Health status and adaptation among long-term cervical cancer survivors

ObjectivesThis study assesses health and adaptation among long-term survivors of cervical cancer. Little research has been published on women who have survived over ten years after diagnosis of this disease. Both clinicians and patients can benefit from increased information on the likelihood of chronic and late effects of cervical cancer across the life course of survivors.Materials and methodsThe investigators interviewed 208 individuals six years or more post-invasive cervical cancer diagnosis from the Connecticut Tumor Registry. Cervical cancer survivors were compared with women from the general population interviewed in the Connecticut Behavioral Risk Factor Survey (BRFS). Measures of health status and adaptation were compared across successive categories of survival time, including self-assessment of general health according to an item from the MOS-36, days of ill health in past month, and days in past month in which activity was limited by physical or mental health.ResultsNo differences were detected in self-reported general health status between cervical cancer survivors and BRFS controls. But cervical cancer survivors more often reported days of illness and days in which their activities were limited by illness during the month prior to interview. No differences were detected in employment, marital status, or health insurance coverage. No statistically significant differences were detected across survival time categories.ConclusionsA high level of adaptation appears to prevail among cervical cancer survivors. Late effects on health status are not evident. However, the possibility that specific subgroups may experience particularly severe challenges should not be ignored and future research should help identify these subgroups.     

Obstetric complications at time of delivery amongst breast cancer survivors: A population-based cohort study

PurposeOur aim was to determine whether breast cancer survivors are at increased risk of obstetric and maternal complications at time of delivery.MethodsThe USA ‘National Inpatient Sample’ database was queried for hospitalizations associated with deliveries, between 2015 and 2018. The incidence of maternal and fetal complications was compared between women with, and without, a personal history of breast cancer.ResultsOf the 2,103,216 birth related admissions, 617 (0.03%) of the women were breast cancer survivors, with the proportion increasing over time (from 0.02% in 2015 to 0.04% in 2018). Breast cancer survivors had a higher socioeconomic status (p < 0.001) and were significantly older compared to other mothers (34 vs. 28 years, p < 0.001). Additionally, they were more likely to suffer from preexisting chronic diseases including cardiopulmonary disease and diabetes mellitus, and had a higher incidence of multiple gestation (4.4% vs. 1.6%) [OR 2.7, 95% CI 1.9–4.0, p < 0.001]. The incidence of acute adverse events at time of delivery including fetal distress, preterm labor, cesarean section and maternal infection was higher amongst the breast cancer survivors. On multivariate analysis age, ethnic group, comorbidities, multiple gestations, and a previous breast cancer diagnosis, but not cancer treatment, were associated with an increased risk of an obstetric adverse event.ConclusionBreast cancer survivors have more comorbidities and are at increased risk of acute obstetrical complications at time of delivery. Further studies are required to validate these findings, and evaluate the ability of interventions to improve obstetrical outcomes amongst breast cancer survivors.     

Supportive care after curative treatment for breast cancer (survivorship care): Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed.As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources.Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.     

Aromatase inhibitors use and risk for cardiovascular disease in breast cancer patients: A population-based cohort study

BackgroundPrior studies regarding use of Aromatase inhibitors (AIs) and risk for cardiovascular disease (CVD) have shown conflicting results. This retrospective cohort study aimed to investigate whether AIs use affects risk for CVD events in postmenopausal breast cancer survivors.MethodsUsing a retrospective cohort study design, four CVD outcomes; heart failure or cardiomyopathy, arrhythmia, acute ischemic heart disease and ischemic stroke or Transient Ischemic Attack were compared with uni- and multivariate Cox regression analyses according to exposure to endocrine therapy (use of AI, tamoxifen or AI/tamoxifen sequentially) or no endocrine therapy.ResultsIn total 15815 postmenopausal women, surgically treated to early breast cancer during 2006–2012, were included. No significantly increased risk for CVD events was observed in patients with AI use in the whole cohort. However, two subgroup analyses showed increased risk for CVD events in the AI/tamoxifen sequential group; heart failure in patients older than 75 years (Hazard Ratio (HR) 2.44; 95% Confidence Interval (CI): 1.32–4.54) and arrhythmia in patients without prior CVD (HR 1.45; 95% CI: 1.01–2.10). An increased risk for arrhythmia and acute ischemic heart disease in patients with at least four years of AI treatment compared with no or short-time exposure was observed (HR 2.12; 95% CI: 1.40–3.25 for arrhythmia; HR 2.03; 95% CI: 1.15–3.58 for ischemic heart disease).ConclusionOur results indicate an increased risk for ischemic heart disease and arrhythmia in patients treated for more than four years with AIs. This should be considered in the risk-benefit assessment concerning endocrine therapy.     

