Medicine › Oncology

Cancer survivorship and care

Works Count: 52062

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Description

This cluster of papers focuses on the quality of life, survivorship, and psychosocial aspects of individuals who have undergone cancer treatment. It includes research on patient-reported outcomes, depression, anxiety, physical activity, symptom management, and the impact of cancer on various aspects of well-being.

Keywords

Cancer Survivorship; Quality of Life; Patient-Reported Outcomes; Depression; Anxiety; Physical Activity; Psychosocial Interventions; Symptom Management; Health-related Quality of Life; Fatigue

Depression as a predictor of disease progression and mortality in cancer patients

2009-09-14

Jillian R. Satin , Wolfgang Linden , Melanie Phillips

Abstract BACKGROUND: Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta‐analysis assessed the extent to which depressive symptoms and … Abstract BACKGROUND: Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta‐analysis assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients. METHODS: Using the MEDLINE, PsycINFO, CINAHL, and EMBASE online databases, the authors identified prospective studies that examined the association between depressive symptoms or major/minor depression and risk of disease progression or mortality in cancer patients. Two raters independently extracted effect sizes using a random effects model. RESULTS: Based on 3 available studies, depressive symptoms were not shown to significantly predict cancer progression (risk ratio [RR] unadjusted = 1.23; 95% confidence interval [CI], 0.85‐1.77; P = .28). Based on data from 25 independent studies, mortality rates were up to 25% higher in patients experiencing depressive symptoms (RR unadjusted = 1.25; 95% CI, 1.12‐1.40; P < .001), and up to 39% higher in patients diagnosed with major or minor depression (RR unadjusted = 1.39; 95% CI, 1.10‐1.89; P = .03). In support of a causal interpretation of results, there was no evidence that adjusting for known clinical prognostic factors diminished the effect of depression on mortality in cancer patients. CONCLUSIONS: This meta‐analysis presented reasonable evidence that depression predicts mortality, but not progression, in cancer patients. The associated risk was statistically significant but relatively small. The effect of depression remains after adjustment for clinical prognosticators, suggesting that depression may play a causal role. Recommendations were made for future research to more clearly examine the effect of depression on cancer outcomes. Cancer 2009. © 2009 American Cancer Society.

Rapid screening for psychologic distress in men with prostate carcinoma

1998-05-15

Andrew Roth , Alice B. Kornblith , Laure Batel-Copel +3 more

BACKGROUND As more oncology care is moved to the outpatient setting, the need for a rapid means for oncologists to identify patients with significant distress has increased. Concurrent with this … BACKGROUND As more oncology care is moved to the outpatient setting, the need for a rapid means for oncologists to identify patients with significant distress has increased. Concurrent with this move has been the pressure to reduce time spent with each patient, adding to the likelihood that a distressed patient will not be recognized and will remain untreated in the current health care environment. METHODS A pilot program was conducted in a prostate carcinoma oncology clinic to test the feasibility of a two-stage approach that identifies patients in significant distress and refers them for treatment. Two pencil and paper self-report measures were used to detect psychologic distress in patients over the previous week: 1) The Hospital Anxiety and Depression Scale (HADS) and 2) "The Distress Thermometer." Patients who scored above an agreed upon cutoff score on either measure (HADS = 15+; Thermometer = 5+) were referred to the psychiatric liaison in the clinic for evaluation. RESULTS Compliance in filling out the measures was excellent; only 8 of 121 patients (6.6%) refused. Thirty-one percent of evaluable patients were referred based on elevated scores. Seventeen of 29 patients actually were evaluated. Eight of 17 patients met Diagnostic and Statistical Manual (of Mental Disorders)-IV criteria for a psychiatric disorder. CONCLUSIONS This approach for rapid screening for distress was acceptable in prostate carcinoma patients, although these older men were reluctant to agree to evaluation and treatment. This simple screening method needs further testing and the identification of barriers on the part of the patient and oncologist that impede the identification of the most distressed patients. Cancer 1998;82:1904-8. © 1998 American Cancer Society.

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Validity and Reliability of the US National Cancer Institute’s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

2015-08-13

Amylou C. Dueck , Tito R. Mendoza , Sandra A. Mitchell +7 more

To integrate the patient perspective into adverse event reporting, the National Cancer Institute developed a patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). To integrate the patient perspective into adverse event reporting, the National Cancer Institute developed a patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

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The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study.

1996-10-01

Mirjam A. G. Sprangers , M. Groenvold , Juan Ignacio Arrarás +7 more

PURPOSE To construct a breast cancer-specific quality-of-life questionnaire (QLQ) module to be used in conjunction with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and to test … PURPOSE To construct a breast cancer-specific quality-of-life questionnaire (QLQ) module to be used in conjunction with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and to test its reliability and validity cross-culturally. PATIENTS AND METHODS Module construction took place after the EORTC guidelines for module development. The module--the QLQ-BR23--consists of 23 items covering symptoms and side effects related to different treatment modalities, body image, sexuality, and future perspective. This module was tested in 170 Dutch, 168 Spanish, and 158 American cancer patients at two points in time. The timing for the Dutch and Spanish patients was before and during treatment with radiotherapy or chemotherapy. For the American patients, the questionnaire was administered at admission at the breast clinic and 3 months after the first assessment. RESULTS Multitrait scaling analysis confirmed the hypothesized structure of four of the five scales. Cronbach's alpha coefficients were, in general, lowest in Spain (range; .46 to .94) and highest in the United States (range; .70 to .91). On the basis of known-groups comparisons, selective scales distinguished clearly between patients differing in disease stage, previous surgery, performance status, and treatment modality, according to expectation. Additionally, selective scales detected change over time as a function of changes in performance status and treatment-induced change. CONCLUSION These results lend support to the clinical and cross-cultural validity of the QLQ-BR23 as a supplementary questionnaire for assessing specific quality-of-life issues relevant to patients with breast cancer.

Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument.

1997-03-01

Marianne J. Brady , David Cella , Fei Mo +6 more

PURPOSE This is the first published report on the validation of the Functional Assessment of Cancer Therapy-Breast (FACT-B), a 44-item self-report instrument designed to measure multidimensional quality of life (QL) … PURPOSE This is the first published report on the validation of the Functional Assessment of Cancer Therapy-Breast (FACT-B), a 44-item self-report instrument designed to measure multidimensional quality of life (QL) in patients with breast cancer. The FACT-B consists of the FACT-General (FACT-G) plus the Breast Cancer Subscale (BCS), which complements the general scale with items specific to QL in breast cancer. The FACT-B was developed with an emphasis on patients' values and brevity and is available in nine languages. METHODS AND RESULTS Two validation samples were used for this report. The first (n = 47) was tested twice over a 2-month period to assess sensitivity to change. Significant sensitivity to change in performance status rating (PSR) was demonstrated for the FACT-B total score, the Physical Well-Being (PWB) subscale, the Functional Well-Being (FWB) subscale, and the BCS. Sensitivity to change in QL as measured by the Functional Living Index-Cancer (FLIC) was documented in the FACT-B total score, PWB, FWB, and Emotional Well-Being (EWB). Additional validity and reliability data were obtained from a larger sample (n = 295). The alpha coefficient (internal consistency) for the FACT-B total score was high (alpha = .90), with subscale alpha coefficients ranging from .63 to .86. Evidence supported test-retest reliability, as well as convergent, divergent, and known groups validity. CONCLUSION The FACT-B is appropriate for use in oncology clinical trials, as well as in clinical practice. It demonstrates ease of administration, brevity, reliability, validity, and sensitivity to change.

Karnofsky performance status revisited: reliability, validity, and guidelines.

1984-03-01

Cyndie Coscarelli Schag , Richard Heinrich , Patricia A. Ganz

Little research has been conducted documenting the reliability and validity of the Karnofsky Performance Status (KPS) scale, and guidelines based on empirical data do not exist to govern its use. … Little research has been conducted documenting the reliability and validity of the Karnofsky Performance Status (KPS) scale, and guidelines based on empirical data do not exist to govern its use. Two hundred ninety-three cancer patients completed a questionnaire that assesses their physical and psychosocial difficulties. Physicians rated patients on the KPS and a subsample of 75 patients was used to evaluate interrater reliability. Analyses were conducted to evaluate the interrater reliability and construct validity of the KPS. The KPS was shown to have good reliability and validity. Detailed examination of the reliability data suggested areas in which physicians err in their judgments. Multiple regression techniques were used to empirically identify seven behaviorally based questions that would be helpful in predicting KPS scores. The seven variables included weight loss, weight gain, reduced energy, difficulty walking, driving, grooming, and working part time. An interview approach with behaviorally based guidelines is presented using these variables to obtain relevant data and make more accurate KPS ratings. With the approach suggested and the guidelines presented, oncologists may train themselves to use the KPS in a standard way, which should increase reliability and validity of the KPS and has implications for patients and research studies that use KPS as a stratifying variable.

Interpreting the significance of changes in health-related quality-of-life scores.

1998-01-01

David Osoba , George Rodrigues , James D. Myles +2 more

PURPOSE To determine the significance to patients of changes in health-related quality-of-life (HLQ) scores assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire … PURPOSE To determine the significance to patients of changes in health-related quality-of-life (HLQ) scores assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). PATIENTS AND METHODS A subjective significance questionnaire (SSQ), which asks patients about perceived changes in physical, emotional, and social functioning and in global quality of life (global QL) and the QLQ-C30 were completed by patients who received chemotherapy for either breast cancer or small-cell lung cancer (SCLC). In the SSQ, patients rated their perception of change since the last time they completed the QLQ-C30 using a 7-category scale that ranged from "much worse" through "no change" to "much better." For each category of change in the SSQ, the corresponding differences were calculated in QLQ-C30 mean scores and effect sizes were determined. RESULTS For patients who indicated "no change" in the SSQ, the mean change in scores in the corresponding QLQ-C30 domains was not significantly different from 0. For patients who indicated "a little" change either for better or for worse, the mean change in scores was about 5 to 10; for "moderate" change, about 10 to 20; and for "very much" change, greater than 20. Effect sizes increased in concordance with increasing changes in SSQ ratings and QLQ-C30 scores. CONCLUSION The significance of changes in QLQ-C30 scores can be interpreted in terms of small, moderate, or large changes in quality of life as reported by patients in the SSQ. The magnitude of these changes also can be used to calculate the sample sizes required to detect a specified change in clinical trials.

Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist

1990-12-01

JCJM de Haes , FCE van Knippenberg , J.P. Neijt

Do stress-related psychosocial factors contribute to cancer incidence and survival?

2008-05-20

Yoichi Chida , Mark Hamer , Jane Wardle +1 more

The rapid assessment of fatigue severity in cancer patients

1999-03-01

Tito R. Mendoza , X. Shelley Wang , Charles S. Cleeland +4 more

BACKGROUND Fatigue is a major disease and treatment burden for cancer patients. Several scales have been created to measure fatigue, but many are long and difficult for very ill patients … BACKGROUND Fatigue is a major disease and treatment burden for cancer patients. Several scales have been created to measure fatigue, but many are long and difficult for very ill patients to complete, or they are not easy to translate for non-English speaking patients. The Brief Fatigue Inventory was developed for the rapid assessment of fatigue severity for use in both clinical screening and clinical trials. METHODS The study enrolled 305 consecutive, consenting adult inpatients and outpatients with cancer who could understand and complete the self-report measures used in the study. The same instruments also were administered to 290 community-dwelling adults to obtain a comparison sample. Research staff completed a form that indicated the primary site and stage of the cancer, rated the Eastern Cooperative Oncology Group performance status of the patient, described the characteristics of the pain, and described the current pain treatment being provided to the patients. RESULTS The BFI was shown to be an internally stable (reliable) measure that tapped a single dimension, best interpreted as severity of fatigue. It correlated highly with similar fatigue measures. Greater than 98% of patients were able to complete it. A range of scores defining severe fatigue was identified. CONCLUSIONS The BFI is a reliable instrument that allows for the rapid assessment of fatigue level in cancer patients and identifies those patients with severe fatigue. Cancer 1999;85:1186–96. © 1999 American Cancer Society.

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Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age

2012-06-21

Wolfgang Linden , Andrea Vodermaier , Regina MacKenzie +1 more

Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer

2005-07-25

Wendy Demark‐Wahnefried , Noreen M. Aziz , Julia H. Rowland +1 more

Purpose Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer … Purpose Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population. Methods Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches. Results Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance. Conclusion With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.

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The Effect of Group Psychosocial Support on Survival in Metastatic Breast Cancer

2001-12-13

Pamela J. Goodwin , Molyn Leszcz , Marguerite Ennis +7 more

Supportive–expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival. Supportive–expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival.

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Who should measure quality of life, the doctor or the patient?

