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Purpose: Living through cancer can have a profound effect on identity. Among those treated for adult-onset cancer, identifying as a cancer survivor is common and has been linked to positive mental ...

BACKGROUND: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. MATERIALS AND METHODS: Female cancer survivors aged 22–45 years, diagnosed between ages 20–35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. RESULTS: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85–1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age

Objectives To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history. Methods We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history. Results Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment. Conclusion These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group. Practical implications Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients’ concerns about the pandemic and how it relates to their course of treatment.

Purpose Due to stay-at-home orders during COVID-19, we transitioned supervised, group, in-person resistance training interventions in two clinical trials in cancer survivors to live, online delivery using video-conferencing technology. We describe the feasibility, preliminary efficacy, and safety of live online group training and compare to in-person training. Methods Adherence (% sessions attended), retention (% participants completing intervention), and safety (# adverse events) data of resistance training groups from two randomized controlled trials in cancer survivors that participated before or during the COVID-19 pandemic were collated. Participants were post-treatment breast cancer survivors and their spouses (n = 62) and prostate cancer survivors (n = 32) (age range: 38-82 years). During COVID-19, delivery of supervised, group resistance exercise sessions was delivered live online via video-conference. Preliminary evidence for training efficacy was assessed by chair stand performance over the 6-month intervention. Results Feasibility of online resistance training was better than in-person for both studies (adherence: 86% vs 82% and 91% vs. 81% and retention 95% vs. 80% and 92% vs. 84% for online and in-person classes). Improvements in chair stand time were similar in prostate cancer and spouse groups that trained online vs. in-person, except for breast cancer survivors who improved more with in-person training (7% vs. 14% for online vs. in-person). Safety was similar between formats (12 vs. 11 adverse events for online vs. in-person). Conclusion Supervised, in-person group resistance training can be feasibly adapted for live, online delivery and could help broaden approaches to exercise delivery in cancer survivors, including older adults. Trial registration The studies described in this commentary were registered on ClinicalTrials.gov on August 3, 2018 (NCT03630354) and on October 30, 2018 (NCT03741335).

PURPOSE To understand the impact of cancer survivors accessing a standard factsheet regarding cancer-related cognitive impairment (CRCI), publicly available to the Australian public via Cancer Council Australia's websites. METHODS Twenty-three cancer survivors completed a questionnaire assessing pre-factsheet knowledge of CRCI. Semi-structured interviews were conducted to explore participants' experiences of CRCI and perceptions of the factsheet. Interviews were analysed via thematic analysis using a framework approach. Finally, participants completed another questionnaire assessing post-factsheet change in knowledge of CRCI. RESULTS Pre- and post-factsheet questionnaire change scores indicated increased knowledge and greater confidence about CRCI. Interview data resulted in five themes: generally positive perceptions of the factsheet's layout and wording; survivors, regardless of treatments received, experienced CRCI symptoms, with some having strong negative emotional responses to their symptoms; perceptions of the factsheet's strategies to manage CRCI ranged from relevant and useful, to impractical or unrealistic if symptoms were too severe; interactions with healthcare system influenced survivors' perceptions of help-seeking, with negative healthcare experiences a major barrier; and generally positive impacts of the factsheet, with survivors praising the factsheet's ability to validate the CRCI experience, increase CRCI knowledge, influence health beliefs, and prompt help-seeking. CONCLUSION The factsheet presentation and wording were acceptable to participants. Its ability to normalise and raise awareness for CRCI validated participants' symptoms. The factsheet's potential as a first-line intervention in a stepped-care approach was identified, with participants finding the suggested self-management strategies practical. The factsheet may overcome barriers to self-reporting by encouraging patients to talk with HCPs about CRCI.

Oncosexology is a multidisciplinary field composed of physicians, nurses, psychologists, and other health care professionals focusing on sexual issues in patients with cancer. Although any cancer diagnosis or treatment can be associated with sexual dysfunction, pelvic malignancies (such as prostate, bladder, or colorectal cancer) have the highest rates of sexual dysfunction in men. This includes erectile dysfunction, testosterone deficiency, ejaculatory dysfunction, orgasmic dysfunction, sexual incontinence, and penile shortening. Testicular cancer and hematologic malignancies also have a significant impact on patients' sexual function. Health care providers should address sexual dysfunction with their patients, including any adverse effects of potential treatment options.

Cancer prevention and control has benefited substantially from behavioral medicine research over the last several decades. The National Cancer Institute’s (NCI) Division of Cancer Control and Population Sciences, ably led by Barbara Rimer and then Bob Croyle since being established in 1997, has been a primary supporter of this research. NCI has made significant investments in many of the topics featured in this special section and will continue to do so. These include research on basic behavioral processes such as affect as well as optimal approaches to health communication. A key and enduring focus has been the support of behavioral interventions, particularly for tobacco, diet, physical activity, and sun exposure. The success of such interventions will be amplified to the extent that they leverage novel research designs, emerging digital technologies, evidence gleaned from the burgeoning field of implementation science, and lessons learned from greater attention to the impact of health disparities and inequities. Moreover, as the cancer survivor population continues to grow given the rapid development of diagnostic and therapeutic science, it will be even more essential to devote attention to understanding and addressing the health care and other needs of survivors such as cognitive dysfunction and financial toxicity. The field of behavioral medicine should be both applauded for its many contributions to reducing the cancer burden and encouraged to continue developing new research ideas in these critical areas.