Survivorship and clinical outcomes of total elbow arthroplasty using the Zimmer Nexel Elbow system

BackgroundTotal elbow arthroplasty (TEA) is a treatment option for patients with rheumatoid arthritis, post-traumatic arthritis, or distal humerus fracture. The objective of this study was to evaluate the clinical, functional, and radiographic outcomes of the semiconstrained Nexel Total Elbow (Nexel) at a single center.MethodsThis is a retrospective case series of consecutive Nexel TEA procedures at a single center between 2014 and 2019. Of the 21 TEAs, 18 were alive and asked to return to the clinic to complete a physical exam, radiographs, the Mayo Elbow Performance Score, Quick Disabilities of the Arm, Shoulder, and Hand, and EuroQol 5D. Patients who could not return in person were offered a remote participation option. Outcomes included the following: implant survival, surgical complications, reoperation for any reason, radiographic assessment to identify loosening and bushing wear, and mean scores on patient-reported outcomes.ResultsThere were 11 TEA procedures who responded (61%), with eight returning to the clinic and three remote participants. The mean follow-up was 53.3 months (28-89 months). None of the TEAs were revised or reoperated on for any reason; the survival rate was 100%. One TEA (13%) had radiographic evidence of loosening, limited to the humeral component. There was no evidence of bushing wear. One TEA experienced ulnar nerve neuropraxia postoperatively, without permanent dysfunction (13%). The majority of patients reported satisfactory outcomes as measured by the Mayo Elbow Performance Score (73%), with a mean score of 90 (standard deviation [sd] = 13). On average, patients reported minimal disability on the Quick Disabilities of the Arm, Shoulder, and Hand (mean = 29, sd = 23) and relatively high health-related quality of life (EuroQol 5D, mean = 0.83, sd = 0.08).ConclusionsClinical and radiographic results of the Nexel TEA, a semiconstrained implant, were favorable. In contrast to the high complication rate and concerning radiographic findings reported previously, the current study reports 100% implant survival, with revision or indication for revision as the endpoint, and low rates of complications with an average of 53 months of follow-up. Bushing wear was not identified as a problem in this series; however, loosening of the humeral component may emerge as an indication for revision. More studies on the Nexel TEA are needed to better understand clinical and radiographic outcomes.     

Survivorship care after breast cancer treatment--experiences and preferences of Australian women

Follow-up care after breast cancer treatment is becoming more complex as it attempts to address the long-term needs of an increasing number of survivors. Workforce issues in oncology challenge the sustainability of current specialist-based care. This study explores survivors’ experiences with follow-up care and attitudes to alternative models including a tailored survivorship care plan and involvement of primary care physicians and breast care nurses.Twenty women across Australia participated in semi-structured telephone interviews. All continued to attend follow-up visits with a specialist oncologist and reported a high level of satisfaction with care. Participants described a strong reliance on their specialist but were open to an increased role for their primary care physician in a shared model of care. Communication between multidisciplinary team members was perceived as an ongoing problem and there was enthusiasm for a patient-held written survivorship care plan to address this, and to meet information needs.     