1988-01-01

ML Slevin , Hilary Plant , Denis J. Lynch +2 more

Validation of the Edmonton Symptom Assessment Scale

2000-05-01

Victor T. Chang , Shirley S. Hwang , Martin Feuerman

BACKGROUND The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of … BACKGROUND The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients. METHODS In this prospective study, 240 patients with a diagnosis of cancer completed the ESAS, the Memorial Symptom Assessment Scale (MSAS), and the Functional Assessment Cancer Therapy (FACT) survey, and also had their Karnofsky performance status (KPS) assessed. An additional 42 patients participated in a test-retest study. RESULTS The ESAS "distress" score correlated most closely with physical symptom subscales in the FACT and the MSAS and with KPS. The ESAS individual item and summary scores showed good internal consistency and correlated appropriately with corresponding measures from the FACT and MSAS instruments. Individual items between the instruments correlated well. Pain ratings in the ESAS, MSAS, and FACT correlated best with the "worst-pain" item of the Brief Pain Inventory (BPI). Test-retest evaluation showed very good correlation at 2 days and a somewhat smaller but significant correlation at 1 week. A 30-mm visual analogue scale cutoff point did not uniformly distinguish severity of symptoms for different symptoms. CONCLUSIONS For this population, the ESAS was a valid instrument; test-retest validity was better at 2 days than at 1 week. The ESAS "distress" score tends to reflect physical well-being. The use of a 30-mm cutoff point on visual analogue scales to identify severe symptoms may not always apply to symptoms other than pain. Cancer 2000;88:2164–71. © 2000 American Cancer Society.

The Karnofsky performance status scale: An examination of its reliability and validity in a research setting

1984-05-01

Vincent Mor , Linda Laliberte , John N. Morris +1 more

The Karnofsky Performance Status Scale (KPS) is widely used to quantify the functional status of cancer patients. However, limited data exist documenting its reliability and validity. The KPS is used … The Karnofsky Performance Status Scale (KPS) is widely used to quantify the functional status of cancer patients. However, limited data exist documenting its reliability and validity. The KPS is used in the National Hospice Study (NHS) as both a study eligibility criterion and an outcome measure. As part of intensive training, interviewers were instructed in and tested on guidelines for determining the KPS levels of patients. After 4 months of field experience, interviewers were again tested based on narrative patient descriptions. The interrater reliability of 47 NHS interviewers was found to be 0.97. The construct validity of the KPS was analyzed, and the KPS was found to be strongly related (P < 0.001) to two other independent measures of patient functioning. Finally, the relationship of the KPS to longevity (r = 0.30) in a population of terminal cancer patients documents its predictive validity. These findings suggest the utility of the KPS as a valuable research tool when employed by trained observers.

Cancer-related fatigue—mechanisms, risk factors, and treatments

2014-08-12

Julienne E. Bower

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Cancer treatment and survivorship statistics, 2012

2012-06-14

Rebecca L. Siegel , Carol DeSantis , Katherine S. Virgo +7 more

Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the … Although there has been considerable progress in reducing cancer incidence in the United States, the number of cancer survivors continues to increase due to the aging and growth of the population and improvements in survival rates. As a result, it is increasingly important to understand the unique medical and psychosocial needs of survivors and be aware of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. To highlight the challenges and opportunities to serve these survivors, the American Cancer Society and the National Cancer Institute estimated the prevalence of cancer survivors on January 1, 2012 and January 1, 2022, by cancer site. Data from Surveillance, Epidemiology, and End Results (SEER) registries were used to describe median age and stage at diagnosis and survival; data from the National Cancer Data Base and the SEER-Medicare Database were used to describe patterns of cancer treatment. An estimated 13.7 million Americans with a history of cancer were alive on January 1, 2012, and by January 1, 2022, that number will increase to nearly 18 million. The 3 most prevalent cancers among males are prostate (43%), colorectal (9%), and melanoma of the skin (7%), and those among females are breast (41%), uterine corpus (8%), and colorectal (8%). This article summarizes common cancer treatments, survival rates, and posttreatment concerns and introduces the new National Cancer Survivorship Resource Center, which has engaged more than 100 volunteer survivorship experts nationwide to develop tools for cancer survivors, caregivers, health care professionals, advocates, and policy makers.

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The prevalence of psychological distress by cancer site

2001-01-01

James Zabora , Karlynn BrintzenhofeSzoc , Barbara Curbow +2 more

The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses … The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined.The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress.The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility.These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs.

The Functional Assessment of Cancer Therapy scale: development and validation of the general measure.

1993-03-01

David Cella , David S. Tulsky , Geoffrey V. Gray +7 more

PURPOSE We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale. … PURPOSE We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale. METHODS AND RESULTS The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being. CONCLUSION The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.

Exercise for the management of cancer-related fatigue in adults

2012-11-08

Fiona Cramp , James Byron‐Daniel

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Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers

2004-06-07

Eva Grunfeld , Doug Coyle , Timothy J. Whelan +7 more

The vital role played by family caregivers in supporting dying cancer patients is well recognized, but the burden and economic impact on caregivers is poorly understood. We prospectively examined the … The vital role played by family caregivers in supporting dying cancer patients is well recognized, but the burden and economic impact on caregivers is poorly understood. We prospectively examined the psychosocial, occupational and economic impact of caring for a person with a terminal illness.We studied 89 caregivers of women with advanced breast cancer receiving care at either the Ottawa or Hamilton regional cancer centres in Ontario. Patients were followed until their death or study completion at 3 years. Patients identified a principal caregiver to participate in the study. The Karnofsky Performance Status (KPS) index, the Medical Outcomes Study 36-item Short Form (SF-36), the Hospital Anxiety and Depression Scale, the Zarit Burden Inventory, FAMCARE and the Medical Outcomes Study Social Support Survey were administered during follow-up. Economic data were collected by means of a questionnaire administered by an interviewer. Assessments were conducted every 3 months during the palliative period (KPS score > 50) and every 2 weeks during the terminal period (KPS score < or = 50).Over half of the caregivers were male (55%) and the patient's spouse or partner (52%), with a mean age of 53 years. At the start of the palliative period, the caregivers' mean physical functioning score was better than the patients' (51.3 v. 35.1, 95% confidence interval [CI] 13.3-20.0); there were similar mean mental functioning scores (46.6 and 47.1 respectively); similar proportions were depressed (11% and 12%); and significantly more caregivers than patients were anxious (35% v. 19%, p = 0.009). More caregivers were depressed (30% v. 9%, p = 0.02) and had a higher level of perceived burden (26.2 v. 19.4, p = 0.02) at the start of the terminal period than at the start of the palliative period. Burden was the most important predictor of both anxiety and depression. Of employed caregivers, 69% reported some form of adverse impact on work. In the terminal period 77% reported missing work because of caregiving responsibilities. Prescription drugs were the most important component of financial burden.Caregivers' depression and perceived burden increase as patients' functional status declines. Strategies are needed to help reduce the psychosocial, occupational and economic burden associated with caregiving.

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Depression and anxiety in women with early breast cancer: five year observational cohort study

2005-02-04

Caroline Burgess , Victoria Cornelius , Sharon Love +3 more

<h3>Abstract</h3> <b>Objective</b> To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis. <b>Design</b> Observational cohort study. … <h3>Abstract</h3> <b>Objective</b> To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis. <b>Design</b> Observational cohort study. <b>Setting</b> NHS breast clinic, London. <b>Participants</b> 222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence. <b>Main outcome measures</b> Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule). <b>Results</b> Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety, at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety. <b>Conclusion</b> Increased levels of depression, anxiety, or both in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support.

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Prevalence of Depression in Patients With Cancer

2004-07-01

Mary Jane Massie

Depression is the psychiatric syndrome that has received the most attention in individuals with cancer. The study of depression has been a challenge because symptoms occur on a broad spectrum … Depression is the psychiatric syndrome that has received the most attention in individuals with cancer. The study of depression has been a challenge because symptoms occur on a broad spectrum that ranges from sadness to major affective disorder and because mood change is often difficult to evaluate when a patient is confronted by repeated threats to life, is receiving cancer treatments, is fatigued, or is experiencing pain. Although many research groups have assessed depression in cancer patients since the 1960s, the reported prevalence (major depression, 0%–38%; depression spectrum syndromes, 0%–58%) varies significantly because of varying conceptualizations of depression, different criteria used to define depression, differences in methodological approaches to the measurement of depression, and different populations studied. Depression is highly associated with oropharyngeal (22%–57%), pancreatic (33%–50%), breast (1.5%–46%), and lung (11%–44%) cancers. A less high prevalence of depression is reported in patients with other cancers, such as colon (13%–25%), gynecological (12%–23%), and lymphoma (8%–19%). This report reviews the prevalence of depression in cancer patients throughout the course of cancer.

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American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors

2010-06-11

Kathryn H. Schmitz , Kerry S. Courneya , Charles E. Matthews +7 more

Early detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and … Early detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and treatments, including risk for recurrent cancer, other chronic diseases, and persistent adverse effects on physical functioning and quality of life. Historically, clinicians advised cancer patients to rest and to avoid activity; however, emerging research on exercise has challenged this recommendation. To this end, a roundtable was convened by American College of Sports Medicine to distill the literature on the safety and efficacy of exercise training during and after adjuvant cancer therapy and to provide guidelines. The roundtable concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups. Implications for disease outcomes and survival are still unknown. Nevertheless, the benefits to physical functioning and quality of life are sufficient for the recommendation that cancer survivors follow the 2008 Physical Activity Guidelines for Americans, with specific exercise programming adaptations based on disease and treatment-related adverse effects. The advice to "avoid inactivity," even in cancer patients with existing disease or undergoing difficult treatments, is likely helpful.

Development of the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

2014-09-29

Ethan Basch , Bryce B. Reeve , Sandra A. Mitchell +7 more

The standard approach for documenting symptomatic adverse events (AEs) in cancer clinical trials involves investigator reporting using the National Cancer Institute's (NCI's) Common Terminology Criteria for Adverse Events (CTCAE). Because … The standard approach for documenting symptomatic adverse events (AEs) in cancer clinical trials involves investigator reporting using the National Cancer Institute's (NCI's) Common Terminology Criteria for Adverse Events (CTCAE). Because this approach underdetects symptomatic AEs, the NCI issued two contracts to create a patient-reported outcome (PRO) measurement system as a companion to the CTCAE, called the PRO-CTCAE. This Commentary describes development of the PRO-CTCAE by a group of multidisciplinary investigators and patient representatives and provides an overview of qualitative and quantitative studies of its measurement properties. A systematic evaluation of all 790 AEs listed in the CTCAE identified 78 appropriate for patient self-reporting. For each of these, a PRO-CTCAE plain language term in English and one to three items characterizing the frequency, severity, and/or activity interference of the AE were created, rendering a library of 124 PRO-CTCAE items. These items were refined in a cognitive interviewing study among patients on active cancer treatment with diverse educational, racial, and geographic backgrounds. Favorable measurement properties of the items, including construct validity, reliability, responsiveness, and between-mode equivalence, were determined prospectively in a demographically diverse population of patients receiving treatments for many different tumor types. A software platform was built to administer PRO-CTCAE items to clinical trial participants via the internet or telephone interactive voice response and was refined through usability testing. Work is ongoing to translate the PRO-CTCAE into multiple languages and to determine the optimal approach for integrating the PRO-CTCAE into clinical trial workflow and AE analyses. It is envisioned that the PRO-CTCAE will enhance the precision and patient-centeredness of adverse event reporting in cancer clinical research.

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Measuring Quality of Life in Routine Oncology Practice Improves Communication and Patient Well-Being: A Randomized Controlled Trial

2004-02-14

Galina Velikova , Laura Booth , Adam B. Smith +4 more

To examine the effects on process of care and patient well-being, of the regular collection and use of health-related quality-of-life (HRQL) data in oncology practice.In a prospective study with repeated … To examine the effects on process of care and patient well-being, of the regular collection and use of health-related quality-of-life (HRQL) data in oncology practice.In a prospective study with repeated measures involving 28 oncologists, 286 cancer patients were randomly assigned to either the intervention group (regular completion of European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire version 3.0, and Hospital Anxiety and Depression Scale on touch-screen computers in clinic and feedback of results to physicians); attention-control group (completion of questionnaires, but no feedback); or control group (no HRQL measurement in clinic before encounters). Primary outcomes were patient HRQL over time, measured by the Functional Assessment of Cancer Therapy-General questionnaire, physician-patient communication, and clinical management, measured by content analysis of tape-recorded encounters. Analysis employed mixed-effects modeling and multiple regression.Patients in the intervention and attention-control groups had better HRQL than the control group (P =.006 and P =.01, respectively), but the intervention and attention-control groups were not significantly different (P =.80). A positive effect on emotional well-being was associated with feedback of data (P =.008), but not with instrument completion (P =.12). A larger proportion of intervention patients showed clinically meaningful improvement in HRQL. More frequent discussion of chronic nonspecific symptoms (P =.03) was found in the intervention group, without prolonging encounters. There was no detectable effect on patient management (P =.60). In the intervention patients, HRQL improvement was associated with explicit use of HRQL data (P =.016), discussion of pain, and role function (P =.046).Routine assessment of cancer patients' HRQL had an impact on physician-patient communication and resulted in benefits for some patients, who had better HRQL and emotional functioning.

Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis

2006-07-04

Margaret L. McNeely

Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. We sought to summarize the available evidence concerning the effects of … Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. We sought to summarize the available evidence concerning the effects of exercise on breast cancer patients and survivors.We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsychINFO, CancerLit, PEDro and SportDiscus as well as conference proceedings, clinical practice guidelines and other unpublished literature resources. We included only randomized controlled trials that examined exercise interventions for breast cancer patients or survivors with quality of life, cardiorespiratory fitness or physical functioning as primary outcomes. We also extracted data on symptoms of fatigue, body composition and adverse effects.Of 136 studies identified, 14 met all the inclusion criteria. Despite significant heterogeneity and relatively small samples, the point estimates in terms of the benefits of exercise for all outcomes were positive even when statistical significance was not achieved. Exercise led to statistically significant improvements in quality of life as assessed by the Functional Assessment of Cancer Therapy-General (weighted mean difference [WMD] 4.58, 95% confidence interval [CI] 0.35 to 8.80) and Functional Assessment of Cancer Therapy-Breast (WMD 6.62, 95% CI 1.21 to 12.03). Exercise also led to significant improvements in physical functioning and peak oxygen consumption and in reducing symptoms of fatigue.Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors. Larger trials that have a greater focus on study quality and adverse effects and that examine the long-term benefits of exercise are needed for this patient group.