Background Cancer survivors develop other chronic medical conditions because of shared risk factors and delayed effects of cancer treatment. This study investigated trends in the prevalence of chronic diseases and estimated their population sizes among adult cancer survivors in the United States from 2002 to 2018. Methods Using 2002-2018 National Health Interview Survey data, this study calculated the age-sex-race/ethnicity-adjusted prevalences and estimated the population sizes for the following chronic conditions among cancer survivors: hypertension, diabetes, stroke, heart disease, chronic obstructive pulmonary disease (COPD)/asthma, hepatitis, arthritis, liver disease, kidney disease, and morbid obesity. This study also examined multiple chronic conditions (MCC; 3 or more health conditions). MCC trends were further examined by sociodemographic factors to identify high-risk populations. Parallel analyses were performed for participants without a cancer history to provide a reference. Results Among 30,728 cancers survivors, increasing trends were observed in the prevalence of hypertension, diabetes, kidney disease, liver disease, and morbid obesity, whereas decreasing prevalence trends were observed for ischemic heart disease, COPD, and hepatitis. Cancer survivors with MCC increased from 4.7 million in 2002 to 8.1 million in 2018 (the prevalence increased from 43.7% to 46.6%). The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the MCC prevalence also increased, although more slowly than among survivors. Conclusions The number of adult cancer survivors in the United States with comorbid illnesses has increased substantially over the past 2 decades. Optimal management of comorbid conditions and aggressive interventions for risk reduction may benefit the cancer survivor population.

BACKGROUND The majority of breast cancer survivors do not engage in sufficient levels of exercise. Community-based exercise programs (CBEP) may mitigate low rates of exercise participation; however, few programs exist. Previous research exploring the determinants of CBEP implementation for cancer survivors is limited in that it has predominantly focused on cancer survivor perspectives or it has failed to rely on a theoretical framework to explore determinants to implementation across various implementation domains. An organizational exploration of the determinants of CBEP implementation for breast cancer survivors is warranted to guide future program implementation. PURPOSE The purpose of this study was to apply the Consolidated Framework for Implementation Research (CFIR) to explore the determinants of CBEP implementation for breast cancer survivors from a program provider perspective. METHODS Data collection and analysis were guided by the CFIR. Program providers completed an online questionnaire and an interview. Transcripts were analyzed using inductive content analysis. Resulting codes were deductively mapped onto the CFIR. RESULTS Seven barriers and seven facilitators were identified, with three key influencers (e.g., program awareness, financial support, and knowledge regarding the benefits of exercise for breast cancer survivors) cited as both barriers and facilitators to program implementation. Barriers primarily operated within the outer setting (e.g., needs and resources) domain of the CFIR, whereas facilitators and key influencers operated across multiple CFIR domains (e.g., culture and planning). CONCLUSIONS Study findings provide insight into the current challenges to CBEP implementation experienced by program providers and highlight potential avenues for future exercise program development and implementation.

PURPOSE: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia. METHODS: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil–lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters. RESULTS: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]). CONCLUSION: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

LAY SUMMARY Guidance on how to approach opioid decisions for people beyond active cancer treatment is lacking. This editorial discusses strategies from the general literature that can be thoughtfully tailored to cancer survivors to provide patient-centered pain and opioid care.

Background Many cancer survivors experience physical and/or psychosocial problems affecting return to work (RTW) and work retention. Current interventions on RTW lack evidence regarding effectiveness, while interventions for work retention are missing. Partners of cancer survivors may also experience work- and health-related outcomes; yet, these consequences are not well understood. Here, the protocol of the STEPS study is described. The study aims are to: 1) evaluate the (cost-)effectiveness of a rehabilitation program for RTW and work retention in cancer survivors, and 2) assess health- and work-related outcomes among cancer survivors’ partners. Methods In a multicentre Randomized Controlled Trial (RCT), 236 working-age cancer survivors with an employment contract will be randomly allocated to a usual care group or an intervention group receiving a multidisciplinary rehabilitation program, combining occupational therapy facilitating work retention (e.g., energy management and self-efficacy training) and reintegration consultation addressing work-related issues (e.g., RTW planning and discussing workplace or task modifications with the supervisor). Alongside the RCT, a prospective cohort study will be conducted among cancer survivors’ partners (n = 267). Participants in the RCT and cohort study will be asked to complete questionnaires at baseline, and after six and 12 months, assessing work- and health-related outcomes. Generalized estimating equations will be used to assess intervention’s effectiveness, compared to usual care, regarding primary (i.e., working hours per week) and secondary outcomes. Also economic and process evaluations will be performed. For the cohort study, logistic or linear regression modelling will be applied assessing work- and health-related outcomes (primary outcome: working hours) of cancer survivors’ partners, and what factors predict these outcomes. Results The study is planned to start in September 2021; results are expected in 2023. Conclusion Compared to usual care, the STEPS intervention is hypothesized to be (cost-)effective and the intervention could be a valuable addition to standard care helping cancer survivors to sustain employment. Further, it is expected that living with a cancer survivor has a substantial impact on work and health of partners, while specific groups of partners that are at particular risk for this impact are likely to be identified. Trial registration Dutch Trial Register (NTR;NL9094; 15-12-2020).

