin’s disease. The aim of this study was to determine the frequencies of second cancers, and their locations with respect to radiotherapy portals.Methods and Materials: Medical records of 202 consecutive patients who survived at least for 5 years after treatment for Hodgkin’s disease, and who were treated with radiotherapy in Helsinki University Central Hospital between 1970 and 1979, were reviewed. Survival data were collected also from the Finnish Cancer Registry and records of other hospitals. The median follow-up time of the patients still alive was 22 years (range, from 13 to 26). All patients received radiotherapy; in addition, 65 patients received MOPP and 3 received MOPP and ABVD.Results: During the follow-up consisting of 4020 person-years, 27 patients developed a second cancer. The cumulative risk for a second cancer was 17% (95% CI, from 10.4 to 23.1 %) at 20 years after the diagnosis of Hodgkin’s disease. Of the 26, 20 (77%) solid second cancers were found within or adjoining the irradiated fields, and the 20-year cumulative risk for a second cancer within the irradiated fields was 12% (6.3–17.5%). The most common second cancers were lung (n = 7) and breast (n = 4) cancer. In a multivariate analysis, predictive factors for a second cancer were: age at diagnosis greater than the median (30 years, relative risk, 3.97, 1.6–12.5), treatment for recurrent lymphoma (RR, 2.75, 1.3–6.7) and primary treatment without splenectomy (RR 4.31, 1.7–11.0). However, portal size and inclusion of chemotherapy as part of the primary treatment were not significantly associated with second cancer in a univariate analysis.Conclusion: Patients treated with radiotherapy for Hodgkin’s disease have a considerable risk for a second cancer in long-term follow-up. The majority of second cancers arise within or next to the irradiated portals, and particular attention should be paid to the irradiated sites in posttreatment follow-up.     

Physical exercise and return to work: cancer survivors’ experiences

Purpose

In this qualitative study, we aimed to explore cancer survivors’ experiences with (1) return to work (RtW) and work performance, (2) a physical exercise program after treatment, and (3) the perceived link between physical exercise and work.

Methods

Semi-structured individual interviews were held with ten cancer survivors of working age who had been treated with chemotherapy and had afterwards completed a group-based supervised physical exercise program. The interviews were audio-taped and transcribed verbatim. MaxQDA was used for coding and analysis. A second assessor was involved in coding two of the interviews.

Results

Eight participants returned to work. Most said that they had suffered cognitive deficits that impaired their work performance. According to half of the participants, the support in RtW from their occupational physician had been insufficient. Overall, the majority of participants enjoyed the exercise program. The main perceived effects were “improved fitness” and “renewed energy.” Most participants thought that physical exercise had likely contributed to their ability to return to work, primarily by increasing energy levels. Some believed that physical exercise had enhanced their work performance by improving their ability to cope with demanding work. Some respondents found that a supportive work environment stimulated their continuation of physical exercise.

Conclusions

Cancer survivors experienced a positive influence of physical exercise on RtW and work performance and a positive influence of RtW on physical exercise. By stimulating and facilitating physical exercise during and after RtW, the time to lasting RtW may be shortened, work performance may be optimized, and sustained participation in physical exercise may be achieved.

Implications for Cancer Survivors

Stimulating and facilitating physical exercise before and during the process of RtW may enhance fitness and energy levels and may lower fatigue and cognitive symptoms during work. An integrated rehabilitation strategy combining physical exercise and adequate support in RtW may shorten the time to lasting RtW, improve work performance, and lead to sustained participation in physical exercise. Ultimately, this strategy may improve cancer survivors’ quality of life.     

Ovarian cancer survivors’ quality of life: a systematic review

Purpose

The assessment of quality of life (QOL) among ovarian cancer (OC) patients has mainly focused on the acute phase of treatment. This systematic review examines studies measuring QOL in patients who survived OC after treatment and synthesizes results in order to assess QOL and patient-reported outcome (PRO) data at long-term follow-up.

Methods

Articles published in English between 1990 to November 2014 were identified with the databases MEDLINE and PubMed, using the specific keywords “OC survivors” combined with the terms, “QOL,” “health-related QOL,” and “PROs.” Data were reviewed for design, time since end of treatment, measurement tools, and outcomes (categorized in three topics: global QOL compared to controls, treatment sequelae, and intervention strategies).

Results

The initial search strategy provided 148 articles of which 31 were considered eligible. Most studies focused on epithelial OC, and only a few studies investigated survivors of ovarian germ cell tumor. More than 60 instruments of QOL measures were used in the corpus. Despite the persistence of psychological and physical symptoms, treatment sequelae, sexual problems, and fear of recurrence in some survivors, most studies demonstrated that OC survivors generally have good QOL compared to healthy women. Studies proposing interventions are lacking.

Conclusions and Implications for Cancer Survivor

OC survivors experience a wide range of sequelae that may persist for a long time and negatively impact QOL. Further large-scale research is needed to fully understand problems that have significant effects on QOL, in order to develop interventions and treatments suitable for women at need.

     

Adult survivors of childhood cancers’ identity disclosures in the workplace

Purpose

Recent medical advances have resulted in unprecedented increases in the number and vitality of employed adult survivors. These survivors must make decisions about whether or not to disclose their identities to others. The purpose of this study was to examine the characteristics that are related to cancer survivorship disclosure in workplace settings (perceived organizational support, centrality of survivorship to one’s self-concept, and the degree to which family and friends know about one’s survivor status) and an important organizational consequence: intentions to leave one’s job.