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Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life

2000-02-14

Julienne E. Bower , Patricia A. Ganz , Katherine A. Desmond +3 more

PURPOSE: To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued … PURPOSE: To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued survivors. PATIENTS AND METHODS: Breast cancer survivors in two large metropolitan areas completed standardized questionnaires as part of a survey study, including the RAND 36-item Health Survey, Center for Epidemiological Studies–Depression Scale, Breast Cancer Prevention Trial Symptom Checklist, Medical Outcomes Study Sleep Scale, and demographic and treatment-related measures. RESULTS: On average, the level of fatigue reported by the breast cancer survivors surveyed (N = 1,957) was comparable to that of age-matched women in the general population, although the breast cancer survivors were somewhat more fatigued than a more demographically similar reference group. Approximately one third of the breast cancer survivors assessed reported more severe fatigue, which was associated with significantly higher levels of depression, pain, and sleep disturbance. In addition, fatigued women were more bothered by menopausal symptoms and were somewhat more likely to have received chemotherapy (with or without radiation therapy) than nonfatigued women. In multivariate analyses, depression and pain emerged as the strongest predictors of fatigue. CONCLUSION: Although the majority of breast cancer survivors in this large and diverse sample did not experience heightened levels of fatigue relative to women in the general population, there was a subgroup of survivors who did report more severe and persistent fatigue. We identified characteristics of these women that may be helpful in elucidating the mechanisms underlying fatigue in this population, as well as directing intervention efforts.

Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies

2011-01-20

Alex J. Mitchell , Melissa Chan , Henna Bhatti +4 more

Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition

2000-10-01

Gregory A. Curt , William Breitbart , David Cella +7 more

Abstract Purpose. This survey was designed to confirm the prevalence and duration of fatigue in the cancer population and to assess its physical, mental, social, and economic impacts on the … Abstract Purpose. This survey was designed to confirm the prevalence and duration of fatigue in the cancer population and to assess its physical, mental, social, and economic impacts on the lives of patients and caregivers. Patients and Methods. A 25-minute telephone interview was completed with 379 cancer patients having a prior history of chemotherapy. Patients were recruited from a sample of 6,125 households in the United States identified as having a member with cancer. The median patient age was 62 years, and 79% of respondents were women. Patients reporting fatigue at least a few times a month were asked a series of questions to better describe their fatigue and its impact on quality of life. Results. Seventy-six percent of patients experienced fatigue at least a few days each month during their most recent chemotherapy; 30% experienced fatigue on a daily basis. Ninety-one percent of those who experienced fatigue reported that it prevented a “normal” life, and 88% indicated that fatigue caused an alteration in their daily routine. Fatigue made it more difficult to participate in social activities and perform typical cognitive tasks. Of the 177 patients who were employed, 75% changed their employment status as a result of fatigue. Furthermore, 65% of patients indicated that their fatigue resulted in their caregivers taking at least one day (mean, 4.5 days) off work in a typical month. Physicians were the health care professionals most commonly consulted (79%) to discuss fatigue. Bed rest/ relaxation was the most common treatment recommendation (37%); 40% of patients were not offered any recommendations. Conclusions. Cancer-related fatigue is common among cancer patients who have received chemotherapy and results in substantial adverse physical, psychosocial, and economic consequences for both patients and caregivers. Given the impact of fatigue, treatment options should be routinely considered in the care of patients with cancer.

A body image scale for use with cancer patients

2001-01-01

Penelope Hopwood , Ian Fletcher , A Lee +1 more

Quality of Life in Long-Term, Disease-Free Survivors of Breast Cancer: a Follow-up Study

2002-01-02

Peter Ganz

Background: Women with breast cancer are the largest group of female survivors of cancer. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors. … Background: Women with breast cancer are the largest group of female survivors of cancer. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors. Methods: Letters of invitation were mailed to 1336 breast cancer survivors who had participated in an earlier survey and now were between 5 and 10 years after their initial diagnosis. The 914 respondents interested in participating were then sent a survey booklet that assessed a broad range of QOL and survivorship concerns. All P values were two-sided. Results: A total of 817 women completed the follow-up survey (61% response rate), and the 763 disease-free survivors in that group, who had been diagnosed an average of 6.3 years earlier, are the focus of this article. Physical well-being and emotional well-being were excellent; the minimal changes between the baseline and follow-up assessments reflected expected age-related changes. Energy level and social functioning were unchanged. Hot flashes, night sweats, vaginal discharge, and breast sensitivity were less frequent. Symptoms of vaginal dryness and urinary incontinence were increased. Sexual activity with a partner declined statistically significantly between the two assessments (from 65% to 55%, P = .001). Survivors with no past systemic adjuvant therapy had a better QOL than those who had received systemic adjuvant therapy (chemotherapy, tamoxifen, or both together) (physical functioning, P = .003; physical role function, P = .02; bodily pain, P = .01; social functioning, P = .02; and general health, P = .03). In a multivariate analysis, past chemotherapy was a statistically significant predictor of a poorer current QOL (P = .003). Conclusions: Long-term, disease-free breast cancer survivors reported high levels of functioning and QOL many years after primary treatment. However, past systemic adjuvant treatment was associated with poorer functioning on several dimensions of QOL. This information may be useful to patients and physicians who are engaging in discussion of the risks and benefits of systemic adjuvant therapy.

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Cancer Survivors’ Adherence to Lifestyle Behavior Recommendations and Associations With Health-Related Quality of Life: Results From the American Cancer Society's SCS-II

2008-04-29

Christopher M. Blanchard , Kerry S. Courneya , Kevin Stein

To examine the prevalence and clustering of physical activity (PA), fruit and vegetable consumption (5-A-Day), and smoking across six major cancer survivor groups and to identify any associations with health-related … To examine the prevalence and clustering of physical activity (PA), fruit and vegetable consumption (5-A-Day), and smoking across six major cancer survivor groups and to identify any associations with health-related quality of life (HRQoL).A total of 9,105 survivors of six different cancers completed a national cross-sectional survey that included the lifestyle behavior questions and the RAND-36 Health Status Inventory.Only a minority of cancer survivors were meeting the 5-A-Day (14.8% to 19.1%) or PA (29.6% to 47.3%) recommendations, whereas most were meeting the smoking recommendation (82.6% to 91.6%). In terms of the lifestyle behavior clusters, only 5% of cancer survivors were meeting all three recommendations. Analyses of covariance generally showed higher HRQoL in survivors who were meeting versus not meeting each lifestyle behavior recommendation with the strongest associations emerging for PA. Trend analyses showed a steep positive association between the number of lifestyle behavior recommendations being met and HRQoL for breast (P < .001), prostate (P < .001), colorectal (P < .001), bladder (P < .001), uterine (P < .001), and skin melanoma (P < .001) cancer survivors.Few cancer survivors are meeting the PA or 5-A-Day recommendations, and even fewer are meeting all three lifestyle recommendations. The association between the current lifestyle recommendations and HRQoL in cancer survivors appears to be cumulative. Interventions to increase PA and fruit and vegetable consumption and reduce smoking are warranted and may have additive effects on the HRQoL of cancer survivors.

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High levels of untreated distress and fatigue in cancer patients

2004-05-25

Linda E. Carlson , Maureen Angen , Jodi Cullum +7 more

The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A … The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A total of 3095 patients were assessed over a 4-week period with the Brief Symptom Inventory-18 (BSI-18), a common problems checklist, and on awareness and use of psychosocial resources. Full data was available on 2776 patients. On average, patients were 60 years old, Caucasian (78.3%), and middle class. Approximately, half were attending for follow-up care. Types of cancer varied, with the largest groups being breast (23.5%), prostate (16.9%), colorectal (7.5%), and lung (5.8%) cancer patients. Overall, 37.8% of all patients met criteria for general distress in the clinical range. A higher proportion of men met case criteria for somatisation, and more women for depression. There were no gender differences in anxiety or overall distress severity. Minority patients were more likely to be distressed, as were those with lower income, cancers other than prostate, and those currently on active treatment. Lung, pancreatic, head and neck, Hodgkin's disease, and brain cancer patients were the most distressed. Almost half of all patients who met distress criteria had not sought professional psychosocial support nor did they intend to in the future. In conclusion, distress is very common in cancer patients across diagnoses and across the disease trajectory. Many patients who report high levels of distress are not taking advantage of available supportive resources. Barriers to such use, and factors predicting distress and use of psychosocial care, require further exploration.

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The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation.

2003-01-01

Kimberly Webster , David Cella , Kathleen J. Yost

The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System is a collection of health-related quality of life (HRQOL) questionnaires targeted to the management of chronic illness. The measurement system, … The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System is a collection of health-related quality of life (HRQOL) questionnaires targeted to the management of chronic illness. The measurement system, under development since 1987, began with the creation of a generic CORE questionnaire called the Functional Assessment of Cancer Therapy-General (FACT-G). The FACT-G (now in Version 4) is a 27-item compilation of general questions divided into four primary QOL domains: Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, and Functional Well-Being. It is appropriate for use with patients with any form of cancer, and extensions of it have been used and validated in other chronic illness condition (e.g., HIV/AIDS; multiple sclerosis; Parkinson's disease; rheumatoid arthritis), and in the general population. The FACIT Measurement System now includes over 400 questions, some of which have been translated into more than 45 languages. Assessment of any one patient is tailored so that the most-relevant questions are asked and administration time for any one assessment is usually less than 15 minutes. This is accomplished both by the use of specific subscales for relevant domains of HRQOL, or computerized adaptive testing (CAT) of selected symptoms and functional areas. FACIT questionnaires can be administered by self-report (paper or computer) or interview (face-to-face or telephone). Available scoring, normative data and information on meaningful change now allow one to interpret results in the context of a growing literature base.

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Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Multicenter Randomized Controlled Trial

2007-09-05

Kerry S. Courneya , Roanne Segal , John R. Mackey +7 more

Breast cancer chemotherapy may cause unfavorable changes in physical functioning, body composition, psychosocial functioning, and quality of life (QOL). We evaluated the relative merits of aerobic and resistance exercise in … Breast cancer chemotherapy may cause unfavorable changes in physical functioning, body composition, psychosocial functioning, and quality of life (QOL). We evaluated the relative merits of aerobic and resistance exercise in blunting these effects.We conducted a multicenter randomized controlled trial in Canada between 2003 and 2005 that randomly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy (median, 17 weeks; 95% CI, 9 to 24 weeks). Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale. Secondary end points were fatigue, psychosocial functioning, physical fitness, body composition, chemotherapy completion rate, and lymphedema.The follow-up assessment rate for our primary end point was 92.1%, and adherence to the supervised exercise was 70.2%. Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem (P = .015), aerobic fitness (P = .006), and percent body fat (adjusted P = .076). Resistance exercise was superior to usual care for improving self-esteem (P = .018), muscular strength (P < .001), lean body mass (P = .015), and chemotherapy completion rate (P = .033). Changes in cancer-specific QOL, fatigue, depression, and anxiety favored the exercise groups but did not reach statistical significance. Exercise did not cause lymphedema or adverse events.Neither aerobic nor resistance exercise significantly improved cancer-specific QOL in breast cancer patients receiving chemotherapy, but they did improve self-esteem, physical fitness, body composition, and chemotherapy completion rate without causing lymphedema or significant adverse events.

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Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation.

1984-05-01

Harvey Schipper , Jennifer Clinch , Anne McMurray +1 more

The classical criteria for the evaluation of clinical trials in cancer reflect alterations in physical well-being, but are insensitive to other important factors, such as psychosocial state, sociability, and somatic … The classical criteria for the evaluation of clinical trials in cancer reflect alterations in physical well-being, but are insensitive to other important factors, such as psychosocial state, sociability, and somatic sensation that may play a critical role in determining the patients' functional response to their illness and its treatment. The Functional Living Index-Cancer is designed for easy, repeated patient self-administration. It is a 22-item questionnaire that has been validated on 837 patients in two cities over a three-year period. Criteria for validity include stability of factor analysis, concurrent validation studies against the Karnofsky, Beck Depression, Spielberger State and Trait Anxiety, and Katz Activities of Daily Living scales, as well as the scaled version of The General Health Questionnaire and The McGill/ Melzack Pain Index. The index is uncontaminated by social desirability issues. The validation studies demonstrate the lack of correlation between traditional measures of patient response and other significant functional factors such as depression and anxiety (r = 0.33), sociability and family interaction, and nausea. These findings elucidate the frequently observed discrepancies between traditional assessments of clinical response and overall functional patient outcome. The index is proposed as an adjunct to clinical trials assessment and may provide additional patient functional information on which to analyse the outcome of clinical trials or offer specific advice to individual patients.