Objective: Self-rated health (SRH) is a salient patient outcome for cancer survivors, and depressive mood and education are known determinants of cancer survivors’ SRH. Moving beyond the well-established direct association between depressive mood, education, and SRH among cancer survivors, this epidemiological study investigated the pathoplastic role of education on depressive mood in relation to SRH among a nationally representative sample of cancer survivors in the United States. Methods: The 2019 National Health Interview Survey was analyzed using data from adult participants (≥18 years old) who self-reported as cancer survivors (n = 3844). Ordered logistic regression was used to evaluate the direct impact of depressive mood and education in relation to SRH. In addition, the pathoplastic moderating effect was evaluated using ordered logistic regression with an interaction term of depressive mood and education in the regression model. All analyses adjusted for complex sample weights so that findings are nationally representative. Results: After adjusting for all covariates, U.S. cancer survivors’ depressive mood was significantly associated with lower SRH, and U.S. cancer survivors’ higher education was significantly associated with higher SRH. As a pathoplastic moderator, cancer survivors’ education significantly moderated the association between depressive mood and SRH. The negative association between depressive mood and SRH was significantly greater among those with higher education. Conclusion: Moving beyond the direct association between depressive mood, education, and SRH, education served as a pathoplastic moderator in relation to depressive mood and SRH. Psycho-oncology providers need to be mindful of the “protective-risk” effect of education in relation to cancer survivors’ depressive mood and SRH.

Background and Purpose:Fear of cancer recurrence (FCR) is a frequent psychological adverse effect among cancer survivors. This study aimed to test the psychometric properties of the Traditional Chinese version of the 12-item Fear of Progression Questionnaire-Short Form (FoP-Q-SF).Methods:An online survey was conducted with 311 cancer survivors in Hong Kong. The factor structure, known-group validity, and internal consistency reliability were examined.Results:The values measuring validity is good, with acceptable goodness-of-fit indexes (RMSEA = 0.073, SRMR = 0.042, CFI = 0.954), moderate to large correlations with unmet needs (0.339–0.816), being female, younger, had completed treatment ≤ 2 years, and had undergone chemotherapy/radiotherapy scored significantly higher on the FoP-Q-SF. The Cronbach’s alpha of the scale was .922.Conclusion:High validity and reliability indicate the scale’s value in assessing FCR in Hong Kong cancer survivors.

Purpose As the cancer survivor population increases, diminished health care provider capacity will place more responsibility on survivors to obtain health information. Many survivors search for cancer information online, yet there is a dearth of research on how survivors obtain and engage with this information. This study examined cancer survivors’ information-seeking behaviors and perceptions during a self-guided online search task. Methods Ten adult cancer survivors (largely breast and thyroid) completed a task in which they searched for online cancer-related information of their choice. Participants were asked to verbally narrate the procedural aspects of the task and provide real-time responses to the search results and experiences related to the task. Transcripts were analyzed using a qualitative descriptive approach, and codes and themes were examined and interpreted. Results Participants searched primarily for information specific to their cancer type and stage, seeking personalized information about risk factors, prognosis, and treatments. Additionally, participants reported having to engage in excessive navigation to find relevant cancer information, citing aesthetic, usability, and credibility features of the websites that they considered barriers to obtaining this information. Conclusions Survivors’ online health information needs require streamlined cancer information resources that are disaggregated by cancer type, stage, and treatment course and located on websites with aesthetic and usability features that facilitate expedient searches for personally relevant cancer information. Implications for Cancer Survivors This study provides useful perspectives of cancer survivors that may inform the development of online cancer resources to better serve this population.

Background Although physical activity (PA) and sedentary time in cancer survivors (CSs) were associated with health-related quality of life (HRQOL), it was not clear whether their associations were similar among CSs with different number of comorbid chronic diseases (CCDs). This study aimed to investigate the associations between PA, sedentary time and HRQOL in CSs with different number of CCDs. Methods A cross-sectional study was conducted among 1546 CSs between June and September 2018 in Shanghai, China. Data were collected with a self-reported questionnaire including sociodemographic characteristics, CCDs, PA, sedentary time and HRQOL. International Physical Activity Questionnaire and Cancer Quality of Life Questionnaire-Core30 were respectively used to measure PA and HRQOL of CSs. Associations of PA and sedentary time with HRQOL among CSs with different number of CCDs were evaluated by using logistic regression, adjusted for confounding factors. Results About seventy-five percent CSs had at least one CCD. Approximately three fifths CSs had high PA level and Conclusions High PA level and long sedentary time have significant association with worse HRQOL of CSs with ≥ 3 CCDs, while high PA level is positively associated with HRQOL in CSs with ≤ 2 CCDs. Our findings may support further studies of the causal association between PA, sedentary times and HRQOL to provide targeted proposal to improve the HRQOL of CSs according to their number of CCDs.