Methods

A total of 151 adult survivors of childhood cancer completed an online survey.

Results

Extent of disclosure of one’s identity as a cancer survivor was negatively associated with turnover intentions. Furthermore, organizational support, identity centrality, and disclosure outside of work were all related to disclosure in the workplace. Relative weight analysis revealed that disclosure outside of work was the most strongly related to disclosure at work. Finally, there were indirect relations such that disclosure mediated the relations among organizational support, identity centrality, and disclosure outside of work and turnover intentions.

Conclusions

Survivors who were more open about their cancer survivor status at work had fewer intentions to leave their organizations. Importantly, although some antecedents to disclosure were personal characteristics, organizations can also encourage identity disclosure demonstrating that they are related to of work retention.

Implications for Cancer Survivors

While disclosure in the workplace is a complex decision to make, the relationship with work retention may reflect that disclosure is more likely to occur in an existing positive work environment or that disclosure itself may contribute to a positive work environment where employees tend to remain. The specific factors that trigger both disclosure and retention require further study although they are clearly related.

     

Long-term survivors of childhood cancers: what knowledge have we gained?

Currently, in the US and Western Europe about 75% of children diagnosed with cancer survive at least 5 years and most survivors are cured. Unfortunately, survivors are at an increased risk of a range of adverse health outcomes compared with that expected from the general population. Large-scale studies of mortality occurring beyond 5-year survival show that the majority of the deaths in the initial decade are because of recurrent tumors. Thereafter, other causes of death that occur increasingly including second malignant neoplasms, cardiac deaths and pulmonary deaths. During the past 25 years, research has focused on estimating the risks of such long-term 'effects' of childhood cancer and its treatment. Studies have examined how risks vary in relation to a range of factors that include treatment exposures, age at treatment, type of childhood cancer, duration of follow-up, and factors that may genetically predispose a survivor to particular complications. This information is critical to counsel survivors and their families in relation to long-term risks and identify specific groups of survivors who are at particularly high risk--with a view to earlier diagnosis or intervention and provide the means of assessing potential benefits and risks of different proposals for future treatment protocols.     

What do cancer survivors believe causes cancer? (United States)

Objective: To describe cancer survivors beliefs about the causes of prostate, colorectal or breast cancers.Methods: A survey of beliefs about cancer causation was completed by 670 cancer survivors (416 with breast cancer, 165 with prostate cancer and 89 with colorectal cancer) enrolled in a population-based study in Colorado. Categorical analysis was used to describe associations between participants beliefs about the cause of their cancer type, both in themselves and in others, and personal characteristics, including gender, age, and familial cancer risk.Results: Cancer survivors most frequently reported genetic factors, smoking, environmental factors (e.g., pollutants or occupation), and psychosocial factors (e.g., stress) as causing their type of cancer. Respondents underestimated the importance of behavioral factors that are known to be associated with increased cancer risk, such as obesity and physical inactivity, while overestimating the importance of stress and environmental pollution.Conclusions: Cancer survivors beliefs about what causes cancer are substantially different than those of experts. Because those affected by cancer should be well informed about the causes of cancer, educational efforts are needed, especially regarding the importance of factors that can be modified to reduce cancer risk.     

Breast and colorectal cancer survivors’ knowledge about their diagnosis and treatment

Introduction  

Aspects of a personal cancer history can have implications for future decisions regarding screening, diagnosis, and treatment. Clinicians must sometimes rely on patients’ self-report of their medical history. This study assessed knowledge of details of cancer diagnosis and treatment among breast and colorectal cancer survivors.     

Health status of older cancer survivors—results of the PolSenior study

Purpose

The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study.

Methods

We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors.

Results

There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4?±?8.2 years and the median time since cancer diagnosis was 8.5 years (Q1–Q3: 4–16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR?=?1.38; 95% CI: 1.04–1.83), and to report poor health (OR?=?1.49; 95%CI: 1.83–2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p?<?0.001).

Conclusions

Cancer survivors over the age of 65 years have a higher prevalence of falls, are more likely to report poor health status, and have a higher number of chronic conditions than the non-cancer population, but they maintain independence in IADLs. Advanced age and elementary education are associated with increased occurrence of functional impairments in older cancer survivors

Implications for cancer survivors

Older cancer survivors may require preventive services to reduce the risk of functional decline.

     

Are cancer survivors well‐performing workers? A systematic review

Cancer, its therapy, and related adverse effects have been associated with reduced work performance, including absenteeism (i.e. absence from scheduled work due to health problems) and presenteeism (i.e. impaired on‐the‐job performance due to health problems) among cancer survivors. This review aimed to compare the work performance of employed cancer survivors with that of cancer‐free controls, and to examine factors related to the impairment of work performance. The findings from this review could bring about suggestions for clinical interventions aimed at improving survivors’ work performance. Literature searches on cancer survivors’ work performance were conducted in three electronic databases (MEDLINE, CINAHL and PsycINFO). Twenty‐six studies were identified. Most studies comprised survivors of breast, prostate, testicular and gastrointestinal cancer. Although survivors diagnosed within 5 years reported more absenteeism than did controls in the studies, there was no difference between controls and survivors diagnosed >5 years earlier. Survivors diagnosed within 5 years also reported more presenteeism than did controls. Many studies reported that the complications related to cancer and its therapy (e.g. fatigue and depression) were associated with presenteeism. A multifaceted intervention for the various factors identified in this review would contribute towards improved work performance among employed cancer survivors.