Depression and cancer mortality: a meta-analysis

2010-01-20

Martin Pinquart , Paul R. Duberstein

Background The goal of the present study was to analyze associations between depression and mortality of cancer patients and to test whether these associations would vary by study characteristics. Method … Background The goal of the present study was to analyze associations between depression and mortality of cancer patients and to test whether these associations would vary by study characteristics. Method Meta-analysis was used for integrating the results of 105 samples derived from 76 prospective studies. Results Depression diagnosis and higher levels of depressive symptoms predicted elevated mortality. This was true in studies that assessed depression before cancer diagnosis as well as in studies that assessed depression following cancer diagnosis. Associations between depression and mortality persisted after controlling for confounding medical variables. The depression–mortality association was weaker in studies that had longer intervals between assessments of depression and mortality, in younger samples and in studies that used the Beck Depression Inventory as compared with other depression scales. Conclusions Screening for depression should be routinely conducted in the cancer treatment setting. Referrals to mental health specialists should be considered. Research is needed on whether the treatment of depression could, beyond enhancing quality of life, extend survival of depressed cancer patients.

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EFFECT OF PSYCHOSOCIAL TREATMENT ON SURVIVAL OF PATIENTS WITH METASTATIC BREAST CANCER

1989-10-01

David Spiegel , H C Kraemer , JoanR. Bloom +1 more

Symptom Prevalence in Patients with Incurable Cancer: A Systematic Review

2007-05-25

Saskia Teunissen , Wendy Wesker , Cas Kruitwagen +3 more

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An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis

2010-01-05

Rebecca M. Speck , Kerry S. Courneya , Louise C. Mâsse +2 more

The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress

1994-01-01

Russell K. Portenoy , Howard T. Thaler , Alice B. Kornblith +7 more

The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology

1993-03-03

N.K. Aaronson , Sam H. Ahmedzai , Bengt Bergman +7 more

Background : In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life … Background : In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. Purpose : We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. Methods : The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. Results : The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient >.70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. Conclusions : These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials. [J Natl Cancer Inst 85: 365-376, 1993]

Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial

2015-12-08

Ethan Basch , Allison M. Deal , Mark G. Kris +7 more

Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. Methods We randomly assigned patients … Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. Methods We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival. Results Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4- v 7.1-point drop; P < .001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts. Conclusion Clinical benefits were associated with symptom self-reporting during cancer care.

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Measuring quality of life: Using quality of life measures in the clinical setting

2001-05-26

Irene J Higginson

This is the second in a series of five articles In modern medicine the traditional way of assessing change in patients has been to focus on laboratory or clinical tests. … This is the second in a series of five articles In modern medicine the traditional way of assessing change in patients has been to focus on laboratory or clinical tests. At its most simple this involves measuring pulse, blood pressure, and temperature, and carrying out physical examinations. At more complex levels it may include haematological analysis, computed tomography, radiography, organ function tests, genetic analysis, and other investigations. While these give important information about the disease, especially about chronic and progressive diseases, it is impossible to separate disease from an individual's personal and social context. No illness exists in a vacuum. One way of capturing the personal and social context of patients is to use quality of life measures.1 These are accepted as outcome measures in clinical research but are rarely used in routine clinical practice, despite the fact that Florence Nightingale was one of the first clinicians to insist on measuring the outcome of routine care to evaluate treatment.2 This article reviews the challenges of using quality of life measures in clinical practice including selecting appropriate measures, analysing data, providing feedback, interpreting results, and incorporating these measures into clinical decision making. Practical ways of resolving the tension between the need for approaches suitable in the clinical encounter and the highly individualised nature of quality of life are also examined. #### Summary points Using quality of life measures in clinical practice ensures that treatment and evaluations focus on the patient rather than the disease The measures are potentially useful in both the clinical encounter and in quality improvement They are not a substitute for measures of disease outcomes and may not always be the most appropriate patient centred outcome to assess Measures developed for research often cannot easily be used in clinical practice Measures that form an integral part of treatment planning …

Cancer treatment and survivorship statistics, 2014

2014-06-01

Carol DeSantis , Chun Chieh Lin , Angela B. Mariotto +6 more

The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health … The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER‐Medicare linked databases; treatment‐related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one‐third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship. CA Cancer J Clin 2014;64:252–271. © 2014 American Cancer Society.

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Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment

2017-06-06

Ethan Basch , Allison M. Deal , Amylou C. Dueck +4 more

This study assesses overall survival associated with electronic patient-reported symptom monitoring vs usual care during routine cancer treatment. This study assesses overall survival associated with electronic patient-reported symptom monitoring vs usual care during routine cancer treatment.

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Cancer treatment and survivorship statistics, 2019

2019-06-11

Kimberly D. Miller , Letícia Nogueira , Angela B. Mariotto +6 more

The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. … The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.

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Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable

2019-10-17

Kristin L. Campbell , Kerri M. Winters‐Stone , Joachim Wiskemann +7 more

The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face … The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue.

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The role of preoperative and postoperative exercise in enhancing quality of life following cystectomy for bladder cancer: a systematic review and meta-analysis

2025-06-26

Beyzanur Güney , Omar Alomarı , Muhammed Edib Mokresh +7 more | Supportive Care in Cancer

Abstract Background/aim Bladder cancer is among the most common malignancies, often treated with radical cystectomy (RC) for muscle-invasive cases. However, RC is associated with high postoperative complication rates. Preoperative and … Abstract Background/aim Bladder cancer is among the most common malignancies, often treated with radical cystectomy (RC) for muscle-invasive cases. However, RC is associated with high postoperative complication rates. Preoperative and postoperative exercise programs have been proposed to enhance recovery and quality of life (QoL) in bladder cancer patients. This systematic review aims to evaluate the impact of exercise interventions on QoL in patients undergoing cystectomy. Methods A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD42024623205). A comprehensive search across Web of Science, PubMed, Scopus, and Cochrane databases identified studies on exercise interventions in cystectomy patients. Eligibility criteria included randomized controlled trials, cohort studies, and case reports involving bladder cancer patients undergoing pre- or postoperative exercise. Data were analyzed using R version 4.3.1, applying random-effects models to calculate mean differences (MDs) and 95% confidence intervals (CIs). Heterogeneity was assessed using τ 2 , I 2 , and Q -tests. Results Ten studies ( n = 564) met the inclusion criteria. Meta-analysis revealed that preoperative exercise significantly improved postoperative QoL scores (standardized mean difference [SMD] = 0.62; 95% confidence interval [CI]: 0.44–0.80; p < 0.001; I 2 = 22%). Postoperative exercise also enhanced cardiorespiratory function and reduced postoperative complications (SMD = 0.48; 95% CI: 0.32–0.64; p < 0.001; I 2 = 18%). Combined pre- and postoperative exercise yielded the highest QoL improvements. Conclusion Exercise programs significantly enhance QoL in bladder cancer patients undergoing cystectomy by reducing complications and improving physical and emotional resilience. However, high heterogeneity, inconsistent outcome measures, and limited statistically significant effects in some domains highlight the need for standardized protocols and further high-quality research.

Culture Impacts Sexual Well‐Being in Autologous Breast Reconstruction: A Multi‐Continental Examination

2025-06-25

Minji Kim , Jeske M. Bubberman , Uchechukwu O. Amakiri +7 more | Journal of Surgical Oncology

ABSTRACT Introduction Sexual health concerns are prevalent in breast cancer patients, yet are difficult to address given the stigma, sensitivity, and cultural differences. This study aims to assess the impact … ABSTRACT Introduction Sexual health concerns are prevalent in breast cancer patients, yet are difficult to address given the stigma, sensitivity, and cultural differences. This study aims to assess the impact of culture on Sexual Well‐being after autologous breast reconstruction (ABR) by examining three different countries from different continents: South Korea for Asia, Netherlands for Europe, and United States of America (USA) for North America. Methods Patients who underwent autologous (ABR) breast reconstruction between 2016 and 2022 and completed at least one BREAST‐Q Sexual Well‐being either preoperative and/or up to 2‐year postoperative were included. Sexual Well‐being was measured by BREAST‐Q, a gold standard patient‐reported outcome measure for breast cancer patients undergoing surgery. Results A total of 1726 ABR patients were included, of which 173 were from Korea, 231 from Netherlands, and 1322 from USA. There were significant differences in BREAST‐Q Sexual Well‐being between the three countries at all timepoints (preoperative, 6‐month, 1‐year, and 2‐year postoperative). In the linear regression model, relative to patients from USA, patients from Korea scored 13 points lower ( β = −13, 95% confidence interval [CI]: −17, −8.5, p < 0.001) while patients from the Netherlands scored 4.5 points higher ( β = 4.5, 95% CI: 1.7, 7.3, p = 0.002). Conclusion In this multi‐continental study, we found that Sexual Well‐being among ABR patients significantly differs by culture. Additional insight and interventions into the lower Sexual Well‐being among Asian patients at all timepoints and American patients postoperatively may be beneficial.

Research progress and trends in colorectal cancer self-management: a bibliometric analysis from 2004 to 2024

2025-06-24

L. Li , Yuezhong Wen | Supportive Care in Cancer

Self-management for patients with colorectal cancer (CRC) has gained increasing attention in recent years due to its critical role in improving patient outcomes and quality of life. This study aims … Self-management for patients with colorectal cancer (CRC) has gained increasing attention in recent years due to its critical role in improving patient outcomes and quality of life. This study aims to explore trends in self-management research for CRC through bibliometric analysis. Publications from 2004 to 2024 were retrieved from the Web of Science Core Collection database. Bibliometric analysis was performed using VOSviewer, CiteSpace, and the R package "bibliometrix" to map research trends, co-authorship networks, institutional collaborations, and patterns of keyword co-occurrence. A total of 1822 publications were identified, showing a steady annual growth rate of 7.49%. The USA led both in the number of publications and citations, followed by China and the United Kingdom. The University of California System was the most prolific institution, with 168 publications. The key author in the field was Vernon Sally W., and Supportive Care in Cancer emerged as the leading journal in this area. The thematic focus of the research is reflected in the prominent co-occurring keywords, such as "woman," "quality of life," and "emergency surgery." Burst keywords, including "colorectal obstruction," "colonic obstruction," "resection," and "depression," highlight the evolving research priorities and emerging interests in the field of CRC self-management. This bibliometric analysis delineated the research trends, key contributors, and emergent discourses within the self-management domain for patients with CRC. It underscores a concentrated research emphasis on the emotional well-being of patients and the critical role of surgical interventions in the self-management of CRC.

Health-Related Quality of Life in Chemotherapy Patients Using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30): A Single-Institution-Based Study From Lahore, Pakistan

2025-06-23

Jawayria Sajid , Kinza Sabir , Nauman Ismat Butt +3 more | Cureus

Futility in healthcare among Mexican female patients with breast cancer in advanced stage: The patient perspective

2025-06-23

María del Mar Yukie Namba-Bando , Irazú Contreras-Yáñez , Juan Alberto Tenorio-Torres +1 more | PLoS ONE

Breast cancer is the leading cause of cancer-related deaths among women in Mexico, and the outcomes for patients are often poor. Futility in healthcare (FHC) occurs when treatment fails to … Breast cancer is the leading cause of cancer-related deaths among women in Mexico, and the outcomes for patients are often poor. Futility in healthcare (FHC) occurs when treatment fails to achieve its intended goals, resulting in negative consequences. This study aimed to estimate the proportion of female patients in Mexico with advanced-stage breast cancer (ABC) who perceive FHC. Additionally, we inform the development and validation of a questionnaire (FHC-Q) to assess this phenomenon. This cross-sectional study was conducted from May 17, 2024, to December 30, 2024, in three phases. It involved three convenience samples (S) of adult women with ABC: S-1 (n = 30), S-2 (n = 201), and S-3 (n = 257). Phase 1 focused on constructing the FHC-Q, evaluating its content validity (expert agreement), and conducting a pilot test to assess its feasibility, all within S-1. Phase 2 involved assessing the questionnaire's reliability (internal consistency and temporal stability), construct validity (correlations between FHC-Q and DASS21 scores, along with exploratory factor analysis), and criterion validity (correlations between FHC-Q and SF-36 scores), all in S-2. Phase 3 estimated the FHC phenomenon in S-3. The definition of FHC was established using the Delphi method. Participants represented typical female Mexican patients with ABC. The FHC-Q comprised 16 items distributed into five dimensions. The FHC-Q demonstrated feasibility and validity, with expert agreement of ≥80% and a five-factor structure explaining 57.8% of the variance. Correlations between the FHC-Q, DASS21 and SF-36 scores were significant and low to moderate. The FHC-Q reliability was confirmed with a Cronbach's alpha of 0.766 and an ICC of 0.845 (95% CI: 0.735-0.909). FHC was perceived by 3.9% of the participants. FHC was perceived by a minority of Mexican women with ABC stages. The FHC-Q was valid, reliable and feasible to assess the phenomenon in the target population.

The impact of physical symptoms on depression and quality of life in patients with lung cancer: the moderating effects of illness perceptions and gender

2025-06-23

Jinhuan Yang , Di Dong , Gan He +6 more | Health and Quality of Life Outcomes

Physical symptoms negatively affect lung cancer patients' emotional well-being and quality of life. It remains understudied about what psychosocial factors may buffer the negative impact of physical symptoms. This study … Physical symptoms negatively affect lung cancer patients' emotional well-being and quality of life. It remains understudied about what psychosocial factors may buffer the negative impact of physical symptoms. This study examines how illness perceptions moderate the impact of physical symptoms on depression and quality of life, and further considers gender differences. A cross-sectional study was conducted on 316 lung cancer patients from Shanghai Chest Hospital in Shanghai, China, between July and September 2021. Participants completed questionnaires assessing physical symptoms, depression, quality of life, and illness perceptions. Hierarchical regression analyses revealed significant two-way interactions between physical symptoms and illness timeline perceptions on both depression (β = 0.12, P = 0.028) and quality of life (β = -0.13, P = 0.010). Additionally, significant three-way interactions involving physical symptoms, illness perceptions, and gender were found. Specifically, illness consequences perceptions interacted with physical symptoms and gender to predict depression (β = 0.17, P = 0.012), while personal control (β = 0.14, P = 0.022) and treatment control (β = 0.17, P = 0.017) interacted similarly to predict quality of life. Simple slope analyses indicated that positive illness perceptions alleviated the negative effects of physical symptoms on depression and quality of life, particularly in females. These findings indicate that facilitating positive illness perceptions may buffer the adverse effects of physical symptoms on depression and quality of life. Personalized psychological interventions aimed at enhancing patients' illness beliefs through positive psychological and behavioral strategies may contribute to improved coping and overall well-being.