Purposes: The purposes of this discrete choice experiment are as follows:1.To investigate the preference of gastric cancer survivors for follow-up care.2.To quantify the importance of follow-up care-related characteristics that may affect the gastric cancer survivors’ choices of their follow-up, so as to provide references for development of the follow-up strategy of gastric cancer survivors.Methods: Discrete choice experimental design principles was applied to develop the survey instrument. All questionnaires were filled out by the respondents and collected on site. A mixed logit model was used to estimate gastric cancer survivors’ preferences. Willingness to pay estimates and simulations of follow-up uptake rates were calculated.Results: All six attributes are significant important for the follow-up care of gastric cancer survivors (p＜0.05). Achieving very thorough follow-up contents was the most valued attribute level (coefficient=1.995). Specialist doctors are the most preferred providers, followed by specialist nurses and gastric cancer survivors were willing to pay more for these attribute levels. Changes in attribute levels affected uptake rate of follow-up. When the multiple attribute levels were changed at the same time, a very thorough follow-up contents provided by the same specialist doctor (specialist nurse), the probability of receiving follow-up increases by 95.82% (94.90%).Conclusions: The characteristics of follow-up care in our study reflect the health management services expectations of gastric cancer survivors. A dedicated specialist nurse involved in follow-up care should be developed to contributes to solve the complex and multifaceted personal needs of gastric cancer survivors.

Purpose Adolescent and young adult cancer survivors require lifelong healthcare to address the late effects of therapy. We examined the impact of different provider models of long‐term follow‐up (LTFU) care on adherence to recommended surveillance. Methods We conducted a retrospective cohort study using administrative health databases in Ontario, Canada. Five‐year survivors were identified from IMPACT, a database of patients aged 15–20.9 years at diagnosis of six cancers between 1992 and 2010. We defined three models of LTFU care hierarchically: specialized survivor clinics (SCCs), general cancer clinics (GCCs), and family physician (FP). We assessed adherence to the Children's Oncology Group surveillance guidelines for cardiomyopathy and breast cancer. Multistate models assessed adherence transitions and impacts of LTFU attendance. Results A total of 1574 survivors were followed for a mean of 9.2 years (range 4.3–13.9 years) from index (5‐year survival). The highest level of LTFU attended in the first 2‐years post‐index was a GCC (47%); only 16.7% attended a SCC. By the end of study, 72% no longer attended any of the models of care and only 2% still attended an SCC. Among 188 survivors requiring breast cancer surveillance, 6.9% were adherent to their first required surveillance testing. Attendance at a SCC in the previous year and higher cumulative FP or GCC visits increased the rate of subsequently becoming adherent. Among 857 survivors requiring cardiomyopathy surveillance, 11% were adherent at study entry. Each subsequent SCC visit led to an 11.3% (95% CI: 1.05–1.18) increase in the rate of becoming adherent. Conclusion LTFU attendance and surveillance adherence are sub‐optimal. SCC follow‐up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve LTFU attendance and promote surveillance adherence., Long‐term follow‐up care attendance and surveillance adherence are sub‐optimal among adolescent and young adult cancer survivors. Specialized survivor clinic follow‐up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve the long‐term follow‐up care attendance and promote surveillance adherence.

Background: Increasing physical activity and reducing sitting time was recommended to cancer survivors after cancer treatment for sustained health and to enhance the quality of life. This study aimed to determine the association of physical activity and sitting time with quality of life among the Malay breast and gynaecological cancer survivors. Methods: A cross-sectional study was conducted among 95 breast and gynaecology cancer survivor subjects. The Malay International Physical Activity Questionnaire (IPAQ) was used to assess physical activity and sitting time. Quality of life was assessed using the Malay EORTC QLQ-C30 questionnaire. Sociodemographic, clinical characteristics and anthropometric measurements were also obtained in this study. Results: The mean age of the subject was 51.8 ± 7.7 years old and the duration of survivorship was 4.3 ± 3.4 years. A total of 76.8% of subjects were categorized as having low physical activity level with a mean MET 403.5 ± 332.7 minutes/week and sitting time of 416.9 ± 151.0 minutes/day. Overall, subjects aged 50 years and above (p=0.006), widowed (p=0.032), retired (p=0.029) and had other non-communicable diseases (p=0.005) showed lower levels of physical activity. Increased physical activity had a positive effect on physical function (r=0.2, p=0.038), reduced insomnia (r=-0.3, p

Objective To better understand how cancer caregivers engage with mental healthcare, this exploratory study sought to assess the distribution and correlates of visit characteristics for mental health-related medical care among spouses of cancer survivors. Methods Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based, outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other), and the health condition(s) associated with the visit. Logistic and multinomial regressions assessed the predisposing, enabling, need, and survivor characteristics associated with the visit characteristics. Results A plurality of spouses of cancer survivors accessed mental healthcare through an office-based visit (90%) with a primary care provider (47%). One third accessed treatment as part of a regular check-up (32%). Several factors were associated with visit characteristics, notably the cancer survivor's health status and healthcare utilization. Conclusions The findings provide an important reminder of the often-invisible mental health burden experienced by cancer caregivers and confirm the importance of routine primary care as a doorway to mental healthcare. Assessing how the care recipient's care needs and caregiving itself may act as barriers to specialty care will be a critical future research trajectory. This article is protected by copyright. All rights reserved.