Preparing professional staff to care for cancer survivors

Introduction Oncology health care professionals frequently lack the background to implement needed survivorship activities and follow-up care. The purpose of this project is to assist providers in the clarification and initiation of potentially durable changes in survivorship care by developing a health professional curriculum, recruiting participants, implementing the course, conducting course evaluation and following participants’ defined goals over time. Materials and methods The curriculum was developed based on recommendations from the Institute of Medicine Report-From Cancer Patient to Cancer Survivor—Lost in Transition. Three concepts were used to structure the course: cancer survivorship quality of life, changing practice via performance improvement, and principles of adult education. Expert faculty designed and implemented the curriculum and teaching methods using adult learning principles and an interactive approach. Competitively-selected, two-person interdisciplinary teams for the first course (July 12–15, 2006, Pasadena, California) were selected based on stated interests, three projected goals, and letters of commitment from administrators. Results Participants represented 52 cancer care settings from 28 states. Teams included Nurses (48.1%), Social Workers (20.7%), Physicians (18.8%), Directors/Administrators (6.6%), Psychologists (2.8%), and others (3%). The institutional barriers identified by teams were lack of survivorship knowledge (94 %), financial constraints (61%), lack of administrative support (6%), and staff philosophy that excluded survivorship (15%). Evaluation of content from the first course was consistently positive. Conclusions Dissemination of survivorship education for health care professionals stimulates participants to define and begin to implement goals for improving survivors’ care. Implications for cancer survivors A training program such as the one described provides professional knowledge regarding survivorship that has the potential to facilitate change in the health care that cancer survivors receive thus ideally improving long term health and well being.     

The contextual model of HRQoL: A paradigm for expanding the HRQoL framework

Cancer is the second leading cause of death in most US populations. Unfortunately, ethnic minority status is associated with increased later stage at diagnosis, greater incidence for many cancer sites, differential treatments, greater mortality and morbidity. The government and public health focus on health disparities, evident in several documents including Healthy People 2010, Unequal Treatment and the Nations Investment in Cancer Research, are spurring interest in research with ethnic minority populations. Research investigating the health-related quality of life (HRQoL) among ethnic minority cancer survivors is new and growing. However, there is a dearth of research that addresses theoretical frameworks in cross cultural research. In conducting research with diverse populations, appropriate theoretical grounding that is responsive to cultural and socioecological contexts must be considered. This paper will discuss the contextual model of HRQoL, a comprehensive framework developed to expand the traditional HRQoL framework to facilitate culturally and socioecologically responsive research. This model may provide a more comprehensive theoretical framework to investigate certain areas of health disparities and risk factors for poor outcomes in HRQoL research with cancer survivors.     

Challenges associated with longitudinal survivorship research: attrition and a novel approach of reenrollment in a 6-year follow-up study of older breast cancer survivors

Introduction  Breast cancer is the most common type of cancer among older women. The vast majority of women with breast cancer become long-term survivors. Methods  We selected a convenience sample of women with: (1) stage I–IIIa disease, (2) age 65-years or older, and (3) permission from physician to contact. Data were collected over 6-years of follow-up from consenting patients’ medical records, telephone interviews, and the National Death Index. Before year 4 of follow-up we attempted to relocate women lost to follow-up using a single protocol and when successful, invited them to reenroll in the study. In this secondary data-analysis, baseline characteristics were compared among subjects with continuous follow-up, those who reenrolled, died, or were lost to follow-up. Results  Among 660 subjects, 177 had complete follow-up, 182 reenrolled after a period of non-participation, 171 died, and 130 were lost to follow-up. No important differences were found between reenrolled women and those with continuous follow-up or those lost to follow-up. There were nominal differences in age and comorbidity among women lost to follow-up compared to those with complete follow-up. Discussion/Conclusions  This study highlights challenges in longitudinal research of cancer survivorship, specifically the potential benefit of reenrollment. Implications for cancer survivors  Our findings provide a novel and promising approach to surmount some of the challenges in longitudinal research aimed at enhancing knowledge and the overall cancer survivorship experience of older adults.