Patient-reported outcomes (PROs) as personalised cancer care: report from a 2023 Australian consensus meeting (PROActive)

2025-06-23

Carolyn Mazariego , Sandra Avery , Geoff P. Delaney +7 more | EClinicalMedicine

Adjuvant melatonin therapy during exercise prescription in breast cancer survivors on physical and anthropometric parameters, quality of life, and hormonal response. A randomized controlled trial

2025-06-23

Ana M. Celorrio San Miguel , Luis M. Cacharro , Gema Santamaría +5 more | Frontiers in Sports and Active Living

Background Breast cancer has a high prevalence in women during the last years of their life. Exercise is instrumental during this recovery period. Nevertheless, little is known about the effects … Background Breast cancer has a high prevalence in women during the last years of their life. Exercise is instrumental during this recovery period. Nevertheless, little is known about the effects of combining nutritional supplements with physical activity. Therefore, this study aims to examine the impact of melatonin in conjunction with physical activity in breast cancer survivors (BCS). Methods Participants were postmenopausal women (60–75 years old) who had been diagnosed with stage I-III breast cancer 5 years ago and had received chemotherapy or radiotherapy. Participants were randomly assigned to two groups: experimental group (MEL) ( n = 10), which received melatonin supplementation (6 mg/day), and the control group (CG) ( n = 10), which received a placebo. Both groups followed an adapted physical activity program. After 10 weeks, body composition, physical condition, health-related quality of life and hormonal pattern were assessed in a randomized, single-blind, placebo-controlled trial (Clinical Trials.gov ID NCT06696378) following the Consolidated Standards of Reporting Trials. A Two-way repeated-measures analysis of variance (ANOVA) was used to examine the interaction effects (time × group) between MEL and CG. A significance level of p &lt; 0.05 indicated a statistically significant difference. Results After 10 weeks, both groups showed a non-significant decrease ( p &gt; 0.05) in fat mass. Both MEL and CG exhibited a significant reduction ( p &lt; 0.05) in the Borg Rating of Perceived Exertion (RPE) when comparing the beginning (T1) and end (T2) of the study Additionally, statistically significant differences ( p = 0.018) were observed overtime between T1 and T2 in the MEL and CG in RPE, with a moderate effect size ( η 2 p = 0.347). On the other hand, the Quality-of-Life Questionnaire (four domains and total score) and Short Physical Performance Battery indicated no significant ( p &gt; 0.05) differences between MEL and CG. Finally, testosterone/cortisol ratio decreased in both groups at the end of intervention, but the difference was not statistically significant ( p &gt; 0.05). Conclusions Melatonin supplementation (6 mg/day) for 10 weeks, combined with a physical activity program, had not significant ( p &gt; 0.05) effects on anthropometry, physical condition, health-related quality of life and hormonal response compared to the placebo group. Our findings suggest no clear effect of melatonin in post-treatment for BCS in the mentioned parameters. Further clinicals trials are recommended to establish definitive recommendations for physical activity and melatonin supplementation in BCS. Clinical Trial Registration Clinical Trials.gov , identifier (NCT06696378).

The impact of timed narrative nursing on the psychological stress status and PTGI score of suspected breast cancer patients during physical examination

2025-06-23

Na Zhang , Tang Ling | Psycho-Oncologie

Health-Related Lifestyle Communication in Oncology: Exploring the Experiences and Preferences of Cancer Survivors

2025-06-22

Rachel Drbohlav Ollerton , Saar Hommes , Nadine Bol +3 more | Health Communication

A healthy lifestyle, particularly having a balanced diet, regular physical activity, and abstaining from alcohol and smoking, is important for the recovery process of cancer survivors. The extent and form … A healthy lifestyle, particularly having a balanced diet, regular physical activity, and abstaining from alcohol and smoking, is important for the recovery process of cancer survivors. The extent and form in which lifestyle information is provided by healthcare providers varies substantially, which could leave many patients with unmet information needs. To better understand current practices and areas for improvement in communicating about these health behaviors, we explored survivors' experiences and preferences regarding communication. Using deductive and inductive content analysis, we analyzed questionnaire responses from survivors with various types of cancers. The results revealed the experiences with information provision, and barriers and facilitators to adhere to treatments. Respondents reported having to search for information themselves, which could lead to negative feelings and neglecting vulnerable groups of patients. Most respondents preferred a multimodal distribution of information and receival of recommendations at the beginning of treatment. Additionally, respondents preferred personalized and non-coercive messages about their lifestyle. The results of this study provide insights into current shortcomings and points for improvement of healthy lifestyle communication practices in oncology. Understanding patients' communication preferences and ways in which they can be implemented could lead to adherence to health behaviors, potentially improving long-term survivorship outcomes. Future research could explore whether tailoring recommendations to individual needs and delivering information at critical stages can enhance patient satisfaction and engagement.

Screening tools for cancer-related fatigue: how do they overlap with validated assessment tools?

2025-06-22

Patricia Blickle , Alexander Haussmann , Martina E. Schmidt +3 more | Fatigue Biomedicine Health & Behavior

Breast and prostate cancer survivors’ understanding of risk and management of cardiovascular and musculoskeletal side effects of treatment: findings from focus groups

2025-06-21

Jack Dalla Via , C Andrew , Brenton J. Baguley +5 more | Supportive Care in Cancer

Abstract Purpose Survival after a cancer diagnosis is improving, increasing the importance of understanding and managing long-term treatment-related adverse effects. This study aimed to understand breast and prostate cancer survivors’ … Abstract Purpose Survival after a cancer diagnosis is improving, increasing the importance of understanding and managing long-term treatment-related adverse effects. This study aimed to understand breast and prostate cancer survivors’ understanding of how cancer treatment may affect cardiovascular and musculoskeletal health. Methods Australian breast and prostate cancer survivors treated with therapies with known cardiovascular adverse effects were recruited via a private cancer care provider. Participants completed an online background questionnaire, then participated in a focus group. Focus groups were recorded, transcribed, then analysed using reflexive thematic analysis. Results In total, 26 cancer survivors (15 breast, 11 prostate; mean age 67 years) participated in one of seven focus groups. Three major themes were developed: 1) Focus is on the here and now, not the future —participants were infrequently told that their cancer treatment can have negative long-term effects; 2) Wanting individualised delivery of side-effect information —participants received varying types and amounts of information about side effects, but it was not delivered in a way that best suited them; and 3) Left wondering how to best manage side effects —few participants were provided with information about how to manage long term side effects, despite wanting this information. Conclusion Important information about long-term side effects of cancer treatment, and how to manage them, was inconsistently provided to breast and prostate cancer survivors. Information about long-term treatment side effects should be delivered in a flexible, individualised way to better enable cancer survivors to understand the risk and engage in preventative health behaviours.

What are safe hemoglobin, neutrophil and platelet counts for people with hematological malignancies to participate in exercise and activities of daily living: a scoping review

2025-06-21

J. Graeme Houston , Kathleen Boyd , Paul Gittings +1 more | Supportive Care in Cancer

The aim of this scoping review was to summarize the extent of the literature in relation to safe levels of platelet, hemoglobin and neutrophil count for people with hematological cancers … The aim of this scoping review was to summarize the extent of the literature in relation to safe levels of platelet, hemoglobin and neutrophil count for people with hematological cancers to participate in exercise or activities of daily living (ADLs). A comprehensive search for this scoping review was completed in July 2024 across five databases: the Cochrane Library, Embase, PEDro, PubMed and OTSeeker. Original studies, reviews and expert opinion papers were included if they focused on people with active hematological cancer diagnoses or those undergoing treatment affecting bone marrow, and referenced safe levels of platelet, hemoglobin and neutrophil count for exercise or ADLs participation. Papers were included if they were published in English and after the year 2000. Forty-seven papers were included. Thirty-four were prospective studies, four were retrospective studies, five were reviews and four were expert opinion papers. Forty-four (94%) referenced platelet, 36 (77%) referenced hemoglobin and 17 (36%) referenced neutrophil count. Regarding platelet count, evidence is emerging away from contradicting exercise to adapting exercise and ADLs. Regarding hemoglobin levels, there were much more distinct criteria for cessation or adaptation of exercise/activity. Neutrophil cut-off values focused on minimization of infection risk being the focus when participants were neutropenic. This scoping review emphasizes that, in people with hematological cancers, evidence for safe levels of blood cells cut-off values for exercise and ADL engagement is evolving, and that prescription of safe exercise and functional rehabilitation is multifactorial.

Predictors of Upper Extremity Function in Breast Cancer Survivors

2025-06-21

Alper Tuğral , Yeşim Bakar , Murat Akyol | Physiotherapy Research International

ABSTRACT Background and Purpose Deteriorated upper extremity function is a leading cause of potential disability and functional decline in breast cancer survivors (BCS) not only during their active treatment but … ABSTRACT Background and Purpose Deteriorated upper extremity function is a leading cause of potential disability and functional decline in breast cancer survivors (BCS) not only during their active treatment but also in their survivorship continuum. Fatigue and decreased muscle strength are the prominent ones that can account for decreased upper extremity function. Therefore, this study aimed to explore the potential contributors to the upper extremity function of BCS. Methods A total of 100 BCS were included. Handgrip strength (HGS) was assessed with a dynamometer while fatigue and self‐reported upper extremity function were assessed with the Fatigue Severity Scale (FSS), Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH), respectively. To control the potential confounding effect of the handedness, the mean value of HGS was used in the regression model. Results HGS was found to be significantly higher on the right side compared to the left side (22.71 ± 3.51 kg vs. 21.45 ± 3.66 kg, t = 5.328, p < 0.001). The mean scores of DASH and FSS were found 21.97 ± 15.62, and 39.62 ± 12.16, respectively. The multivariate linear regression analysis showed that a total of 26.9% of the cumulative variance in DASH is explained by the mean HGS, FSS, and body mass index (BMI) (F (4,95) = 11.793, p < 0.001, R 2 = 0.269, Cohen's f 2 :0.54). There were no significant effects and/or interactions of any clinical features of BCS on DASH. FSS and DASH also significantly correlated with each other ( r = 0.49, p < 0.001). Discussion This study showed that HGS shows itself as a significant outcome measure to predict upper extremity function in BCS. Because BCS can experience fatigue even years after the completion of primary treatment, it is noteworthy to consider it when evaluating the function of BCS. Trial Registration ClinicalTrials.gov Identifier: NCT04245657

Exploring the influence and identifying key predictors of sleep difficulties on health status in long-term breast cancer survivors: a cross-sectional study

2025-06-21

Francisco Álvarez-Salvago , Clara Pujol-Fuentes , Maria Figueroa-Mayordomo +6 more | Supportive Care in Cancer

Effects of Home-Based Rehabilitation for Patients With Advanced Lung Cancer Undergoing Platinum-Based Chemotherapy: A Randomized Controlled Trial

2025-06-20

Mi Jin Hong , Young Jin Lee , Jong Bum Park +4 more | Annals of Rehabilitation Medicine

To investigate the effects of a home-based rehabilitation program on physical capacity, lung function, and health-related quality of life (QOL) in patients with advanced lung cancer undergoing platinum-based chemotherapy. Between … To investigate the effects of a home-based rehabilitation program on physical capacity, lung function, and health-related quality of life (QOL) in patients with advanced lung cancer undergoing platinum-based chemotherapy. Between December 2021 and December 2023, participants were randomly assigned to exercise and control groups. The exercise group engaged in a home-based exercise program, including respiratory, aerobic, and resistance training, for 60 minutes per session, three times per week, before the first tumor response evaluation. Outcome evaluations included the 6-minute walk test, spirometry to measure lung function (specifically assessing forced expiratory volume in 1 second [FEV1] and forced vital capacity, hand grip strength, and QOL assessments using the Short Form 36-Item Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module 29. Participants were assessed at baseline, post-intervention, and followed up for 1 year. Twenty-one of the 26 participants completed the study. The control group showed a significant decrease in FEV1 (p=0.011). Delays in chemotherapy occurred in 40.0% of participants in the control group but none in the exercise group (p=0.019). Mental health showed improvement in the exercise group (p=0.041), whereas adverse effects were more common in the control group (p=0.007), according to QOL questionnaire results. Home-based rehabilitation during chemotherapy may help maintain lung function, improve mental health, and reduce side effects in patients with lung cancer, warranting further research.