This case-control study was conducted to determine the antibody titer against the measles virus in childhood cancer survivors' post-chemotherapy treatment to determine the patient's immune status against the measles virus.We enrolled 38 children who were in complete remission and whose treatments had been stopped for at least 3 months and 38 age and sex-matched healthy controls. We analyzed the medical records of the cancer survivors, and each study participant's serum sample was analyzed by the ELISA method to determine the antibody titer against measles.The cancer survivors had significantly lower measles antibody titers than the healthy control participants, and 78.9% of cancer survivors were unprotected (seronegative) compared to 7.9% in healthy controls. After multivariate analysis, there was no statistically significant factor associated with loss of protective humoral immunity against measles.These results underline the need for post-chemotherapy measles antibody testing and revaccination of seronegative survivors.

Gynecologic cancer survivors’ complex needs are too often overlooked. This study aimed to identify the associations between unmet needs and quality of life, and selected characteristics of Indonesian gynecologic cancer survivors. This study was a cross-sectional, correlation study. A total of 298 participants completed the Cancer Survivor Unmet Needs (CaSUN), EORTC QLQ-C30, and demographic and clinical-related questionnaires. A higher level of unmet needs was linked to lower perceived quality of life. Higher levels of unmet needs were associated with younger age, lower income, higher educational background, shorter time since diagnosis, more advanced cancer stage, and having combination therapies (p < 0.05). The most frequently reported unmet need of the Indonesian gynecologic cancer survivors was financial support (70.5%). The gynecologic cancer survivors who had completed primary treatment need continuous comprehensive cancer care to help them cope with the lingering or emerging problems related to cancer and its treatment.

Background Research on cannabis use among those with a history of cancer is limited. Methods Prevalence of past-year cannabis use among individuals with and without a cancer history and predictors of use within these 2 groups were determined using data from the Population Assessment of Tobacco and Health study, a nationally representative, longitudinal survey conducted in the United States (waves 1-4; 2013-2018). Discrete time survival analyses were used to estimate baseline (wave 1) predictors (physical health status, mental health status, pain, and demographic variables) on past-year engagement with cannabis within individuals who reported a cancer diagnosis at wave 1 (n = 1022) and individuals who reported never having cancer at any wave (n = 19,702). Results At the most recent survey, 8% of cancer survivors reported past-year cannabis use, compared with 15% of those without a cancer history. Across 4 time points, an estimated 3.8% of cancer survivors engaged with cannabis, as compared to 6.5% of those without a cancer history. Across both groups, older age and having health insurance were associated with lower likelihood of engaging in cannabis use, whereas greater levels of pain were associated with higher likelihood of engaging in cannabis use. Among those without a cancer history, being female, White, and having better mental health status were associated with lower likelihood of engaging in cannabis use. Conclusions Although cannabis use prevalence is lower among cancer survivors, the reasons for use are not markedly different from those without a cancer history. Continued monitoring of use, reasons for use, and harms or benefits is warranted. Lay Summary Results from this study, which uses data from the Population Assessment of Tobacco and Health Study, indicate that cannabis use is generally increasing across cancer survivors and those without a history of cancer. Cancer survivors are using cannabis at slightly lower rates than those without a history of cancer. Factors related to pain seem to be more prevalent in cancer populations relative to the general population, and could be contributing to cannabis use within cancer survivor populations.

Background: This study aimed to investigate trends in the prevalence of current smokers and motivation to quit among Korean male cancer survivors.Methods: Out of 20,012 men who participated in the Korea National Health and Nutrition Examination Survey V (2010–2012), VI (2013–2015), and VII (2016–2017), 742 cancer survivors were included. A cancer survivor was defined as a person who concurred to the item, “The cancer has been diagnosed by a doctor” in the health questionnaire. Smoking status was classified as current, former, and never smokers. Regarding motivation to quit smoking, we defined those who had a willingness to quit within 6 months as the willing group. Logistic regression analysis was conducted to examine trends in the prevalence of current smokers and the proportion of the willing group among current smokers.Results: Overall, 3.7% of Korean men who participated in the study were cancer survivors. Current smokers constituted 19.5%, 19.1%, and 15.3% of cancer survivors in phases V, VI, and VII respectively which did not show significant changes (P for trend=0.33). However, the proportion of current smokers in the non-cancer group was significantly reduced to 46.6%, 41.2%, and 38.9% in phases V, VI, and VII, respectively (P for trend