Comparing aerobic and resistance exercise emphasis during androgen deprivation and radiation therapy for prostate cancer: A randomised feasibility trial

2025-06-20

Kira Murphy , Bróna Kehoe , Suzanne Denieffe +3 more | Supportive Care in Cancer

Abstract Purpose Most exercise interventions for men with prostate cancer utilise resistance and aerobic exercise, though the optimal combination of each for cardiometabolic health and quality of life outcomes is … Abstract Purpose Most exercise interventions for men with prostate cancer utilise resistance and aerobic exercise, though the optimal combination of each for cardiometabolic health and quality of life outcomes is unclear. This study aimed to determine the feasibility of an aerobic-emphasised (AE) versus a resistance-emphasised (RE) exercise intervention in men with prostate cancer undergoing androgen deprivation therapy (ADT) and radiation therapy (RT). Methods A 6-month two-armed randomised feasibility study was undertaken. Prostate cancer patients ( n = 24) undergoing ADT and RT were randomised to either an AE ( n = 12) or RE ( n = 12) supervised programme. The primary outcome was feasibility, assessed via recruitment, retention, adherence and safety. Results Twenty-four men were randomised, the recruitment rate was 19%. For AE and RE respectively, retention was 75% and 83%, adherence to the exercise prescription was 80% and 76%, attendance was 91% and 92%, with attendance during RT at 96% and 95%. No serious adverse events were recorded. Preliminary evidence favoured the AE intervention ( p < 0.05) for certain quality of life domains and haematology markers and the RE intervention ( p = 0.05) for BESS balance scores. Pre- to post-intervention improvements ( p < 0.05) were observed in multiple functional fitness outcomes. Conclusion An exercise trial that carefully varies both resistance and aerobic elements is feasible for men with prostate cancer undergoing active treatment. Strategies would have to be implemented to increase recruitment for a larger trial. Trial registration The trial has been registered on ClinicalTrials.gov as of the 14 th of December 2021 (NCT05156424).

Effects of COVID-19 on Physical Activity and Barriers Among Breast Cancer Survivors

2025-06-20

Nouf Alhomaidhi , Gabrielle Riazi , Sabrina Pereira Menezes +4 more | Research Square (Research Square)

<title>Abstract</title> Purpose This study aimed to examine the impact of the COVID-19 pandemic on the frequency and duration of physical activity among breast cancer survivors in the United States. Specifically, … <title>Abstract</title> Purpose This study aimed to examine the impact of the COVID-19 pandemic on the frequency and duration of physical activity among breast cancer survivors in the United States. Specifically, it addressed whether differences existed in exercise routines across pre-COVID-19, during COVID-19, and post-COVID-19 periods, and identified persistent barriers affecting these survivors’ physical activity habits. Methods A cross-sectional survey was administered online to breast cancer survivors recruited via social media and word of mouth. The survey, which incorporated a modified International Physical Activity Questionnaire (IPAQ) short form, collected self-reported data on the frequency and duration of vigorous, moderate, and walking activities across three distinct time periods. Data were analyzed using one-way repeated measures ANOVAs and Friedman tests, with a significance level of p < 0.05. Results Findings revealed a significant reduction in physical activity days during COVID-19 compared to pre-COVID-19, with partial recovery post-COVID-19. However, the duration of moderate physical activity significantly declined post-COVID-19. Common barriers identified included lack of self-motivation, restricted access to exercise facilities, and injury concerns. Conclusions The COVID-19 pandemic has had a lasting negative impact on the exercise routines of breast cancer survivors, with persistent barriers continuing into the post-pandemic period. Implications for Cancer Survivors: Tailored interventions and ongoing support are needed to overcome barriers and promote increased physical activity, ultimately enhancing quality of life for breast cancer survivors.

The effect of a 12-session community exercise programme on health measures across varying cancer types and rehabilitation stages

2025-06-20

Isaac Oppong , Roozbeh Naemi | Supportive Care in Cancer

A Home-Based Interdisciplinary Intervention to Enhance Functionality in Oncology Patients: Results from a Clinical Trial

2025-06-20

Eduardo José Fernández Rodríguez , Celia Sánchez Gómez , María Isabel Rihuete Galve +2 more | Journal of Clinical Medicine

Background/Objectives: Dyspnoea and functional decline are common among cancer patients with associated respiratory conditions. This study aimed to evaluate the effectiveness of an Effort Re-education Programme (ERP) in improving functionality … Background/Objectives: Dyspnoea and functional decline are common among cancer patients with associated respiratory conditions. This study aimed to evaluate the effectiveness of an Effort Re-education Programme (ERP) in improving functionality and quality of life in hospitalised oncology patients compared to Conventional Clinical Practice (CCP). Methods: A stratified, randomised, prospective clinical trial was conducted involving 65 patients with cancer and associated respiratory conditions. Participants were assigned to either a control group (CCP) or an experimental group (ERP + CCP). Functionality (Barthel Index), health-related quality of life (EORTC QLQ-C30), overall performance (Karnofsky Scale), and instrumental activities of daily living (Lawton and Brody Scale) were assessed at baseline and one month post-discharge. Results: The ERP group showed significantly greater improvements in all outcome measures: Barthel Index (mean change: +18.33 vs. +6.19), EORTC QLQ-C30 (+16.4 vs. +6.6), Karnofsky (+18.75 vs. +5.6), and Lawton–Brody (+2.78 vs. +0.78), all with p < 0.001 and moderate-to-large effect sizes (Cohen’s d = 0.72–1.19). No readmissions were reported in the ERP group, versus 37.5% in the control group. Conclusions: The ERP significantly improves basic and instrumental functionality, autonomy, and health-related quality of life in oncology patients with respiratory conditions. These findings support the integration of Functional Re-education Programmes into routine clinical practice as a complement to standard care.

Patient-reported emotional responses and coping mechanisms in cancer recurrence: a systematic review of qualitative evidence

2025-06-20

Fang Jingyuan , Chenzhao Yuan , Benjamas Suksatit | Supportive Care in Cancer

Telehealth and Time Burden in Patients With Advanced Cancer

2025-06-20

Rahul Banerjee , Yvette C. Acob | JAMA Network Open

Clinically-based Exercise Oncology Programs

2025-06-20

Karen Y. Wonders | ACSMʼs Health & Fitness Journal

Apply It! • Best practices for exercise oncology program development • Defining various roles included in multidisciplinary, collaborative exercise oncology workforce • Reviewing various exercise interventions in cancer care • … Apply It! • Best practices for exercise oncology program development • Defining various roles included in multidisciplinary, collaborative exercise oncology workforce • Reviewing various exercise interventions in cancer care • Challenges and opportunities associated with integrating exercise programs into clinical settings

Difference in excess late mortality between early-onset and late-onset cancer survivors: a nationwide cross-sectional study

2025-06-20

Jian Li , Xiaohong Kuang | International Journal of Surgery

Outcome Measures of Fatigue in Adults with Cancer Receiving Radiation Therapy: A Scoping Review

2025-06-19

Courtney Apostol , Danielle Hitch | Research Square (Research Square)

<title>Abstract</title> Cancer-related fatigue (CRF) is a debilitating symptom experienced by many people undergoing radiation therapy, significantly impacting daily functioning and quality of life. Occupational therapists play a vital role in … <title>Abstract</title> Cancer-related fatigue (CRF) is a debilitating symptom experienced by many people undergoing radiation therapy, significantly impacting daily functioning and quality of life. Occupational therapists play a vital role in managing CRF, yet the lack of standardised outcome measures tailored to occupational therapy practice hinders effective assessment and intervention. This scoping review aimed to identify and map validated fatigue outcome measures suitable for outpatient radiotherapy settings and discuss their relevance to occupational therapy. Following the Arksey and O’Malley framework, a comprehensive search was conducted across MEDLINE, CINAHL, Embase, and PubMed, identifying 445 records. After screening, 12 studies published between 2010 and 2022 from seven countries were included. Breast, head and neck, and prostate cancers were commonly studied, most often using prospective cohort designs. Most studies used multidimensional, self-reported outcome measures, administered at multiple time throughout radiotherapy and at follow up. While these measures assessed physical, emotional, and cognitive fatigue, few addressed activity or participation in daily life. The findings highlight a gap in outcome measures that comprehensively evaluate activity and participation, which limits their utility in tailoring interventions or demonstrating the impact of occupational therapy. This review underscores the need for developing or adapting CRF outcome measures that better align with occupational therapy goals, to enhance clinical decision-making and research in outpatient radiotherapy settings.

Development of a unified system for assessing health related quality of life across the cancer care continuum: the EUonQoL Delphi study to identify priorities for quality of life domains

2025-06-19

Maike G. Sweegers , Eva de Jongh , Christopher Bedding +7 more | Journal of Patient-Reported Outcomes

Distress thermometer and determinants of psychological distress in metastatic breast cancer

2025-06-19

Huihui Sun , Huimin Lv , Limin Niu +3 more | BMJ Supportive & Palliative Care

Background Metastatic breast cancer (MBC) is generally considered an incurable disease, and patients require continuous systematic treatment. Receiving the diagnosis and treatment of MBC is a distressing experience that may … Background Metastatic breast cancer (MBC) is generally considered an incurable disease, and patients require continuous systematic treatment. Receiving the diagnosis and treatment of MBC is a distressing experience that may accelerate an episode of psychological disorder. This study examined the performance of the distress thermometer (DT) and identified the risk factors associated with psychological distress (PD). Methods We assessed 337 patients diagnosed with MBC in Henan Cancer Hospital. All patients completed the electronic DT and Hospital Anxiety and Depression Scale (HADS) online. Receiver operating characteristic (ROC) analysis compared DT accuracy against HADS-Total score (HADS-T) defined PD (HADS≥15). Multivariate regression identified PD-associated factors. Results DT average scores were significantly higher in HADS-T≥15 patients (4.27 vs 2.01, p<0.001). In ROC analysis, the DT showed strong discriminatory power relative to the HADS diagnosis of depression and anxiety, with an area under the curve of 0.76. A score of 4 represented the optimal trade-off between sensitivity (0.58) and specificity (0.85) characteristics for detecting distress. PD was associated with (unstandardised coefficient (B)=1.663, p=0.04) curative effect, and patients with poorer therapeutic effects experience more distress. Conclusion The single-item DT has been determined to be a valid tool for screening distress in patients with MBC. We recommend using a cut-off score of 4 in this population. While our analysis revealed a significant association between poor treatment response and elevated distress scores, these findings cohere with the broader clinical imperative to prioritise distress management for all cancer patients regardless of treatment outcomes.

Comparing the Accuracy of Different Wearable Activity Monitors in Patients With Lung Cancer and Providing Initial Recommendations: Protocol for a Pilot Validation Study

2025-06-19

Roberto M. Benzo , R. B. Singh , Carolyn J. Presley +7 more | JMIR Research Protocols

Background Wearable activity monitors (WAMs) provide insights into physical activity (PA) and are widely used in behavioral interventions and cancer survivorship research. However, validation studies of wearable devices in populations … Background Wearable activity monitors (WAMs) provide insights into physical activity (PA) and are widely used in behavioral interventions and cancer survivorship research. However, validation studies of wearable devices in populations with cancer are scarce, and existing studies using activity monitors in patients with cancer lack standardization. This gap is particularly significant in patients with lung cancer (LC), who often experience unique mobility challenges and gait impairments that may affect device accuracy. This study addresses this gap by validating the Fitbit Charge 6, ActiGraph LEAP, and activPAL3 micro in patients with LC in both laboratory and free-living conditions and developing a standardized framework for assessing wearable devices in populations with cancer and impaired mobility. Objective This study aims to validate and compare the accuracy of consumer-grade (Fitbit Charge 6) and research-grade (activPAL3 micro and ActiGraph LEAP) WAMs in patients with LC under both laboratory and free-living conditions. Moreover, this protocol aims to establish standardized procedures that can be adapted for validating current and future generations of wearable devices while accounting for disease-specific factors that may impact measurement accuracy. Methods In total, 15 adults diagnosed with LC (stages 1-4) will participate in laboratory and free-living protocols, wearing Fitbit Charge 6, activPAL3 micro, and ActiGraph LEAP devices simultaneously. The laboratory protocol will consist of a series of structured activities, including variable-time walking trials, sitting and standing tests, posture changes, and gait speed assessments. Activities will be video recorded for validation. In the free-living protocol, participants will wear the devices continuously for 7 days except during water-based activities. WAM-based outcome measures will include step count; time spent at light, moderate, and vigorous PA intensity levels; posture; and posture changes (only the activPAL3 micro measured posture). Validated survey instruments will be administered both before and after WAM data collection to control for potential confounding factors that may influence movement patterns and device accuracy. Laboratory-based validity measures will compare WAM data to video-recorded observations. Sensitivity, specificity, positive predictive value, and agreement will also be determined. Free-living agreement between devices will be assessed using Bland-Altman plots, intraclass correlation analysis, and 95% limits of agreement. Results Data collection is ongoing, with 11 participants enrolled and 7 (64%) having completed both in-laboratory and free-living protocols. On average, enrolled participants are aged 63.0 (SD 7.8; range 50.0-73.0) years, with 8 (73%) participants being women. Participant enrollment is expected to conclude in mid-2025, and initial findings are expected to be disseminated by the end of 2025. Conclusions This is the first study that validates WAM accuracy for populations with LC while providing comprehensive recommendations for future validation studies. This study will provide critical insights into the accuracy and reliability of WAMs for assessing PA in LC survivors, which are essential for interpreting clinical research and informing future interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/70472

The effects of different types of exercise interventions on psychological resilience during cancer treatment: A network meta-analysis and systematic review

2025-06-19

Shuting Liu , Sinan Wang , Haixiang Bi +2 more | Psycho-Oncologie

Digital Behavior Change Interventions to Promote Physical Activity and Reduce Sedentary Behavior Among Survivors of Breast Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2025-06-19

Xiaoyan Zhang , Jiaxin Fang , Yufang Hao +3 more | Journal of Medical Internet Research

Background Survivors of breast cancer often face challenges in maintaining physical activity (PA) and reducing sedentary behavior (SB), which are crucial for recovery and long-term health. Digital behavior change interventions … Background Survivors of breast cancer often face challenges in maintaining physical activity (PA) and reducing sedentary behavior (SB), which are crucial for recovery and long-term health. Digital behavior change interventions (DBCIs) have emerged as promising tools to address these behavioral targets. Objective This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in promoting PA and reducing SB among survivors of breast cancer. Methods A comprehensive search of 10 databases—PubMed, Embase, PsycINFO, the Cochrane Library, CINAHL, Web of Science, the China National Knowledge Infrastructure database, the Wanfang database, the VIP database, and the Sedentary Behavior Research Database—was conducted to identify eligible randomized controlled trials that investigated the effectiveness of DBCIs in promoting PA and reducing SB among survivors of breast cancer. Study quality was assessed using the Cochrane Risk-of-Bias tool. Data synthesis was conducted via Review Manager. Owing to anticipated heterogeneity, a random-effects meta-analysis was used. The evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results A total of 29 randomized controlled trials involving 2229 participants met the inclusion criteria. Most DBCIs were delivered at the interpersonal level using common behavior change techniques, including social support (unspecified), instruction on how to perform the behavior, demonstration of the behavior, action planning, and problem-solving. Meta-analysis revealed that DBCIs significantly improved shoulder range of motion across all planes (flexion: standardized mean difference [SMD]=2.08, 95% CI 1.14-3.01; P<.001; extension: SMD=1.74, 95% CI 0.79-2.70; P<.001; abduction: SMD=2.32, 95% CI 1.35-3.28; P<.001; external rotation: SMD=2.29, 95% CI 0.96-3.62; P<.001; internal rotation: SMD=2.98, 95% CI 1.08-4.87; P=.002; adduction: SMD=2.09, 95% CI 1.16-3.02; P<.001), finger climbing wall height (SMD=1.65, 95% CI 1.35-1.95; P<.001), upper-extremity function (SMD=−0.96, 95% CI −1.50 to −0.42; P<.001), quality of life (SMD=1.83, 95% CI 0.44-3.22; P=.01), and reduced pain (SMD=−0.58, 95% CI −0.93 to −0.22; P=.002). However, no significant differences were found in steps (P=.69), time spent in light PA (P=.51), time spent in moderate to vigorous PA (P=.43), sedentary time (P=.18), or physical function (P=.71 or .11). Conclusions DBCIs effectively improve upper-body mobility, function, quality of life, and pain management in survivors of breast cancer. Future research should explore multilevel DBCIs specifically designed to address whole-body PA and SB reduction, with effectiveness evaluated through methodologically rigorous, large-scale trials. Trial Registration PROSPERO CRD42023448098; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023448098

Symptom burden and symptom clusters in patients with breast cancer undergoing endocrine therapy: a cross‐sectional survey

2025-06-19

Baojin Han , Simeng Ren , Jiayue Jin +6 more | Supportive Care in Cancer

In China, many breast cancer (BC) patients opt for traditional Chinese medicine (TCM) to manage unpleasant symptoms. This study aimed to investigate the symptom clusters among patients with BC who … In China, many breast cancer (BC) patients opt for traditional Chinese medicine (TCM) to manage unpleasant symptoms. This study aimed to investigate the symptom clusters among patients with BC who are undergoing endocrine therapy and actively seek TCM treatment in China. Patients with BC who were undergoing endocrine therapy were recruited. Data on symptom burden were gathered using the M.D. Anderson Symptom Inventory-Traditional Chinese Medicine (MDASI-TCM) and a BC-specific symptom questionnaire. The patient's quality of life (QoL) over the previous week was assessed using single-item QoL scales. A total of 214 patients were enrolled in the study. The most common moderate to severe symptoms were sleep disturbance (n = 122, 57%), difficulty remembering (n = 105, 49%), sweating (n = 90, 42%), fatigue (n = 89, 41%), and distress (n = 84, 39%). Premenopausal patients experienced higher burdens from sweating, hot flashes, sadness, heat in the palm or solos of the feet, abnormal vaginal discharge, and vaginal dryness (P < 0.05). Six distinct symptom clusters were identified: distress-sleep disturbance, breast-sexual dysfunction, fatigue-related, hot flashes-sweating, pain-joint stiffness, and constipation-bitter taste. The distress-sleep disturbance symptom cluster (B = -0.258, 95% CI -0.383 to -0.133, P < 0.001) and hot flashes-sweating symptom cluster (B = -0.128, 95% CI -0.243 to -0.013, P = 0.029) had a notably detrimental impact on QoL. This study identified six symptom clusters among BC patients undergoing endocrine therapy and who utilize TCM in China. Clinical and demographic factors should be considered in managing these symptoms. The distress-sleep disturbance and hot flashes-sweating clusters particularly deserve more attention due to their significant impact on QoL.

Effects of exercise interventions on bone health and body composition in postmenopausal women with breast cancer: a systematic review and meta-analysis

2025-06-18

Shan Yu , Chengfei Gao , Chuanjian Yi +1 more | Frontiers in Oncology

Objective To evaluate the effects of exercise interventions on bone health and body composition in postmenopausal women with breast cancer. Methods A systematic search was conducted across PubMed, EMBASE, Web … Objective To evaluate the effects of exercise interventions on bone health and body composition in postmenopausal women with breast cancer. Methods A systematic search was conducted across PubMed, EMBASE, Web of Science, CENTRAL, and CNKI databases for randomized controlled trials (RCTs) published before October 2024. Data from eligible studies were extracted and analyzed using STATA software. Results Eight RCTs comprising 1099 participants were included. The results indicated no significant differences between exercise and control interventions in patients’ bone mineral density (BMD) at the lumbar spine (WMD = 0.116, 95% CI [-0.357, 0.589], p = 0.631), femoral neck (WMD = -0.214, 95% CI [-0.497, 0.068], p = 0.137), or total hip (WMD = 0.299, 95% CI [-0.283, 0.882], p = 0.314). For body composition parameters, exercise interventions led to significant improvements in lean mass (WMD = 0.192, 95% CI [0.023, 0.362], p = 0.026) and marked reductions in percent body fat (WMD = -1.327, 95% CI [-2.587, -0.066], p = 0.039) compared to the control. However, no significant differences were observed in body weight (WMD = -0.024, 95% CI [-0.193, 0.146], p = 0.784) or fat mass (WMD = -0.078, 95% CI [-0.703, 0.546], p = 0.806) between the two interventions. Conclusion The current evidence suggested that exercise interventions effectively improve lean mass and reduce percent body fat but have a limited impact on BMD in postmenopausal women with breast cancer. A multimodal, individualized exercise program is recommended to address the challenges of bone health and body composition in this population. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024613744.

Factors associated with self-care practices in postoperative colorectal cancer patients undergoing chemotherapy

2025-06-18

Higini Cao , T.K. Nguyen , Kieu Ngoc Thi +2 more | Y HOC TP HO CHI MINH

Self-care practices are essential for helping patients undergoing adjuvant chemotherapy after colorectal cancer surgery in managing and coping with the common side effects of treatment. However, these practices can be … Self-care practices are essential for helping patients undergoing adjuvant chemotherapy after colorectal cancer surgery in managing and coping with the common side effects of treatment. However, these practices can be influenced by various factors. Identifying these factors is crucial, as it enables healthcare providers, particularly nurses, to design and implement interventions that can improve patients’ self-care abilities and overall quality of life. A descriptive analytical cross-sectional study was conducted on 200 postoperative colorectal cancer patients receiving adjuvant chemotherapy at Cho Ray Hospital, who were interviewed directly using a structured questionnaire between April and August 2023. Participants who met the inclusion criteria and provided consent were included in the study. The mean age of the patients was 57.8±11.4 years, with 65% being male, and 64% had been undergoing chemotherapy for less than six months. The proportion of patients practicing good self-care was 24%, indicating that the rate of effective self-care practices remained low. Multivariable logistic regression analysis revealed independent associations, showing that employed patients and those with higher education levels were more likely to engage in good self-care practices (Employment: OR=4.05, 95%CI: 1.82–10.1, p=0.045; High school: OR=9.72, 95%CI: 3.62–9.62, p=0.001; University: OR=5.38, 95%CI: 3.46-35.3, p=0.008). Additionally, patients with better knowledge and the ability to meet their basic needs were more likely to practice good self-care (Chemotherapy and self-care knowledge: OR=3.01, 95%CI: 1.80–5.04, p<0.001; Ability to meet basic needs: OR=5.31, 95%CI: 1.71–16.5, p=0.004). The rate of effective self-care practices among patients remained low. Interventions to improve self-care should consider factors such as employment status, level of education, family history of cancer, duration of chemotherapy-related side effects, knowledge of chemotherapy and self-care, and the capacity to meet basic needs to effectively enhance self-care behaviors

Burden of Functional Impairments in Latin American Cancer Survivors

2025-06-18

Ana Carolina Méndez Silva , Gema Herrera-Belmonte , Vanessa Uclés-Villalobos +5 more | Current Physical Medicine and Rehabilitation Reports

A systematic review of patient-reported outcome measures (PROMs) to assess health-related quality of life (HRQoL) for breast cancer patients who are undertaking adjuvant endocrine therapy

2025-06-18

Rila Su , Claire Snyder , Albert W. Wu +4 more | Quality of Life Research

What are the optimal mind-body therapies for cancer-related pain? A network meta-analysis

2025-06-18

Xiu-yun He , Guihong Liang , Zhiyong Zou +6 more | Deleted Journal

Abstract Introduction Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies (MBTs) as a method for treating cancer-related pain (CRP). However, the most effective … Abstract Introduction Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies (MBTs) as a method for treating cancer-related pain (CRP). However, the most effective MBTs for improving CRP in this population remain unknown. Therefore, this network meta-analysis (NMA) aimed to assess and rank the relative efficacy of different MBTs for CRP, and to conduct subgroup analyses according to different cancer types and stages of treatment. Content Eight electronic databases were searched for randomized controlled trials (RCTs) that compared different MBTs to improve pain in adults living with cancer. RCTs were evaluated using the Cochrane risk of bias tool. A random effects network meta-analysis was performed within a frequentist framework. Of the 4,916 articles retrieved and screened against the selection criteria. 36 studies with a total 2,387 participants were eligible to be included in the analysis. Qigong demonstrated significantly greater effects than Usual care (standardized mean difference [SMD] −0.85, 95 % confidence interval [CI] −1.46 to −0.24), Waitlist (SMD −0.93, −1.77 to −0.08), and Massage (SMD −1.71, −3.20 to −0.23), with the highest surface under the cumulative ranking value of 86.5 %, was ranked first. It was preceded by Conventional exercise (75.2 %), Taichi (74.9 %), with Massage having the lowest rank (7.2 %). In a subgroup analysis of breast cancer, Taichi (89.6 %), Conventional exercise (68.4 %), and Pilates (68.3 %) ranked as the top three. Summary and outlook This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies (MBTs) for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.

Latent class analysis of depression among patients with non-small cell lung cancer after surgery: A cross-sectional study

2025-06-17

Xiaoxu Wang , Jinxin Liu , Cuicui Li +4 more | PLoS ONE

Background Depression exhibits heterogeneity. However, limited research has explored this heterogeneity in patients with non-small cell lung cancer (NSCLC) after surgery from a person-centered perspective. This study aimed to identify … Background Depression exhibits heterogeneity. However, limited research has explored this heterogeneity in patients with non-small cell lung cancer (NSCLC) after surgery from a person-centered perspective. This study aimed to identify classes of depression using latent class analysis (LCA) in patients with NSCLC after surgery and to explore the association between these classes and demographic and clinical characteristics, physical symptoms, distress disclosure, and relationship quality. Methods A cross-sectional study was conducted with 234 patients with NSCLC in China from March 17, 2024 to May 16, 2024. Participants provided written informed consent before participating in the study. LCA was performed to identify latent classes of depression. Binary logistic regression analysis was employed to examine the association between the identified classes and related factors. Result This study identified two distinct classes: the severe depression group (Class1, N = 162, 69%) and the mild depression group (Class2, N = 72, 31%). Binary logistic regression result demonstrated that, compared with the mild depression group, factors associated with the severe depression group included pain, fatigue, sleep quality, reluctance to distress disclosure and perceived low relationship quality. Conclusions The current study provides evidence of the heterogeneity of depression among Chinese patients with NSCLC after surgery. Healthcare providers can develop tailored interventions by identifying the unique characteristics of each depression class. For patients in the severe depression group, interventions should focus on symptom alleviation, encouraging self-disclosure, and enhancing the quality of family relationships to improve their depression. As this study is cross-sectional, future research should validate these depression classes in larger and more diverse populations, both in China and globally. Trial registration Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn ; registration no.: ChiCTR2400081943).