Background: Dietary supplements (DS) use is known to be common among cancer survivors. However, detailed information on the factors influencing DS use seems insufficient, including cancer-related and psychological factors.Methods: Study subjects were 1,852 Korean adult cancer survivors recruited from cancer survivor clinic of two university-affiliated hospitals. Data were collected retrospectively through review of medical records and self-administered questionnaires. Psychological factors were assessed using Hospital Anxiety and Depression Scale (HADS) and Fear of Cancer Recurrence Inventory-Short Form. Factors associated the DS use were evaluated by multiple logistic regression analysis after adjusting for covariates.Results: The prevalence of long-term DS use was 15.7% in overall (17.5% in female and 11.6% in male). Female survivors were 3.14 times (95% confidence interval [CI], 1.89–5.22) more likely to use DS than male. In male cancer survivors, ever-smoking and previous radiotherapy were positively associated with DS use. In females, breast cancer survivors were 0.32 times less likely to use DS compared with stomach cancer survivors, and survivors with family history of cancer were 1.39 times more likely to use DS than those without. After adjusting for sociodemographic, clinical, and lifestyle factors, survivors with anxiety (HADS ≥8) used DS 1.38 times (95% CI, 1.01–1.91) more frequently, compared with those without anxiety.Conclusion: Diverse factors such as female sex, cancer treatment modality, smoking history, family history and anxiety status were associated with DS use in Korean cancer survivors. Targeted strategies with consideration of these factors are needed for counseling DS use for cancer survivors.

Lung cancer screening with low-dose computed tomography (LDCT) can reduce mortality from lung cancer. Individuals with previous malignancy are at an increased risk of lung cancer but are often underrepresented in clinical trials. This study compares the outcomes of LDCT screening among individuals with and without cancer history.The study cohort included consecutive participants undergoing LDCT screening at a tertiary care cancer institution. Abnormal screening result was defined as having Lung-RADS 3 or 4 at baseline (T0). Participant information was prospectively collected and predicted risk of lung cancer was calculated per the PLCOm2012 model.A total of 454 participants underwent LDCT screening. Abnormal screening result occurred in 57 (13.2%) participants at T0, and lung cancer was diagnosed in 11 (2.4%) participants. Among 153 individuals with cancer history, abnormal result occurred in 9.8%, compared with 15.4% among those without cancer history (P = .11). Lung cancer was diagnosed in 1.3%, compared with 3.5% (P = .22). The predicted risk of lung cancer at 6 years was higher among individuals with cancer history than those without: 4.8% versus 2.2% (P .001). In a multivariable analysis, cancer history significantly reduced the likelihood of abnormal screening (odds ratio, 0.49; 95% confidence interval, 0.26-0.94; P = .03). We observed a higher proportion of participants who had a previous CT scan available for comparison at T0 among individuals with cancer history than those without: 43.1% versus 9.1% (P .001).In this single-institutional study, individuals with cancer history were significantly less likely to have abnormal screening results than those without cancer history.

Purpose: This is the first pilot study to examine survivors’ experiences and primary care physicians and nurse practitioners’ knowledge and behaviour practices with respect to late effects (e.g., fatigue, chemobrain, lymphodema, cardiac problems, reproductive, infertility and sexual health issues, bone problems, and pain). Methods: Two separate focus groups consisting of 5 breast cancer survivors and 5 primary care physicians and nurse practitioners recruited from a local hospital in Central Illinois answered predetermined questions about cancer survivorship care. We intentionally limited the sample in order to conduct a detailed discussion (90 minutes) to gain every participant’s perspective. Results: Breast cancer survivors expressed a void in discussion and lack of knowledge among their primary care physicians regarding late effects as well as psychological consequences, referrals to support groups, and availability of resources (e.g., finances), thereby negatively affecting survivors’ quality of life. A primary care clinician (PCC) focus group revealed a service gap for mental health services for all patients, knowledge deficit about late effects, and lack of awareness of patient resources. Both cancer survivors and PCCs were extremely supportive about a shared care survivorship model between oncology and primary care. All focus group participants were unequivocally receptive about enhancing survivorship care throughout a cancer survivor’s lifetime. Conclusion: Complementing cancer survivorship care with primary care clinicians in the areas of late effects, in addition to psychological consequences, screening, and lifestyle habits will enhance a cancer survivor’s health-related quality of life.

Overall cancer death rates have fallen since a peak in 1991 due to declining death rates for lung, colorectal, breast, and prostate cancers. A "cancer survivor" is defined as anyone with a cancer diagnosis. Their numbers are increasing for several reasons including better screening, earlier detection, and improved treatments. The American Cancer Society's projections for colorectal cancer in 2020 are 147,950 new cases and 53,200 deaths. By 2024, there will be an estimated 1.71 million colorectal cancer survivors (17% of all cancer survivors) and many will experience long-term consequences. These problems may be the result of one or more treatment options: surgical resection, systemic chemotherapy, and radiation therapy. Problems include issues with bowel, ostomy, bladder, sexual health, peripheral neuropathy, and mental health. Colorectal cancer survivors are especially receptive to making lifestyle changes to improve their long-term health. Gastroenterology nurses can utilize evidence-based recommendations for weight management, diet, physical activity, and lifestyle with the goal of preventing recurrence and a second primary cancer and promoting overall long-term health.