Communication and fear of cancer recurrence in colorectal cancer survivors and their partners

2025-06-16

Hannah Z. Catzen , Paul Abrahamse , Kevin C. Ward +2 more | Supportive Care in Cancer

Abstract Purpose Little is known about how colorectal (CRC) survivors and their partners communicate about cancer or experience fear of cancer recurrence (FCR). To effectively support and guide survivors and … Abstract Purpose Little is known about how colorectal (CRC) survivors and their partners communicate about cancer or experience fear of cancer recurrence (FCR). To effectively support and guide survivors and partners, we designed a dyadic survey and investigated whether survivors’ health-related quality of life (HRQoL) was associated with dyadic discordance in communication or FCR. Methods From 2019–2020 we surveyed survivors of stage III CRC and their partners. We measured dyadic cancer communication using the Lewis Mutuality and Interpersonal Sensitivity Scale. We asked dyads 3 questions about FCR. We measured survivors’ HrQoL using the PROMIS-29 + 2 profile, v 2.1. We used bivariate analyses and multivariable logistic regressions to compare survivor and partner responses, describe characteristics of discordant dyads, and assess associations between survivors’ HrQoL and discordance in cancer communication and FCR. Results We analyzed data from 307 paired survivor-partner dyads (51% survivor response rate; 73% partner response rate). 29% dyads were discordant in cancer communication. 26% dyads were discordant in FCR. Greater discordance in cancer communication was associated with female survivor sex and greater partner educational attainment. Greater discordance in FCR was associated with younger survivor age and receipt of radiation (all p < 0.05). Worse survivor HRQoL was associated with greater discordance in FCR and receipt of radiation (all p < 0.01). Conclusions Our findings highlight the complex dynamics dyads experience during CRC survivorship. While open communication is crucial, differing levels of shared fears and concerns can significantly impact health-related quality of life (HRQoL). Addressing these issues, especially FCR, can enhance patient-centered survivorship care.

Nutritional status and quality of life of patients with breast cancer receiving chemotherapy

2025-06-16

Tien Quang Nguyen , Phuong Pham , Bach Hoang +2 more | World Academy of Sciences Journal

Promoting resilience in stress management (PRISM) for patients with early stage breast cancer: a pilot feasibility study

2025-06-16

Gabrielle B. Rocque , Etzael Ortiz Olguin , Jessi M Shuey +7 more | Breast Cancer Research and Treatment

Abstract Purpose Women with breast cancer often experience persistent psychological distress. Promoting resilience in stress management (PRISM) is a manualized, skills-based, psychosocial intervention shown to promote resilience and alleviate psychological … Abstract Purpose Women with breast cancer often experience persistent psychological distress. Promoting resilience in stress management (PRISM) is a manualized, skills-based, psychosocial intervention shown to promote resilience and alleviate psychological distress among adolescents and young adults with cancer. Methods This pilot, convergent mixed methods study examined PRISM’s feasibility and in-sample preliminary impact (single-group) on psychosocial outcomes of women with early stage breast cancer (EBC). Women receiving chemotherapy for stage I–III breast cancer completed six standard PRISM sessions focused on rapport building, stress management, goal setting, cognitive reframing, meaning-making, and family integration. Feasibility, the primary outcome, was defined as 70% of participants completing all intervention sessions and pre-post survey. Secondary outcomes included intervention acceptability, appropriateness, and 8 psychosocial outcomes. Patient perspectives on PRISM were elucidated via qualitative interviews and deductively analyze. Pre- and post-intervention changes in survey scores were analyzed using paired t-tests and Cohen’s d effect size. Results Of 57 patients approached, 30 (53%) participated in PRISM; participants were 57% Black with median age of 51 years (IQR 47–59). PRISM sessions were feasible based on the 83% completion rate. Additional secondary implementation outcomes also demonstrated feasibility, acceptability, and appropriateness using validated survey measured. The largest effects were observed in participants’ resilience ( d = 0.6), growth ( d = 0.5), and self-improvement ( d = 0.5). Interviews supported both feasibility and impact of PRISM. Conclusion The PRISM-EBC intervention was feasible, and pre-post changes suggest potential benefit, warranting further investigation in a future randomized controlled trial.

Corrigendum to “Physical Performance and Activity in Older Prostate Cancer Survivors in Comparison with Population-based Matched Controls” [Eur. Urol. Open Sci. 71 (2025) 85–95]

2025-06-16

Reidun Sletten , Marit Slaaen , Line Oldervoll +7 more | European Urology Open Science

Patient Reported Tolerance of 90 Days of Pre-Operative Endocrine Therapy: Results from the POWER Trial

2025-06-16

Trish Millard , Lena Turkheimer , Jenna Schlefman +3 more | The Oncologist

Abstract Background Prospective randomized data supports radiation omission in women ≥ 65 years who take adjuvant endocrine therapy (AET) following breast-conserving surgery. Many patients who omit radiation stop AET early … Abstract Background Prospective randomized data supports radiation omission in women ≥ 65 years who take adjuvant endocrine therapy (AET) following breast-conserving surgery. Many patients who omit radiation stop AET early due to side effects. In the POWER trial, a prospective single-arm study, patients took 90 days of pre-operative endocrine therapy (pre-ET) to assess tolerance before making adjuvant treatment decisions. We hypothesized that patient-reported outcomes (PROs) during pre-ET would be heterogeneous and that 90 days was sufficient time for symptoms to develop. Patients and Methods PRO data from POWER trial participants was obtained before, during, and after pre-ET, including health-related quality of life (HRQoL), depression, and ET symptoms using the EORTC-QLQ, CESD-R, and BCPT-SCL tools. PRO assessments were further analyzed after stratifying patients by high or low perceived sensitivity to medicine (PSM). Results Pre-ET PROs were assessed for 75 participants. The majority (73.3%) reported symptoms during pre-ET. Only 10.7% had symptoms severe enough to stop pre-ET before 90 days. Vasomotor (42.7%) and musculoskeletal (41.3%) symptoms were the most common. HRQoL was preserved for 66.6% participants. Patients with high PSM had more ET side effects. Conclusion Patients developed similar side effects during pre-ET as those typically seen with AET. PROs and the impact of pre-ET on HRQoL were patient-dependent. A 90-day course of pre-ET is sufficient for patients to develop symptoms reflective of long-term AET. Future analyses will assess the association of pre-ET PROs with AET initiation and adherence.

Development and validation of a nomogram for predicting cancer-related fatigue in patients with glioma: a multicenter study

2025-06-16

Qiuxia Wu , Chang Su , Minyan Xing +1 more | Frontiers in Oncology

Background Cancer-related fatigue (CRF) is one of the most prevalent symptoms which drastically affect patient health and quality of life. This study aimed to construct and validate a nomogram to … Background Cancer-related fatigue (CRF) is one of the most prevalent symptoms which drastically affect patient health and quality of life. This study aimed to construct and validate a nomogram to accurately predict the occurrence of cancer-related fatigue in patients with glioma. Methods This cross-sectional study included 470 glioma patients from two hospitals (training cohort: n=284; validation cohort: n=186). All patients were categorized into two groups based on their Numerical Rating Scale scores of cancer-related fatigue: a no or mild fatigue group (scores 0-3) and a moderate to severe fatigue group (scores 4-10). LASSO model and multivariable logistic regression analyses were used to determine the significant risk factors contributing to the occurrence of cancer-related fatigue in glioma patients. A nomogram was constructed and its predictive accuracy and conformity was validated by ROC curves, calibration curves and decision curve analysis. Results Combining LASSO algorithm and multivariable logistic regression analyses, the cancer stage (p=0.014), and the scores of Perceived Social Support Scale (PSSS) (p&lt;0.001), physical functioning (PF) (p&lt;0.001), bodily pain (BP) (p=0.031), general health (GH) (p&lt;0.001), and mental health (MH) (p=0.009) were the independent risk factors for cancer-related fatigue of glioma patients. A clinically quantitative predictive model nomogram was developed based on these extracted risk factors. The concordance-index of nomogram was 0.964 (0.935-0.993). The AUC values of nomogram were 0.916 (CI: 0.879-0.953) in the training cohort and 0.885 (CI: 0.829-0.941) in the validation cohort. The calibration curves of this nomogram exhibited a notable concordance with the ideal diagonal line. The decision curve analyses illuminated that this nomogram achieved high clinical net benefit. Conclusion The nomogram, incorporating the cancer stage of glioma, perceived social support, and quality of life of patients, demonstrated good accuracy and clinical practicality. It can serve as a valuable prediction and evaluation tool for anticipating the occurrence of cancer-related fatigue in patients with glioma.

Work-related experiences and needs while undergoing curative cancer therapy: exploring the target population’s perspective during the developmental phase of a work-oriented intervention

2025-06-16

Linda Eklund , Maria Engström , Angela G. E. M. de Boer +5 more | Supportive Care in Cancer

Abstract Purpose Cancer affects a great number of people during working life, and tailored interventions targeting this population are important. The present study, focused on the developmental phase of a … Abstract Purpose Cancer affects a great number of people during working life, and tailored interventions targeting this population are important. The present study, focused on the developmental phase of a work-oriented intervention, aimed to describe work-related experiences and needs among people undergoing curative cancer therapy. Methods People ( n = 22, age md 55 years, range 39–64, purposive sampling) undergoing adjuvant or neo-adjuvant chemo-/radiotherapy for breast ( n = 12), prostate ( n = 5), or colorectal ( n = 5) cancer were individually interviewed using a semi-structured interview guide covering their ability to work and work-related facilitators, barriers, and needs. Qualitative content analysis with an inductive approach was applied. Results When undergoing curative cancer treatment, striving for work–life balance and a normal life is challenging, but necessary for wellbeing, according to the participants. Five subthemes described their experiences and needs: “Cancer is not my identity, and working helps me experience a sense of self,” “I mostly have confidence in my future ability to work,” “I need to find a new balance between work, private life, and my changed health needs,” “Having flexible working conditions helps me work, and both strengthens and limits my wellbeing,” and “Having access to individual support, in which others and I participate, affects my ability to work.” Conclusion While undergoing curative cancer therapy, striving for work–life balance and a normal life is challenging but necessary for wellbeing. Our study findings suggest that a work-oriented intervention tailored to individual needs, flexibility in working conditions, and cooperation between the employee and various stakeholders are warranted during the early stage of cancer therapy.

A decade review of mental health monitoring in clinical trials for United States Food and Drug Administration‐approved genitourinary cancer treatments

2025-06-15

Farzad Teymouri , Parnian Jabbari , Omid Yazdanpanah +3 more | BJU International

Prevalence of depression and anxiety among cancer patients

2025-06-14

A Brar , Richard J. Rebello , Abdul Sajid Mansoori | Adesh University Journal of Medical Sciences & Research

Objectives: The objective is to study the prevalence of anxiety and depression in patients with cancer. Material and Methods: Cancer patients who presented to the oncology and psychiatric departments of … Objectives: The objective is to study the prevalence of anxiety and depression in patients with cancer. Material and Methods: Cancer patients who presented to the oncology and psychiatric departments of AIIMS were the subject of a cross-sectional investigation. Participants’ informed written agreement was obtained during the development of the case and thorough verbal explanations and descriptions of the research issue. Confidentiality was guaranteed to them. The lead investigator used Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale after using the semi-structured proforma to record the patients’ sociodemographic information. The ICD-0 criteria will be applied to diagnose anxiety and depression. Results: The average age of the patients was 52.57 years. The predominant mental illness of somewhat more than half ( n = 17; 56.67%) of the patients was either a depressive disorder or generalized anxiety disorder. The majority of patients with generalized anxiety disorder ( n = 11; 36.67%) had mild anxiety ( n = 5, 16.6%), followed by moderate anxiety ( n = 4, 13.3%), while the least number had severe anxiety ( n = 2, 6.67%). Depression was marginally more prevalent than generalized anxiety disorder ( n = 15; 50%). Conclusion: Depression and anxiety can make it more difficult to follow a treatment plan, make physical symptoms worse and lead to more people using healthcare services. Therefore, mental therapies may be necessary during cancer patients’ therapy to control their anxiety and depression.

Translating advocacy into action: exploring oncology healthcare professionals’ awareness and use of the Clinical Oncology Society of Australia position statement on exercise in cancer care

2025-06-14

Jack Dalla Via , Francesca Cehic , Carolyn J. Peddle‐McIntyre +6 more | Supportive Care in Cancer

Abstract Purpose The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care encourages all healthcare professionals to discuss, recommend, and refer people with cancer to exercise; … Abstract Purpose The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care encourages all healthcare professionals to discuss, recommend, and refer people with cancer to exercise; however, use of these recommendations in practice is unknown. Methods Oncology healthcare professionals working in Australia were invited to complete a cross-sectional online survey that assessed contextual factors that influence implementation of COSA exercise guidance in cancer care, based on the Consolidated Framework for Implementation Research. Results We received 133 survey responses. Most were women (74%), nurses (35%), or oncologists (26%), involved in cancer care for > 10 years (63%), and in a public hospital setting (69%). Most participants agreed that exercise is beneficial (94%) and the COSA recommendations would positively influence patients’ exercise behaviours (94%). However, only 35% routinely apply COSA recommendations in practice, and only 35% believe they are the best person to provide exercise support. Patient-level barriers included needing additional support to access exercise (92%), most commonly financial (74%). Organisational-level barriers included a lack of dedicated resources to support delivering exercise guidance (69%), and not believing providing exercise guidance is an important part of their role (51%). Only 24% agreed their organisation revised practice based on the COSA recommendations. Conclusion Despite most oncology healthcare professionals agreeing that exercise is beneficial, and that the COSA recommendations are important for patients, only a minority actually apply the recommendations in their practice. Targeted implementation efforts are needed to facilitate use of COSA exercise guidance in clinical practice.