Purpose We explored adolescent and young adult cancer survivor (AYA) experiences with COVID-19 to understand the impact of living through a pandemic, unmet needs, and coping strategies. Methods AYAs were recruited nationally, completed an online survey, and attended one of six online focus groups. We used qualitative content analysis to analyze focus group data. Results Thirty-nine AYAs completed the survey, and 24 also participated in the focus groups. In the survey, AYAs responded that COVID-19 increased anxiety about their health or their family’s health, feelings of isolation, and worries about job security. Overarching focus group themes included AYA behavioral responses to the pandemic similar to their peers, the added burden of cancer, and unexpected advantages of a cancer history. When discussing the added burden of cancer, subthemes included difficulties and delays in medical care, mental health stressors, and compounding uncertainty. Unexpected advantages of a cancer history included relying on coping strategies developed during active treatment and resiliency from practicing social distancing during treatment. Conclusions AYAs have struggled in the early pandemic in ways similar to their peers but with compounding uncertainty regarding their unknown risk due to cancer history. Healthcare providers and systems can better support AYAs by providing additional psychosocial supports, developing strategies to triage good candidates for telehealth, and providing information about cancer survivor-specific risks for COVID-19. Implications for Cancer Survivors Our findings indicate a need for psychosocial supports that address managing anxiety and uncertainty. AYAs may be able to draw on their cancer experiences to navigate the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01069-9.

Purpose Determine whether a diverse set of problems experienced by breast cancer survivors (BCS) following curative treatment can be formulated into a reduced number of clusters, potentially simplifying the conceptualization of these problems. Method Female BCS were recruited from four cancer hospitals in China. The Chinese translation of the Cancer Survivor Profile (CSPro) was used to measure 18 common problem areas, as supported by epidemiological and phenomenological research. The Functional Assessment of Cancer Therapy–Breast (FACT-B) was used to measure quality of life, as a validation of any observed groupings. Hierarchical clustering using multiple distance criteria and aggregation methods to detect patterns of problems was used. Results A total of 1008 BCS (mean 46.51 years old) living in both urban and rural areas were investigated. Hierarchical cluster analysis identified two major clusters of problems. One set was classified as “functional limitations,” while the other cluster was labeled “multi-problems.” Those who fell into the multi-problem cluster experienced poorer quality of life. Conclusion Eighteen non-medical problems were broken down into two major clusters: (1) limitations in higher level functions required of daily life and (2) limitations in health care–seeking skills, problems with certain symptoms, unhealthy behaviors, and financial problems related to cancer. The breakdown of problem areas into these two clusters may help identify common mechanisms. Implications for Cancer Survivors In the future, the search for common clusters and the mechanisms for the many problems that breast cancer survivors and other cancer survivors can experience following primary treatment may improve how we help manage these problems in the future.

Assess the feasibility, acceptability, and preliminary efficacy of a healthy lifestyle website, SurvivorSHINE ( www.survivorshine.org ), for cancer survivors using a mixed-methods approach. Formative research included a comprehensive literature review and four focus groups on website preferences with diagnosis-diverse cancer survivors (N = 17). Their feedback informed a web adaptation of a telephone counseling and mailed-print lifestyle intervention previously found effective for cancer survivors. The resulting web-based intervention was examined in a 3-week, single-arm trial among 41 cancer survivors. Assessments of physical activity, diet, body weight, and knowledge related to exercise and diet guidelines for cancer survivors occurred at baseline and 3 weeks later, along with exit interviews. Themes from focus groups indicated cancer survivors’ desire for easy-to-use, interactive web-based platforms to access credible diet and exercise information. The study sample was recruited within 12 months, and study retention was high (85.4%). Participants showed significant pre- to post-test improvements in diet and exercise knowledge (t = 5.31, p

BACKGROUND Substance use can exacerbate cancer-related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors. METHODS The authors used data from the National Survey of Drug Use and Health (2015-2018) to identify a nationally representative sample of AYAs aged 12 to 34 years. Outcomes assessed past-year tobacco, alcohol, marijuana, and illicit drug use; misuse of prescription opioids; SUDs; and SUD treatment. Multiple logistic regression was estimated to compare outcomes between 832 AYAs who reported a cancer history (survivors) and 140,826 AYAs who did not, adjusting sequentially for sociodemographic characteristics and health status. RESULTS In regressions adjusting for sociodemographic characteristics, survivors were more likely than a noncancer comparison group of peers to use alcohol (6% relative increase; P = .048) and illicit drugs (34% relative increase; P = .012), to misuse prescription opioids (59% relative increase; P < .001), and to have a marijuana (67% relative increase; P = .011), illicit drug (77% relative increase; P < .001), or prescription opioid (67% relative increase; P = .048) SUD. When further adjusting for health status, survivors were still 41% more likely (P < .001) to misuse prescription opioids than noncancer peers. Among those with SUDs, survivors were more likely than peers to receive treatment (unadjusted, 21.5% vs 8.0%; adjusted, P < .05). CONCLUSIONS AYA survivors were as likely as or more likely than noncancer peers to report substance use problems. These findings underscore the importance of interventions to reduce substance use and improve SUD treatment among AYA cancer survivors. LAY SUMMARY The authors assessed substance use, misuse, and substance use disorders, as well as the receipt of treatment for substance use disorders, among adolescent and young adult (AYA) cancer survivors. In a nationally representative AYA sample, cancer survivors, despite their increased risk for morbidity and early mortality, were as likely as or more likely than peers without cancer to experience substance use problems. In particular, survivors had a significantly higher rate of prescription opioid misuse than peers. However, only 1 in 5 AYA survivors who experienced substance use disorders received treatment. These findings underscore the importance of interventions toward reducing substance use and improving access to treatment among AYA survivors.

BackgroundCancer treatment-related morbidity relevantly compromises health status in cancer survivors, and efforts to optimise health-related outcomes in this population are vital to maximising healthy survivorship. A pre-treatment assessment – and possibly preventive management strategies – of cancer patients at increased risk for cardiovascular disease (CVD) seems a rational approach in this regard. Definitive evidence for such strategies is largely lacking, thereby impeding the formulation of firm recommendations.ResultsThe current scoping review aims to summarise and grade the evidence regarding strategies for prediction and prevention of CVD in adults in relation to oncological treatments. We conducted a scoping literature search for different strategies for primary prevention, such as medical and lifestyle interventions, as well as the use of predictive risk scores. We identified studies with moderate to good strength and up to now limited evidence to recommend primary preventive strategies in unselected patients treated with potentially cardiotoxic oncologic therapies.ConclusionEfforts to minimize the CVD burden in cancer survivors are needed to accomplish healthy survivorship. This can be done by means of robust models predictive for CVD events or application of interventions during or after oncological treatments. Up to now there is insufficient evidence to implement preventive strategies in an unselected group of patients treated with potential cardiotoxic oncological treatments. We conclude that randomised controlled trials are needed that evaluate medical and lifestyle interventions in groups at increased risk for complications, in order to be able to influence chronic illness risks, such as cardiovascular complications, for cancer survivors.

Exposure to cranial radiotherapy is associated with an increased risk of subsequent CNS neoplasms among childhood, adolescent, and young adult (CAYA) cancer survivors. Surveillance for subsequent neoplasms can translate into early diagnoses and interventions that could improve cancer survivors' health and quality of life. The practice guideline presented here by the International Late Effects of Childhood Cancer Guideline Harmonization Group was developed with an evidence-based method that entailed the gathering and appraisal of published evidence associated with subsequent CNS neoplasms among CAYA cancer survivors. The preparation of these guidelines showed a paucity of high-quality evidence and highlighted the need for additional research to inform survivorship care. The recommendations are based on careful consideration of the evidence supporting the benefits, risks, and harms of the surveillance interventions, clinical judgment regarding individual patient circumstances, and the need to maintain flexibility of application across different health-care systems. Currently, there is insufficient evidence to establish whether early detection of subsequent CNS neoplasms reduces morbidity and mortality, and therefore no recommendation can be formulated for or against routine MRI surveillance. The decision to start surveillance should be made by the CAYA cancer survivor and health-care provider after careful consideration of the potential harms and benefits of surveillance for CNS neoplasms, including meningioma.

Cancer patients vary in their comfort with the label “survivor”. Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer “survivor”. Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the “survivor” label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term “survivor”, 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label “survivor” for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as “survivors” in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.

The aim of this population‐based study was to evaluate the impact of being a cancer survivor (CS) on COVID‐19 risk and prognosis during the first wave of the pandemic (27 February 2020 to 13 May 2020) in Reggio Emilia Province. Prevalent cancer cases diagnosed between 1996 and 2019 were linked with the provincial COVID‐19 surveillance system. We compared CS' cumulative incidence of being tested, testing positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), being hospitalized and dying of COVID‐19 with that of the general population; we compared COVID‐19 prognosis in CS and in patients without cancer. During the study period, 15 391 people (1527 CS) underwent real‐time polymerase chain reaction for SARS‐CoV‐2, of whom 4541 (447 CS) tested positive; 541 (113 CS) died of COVID‐19. CS had higher age‐ and sex‐adjusted incidence rate ratios (IRR) of testing (1.28 [95% confidence interval, CI = 1.21‐1.35]), of positive test (IRR 1.06 [95% CI = 0.96‐1.18]) and of hospitalization and death (IRR 1.27 [95% CI = 1.09‐1.48] and 1.39 [95%CI = 1.12‐1.71], respectively). CS had worse prognosis when diagnosed with COVID‐19, particularly those below age 70 (adjusted odds ratio [OR] of death 5.03; [95% CI = 2.59‐9.75]), while the OR decreased after age 70. The OR of death was higher for CS with a recent diagnosis, that is, What's new Immunosuppressed status caused by cancer or cancer treatment has been suggested to increase the risk of SARS‐CoV‐2 infection and worse outcomes in cancer patients compared to the general population. This study in an Italian province with a high tumour incidence rate that saw a high cumulative COVID‐19 incidence found that, during the first wave, the cumulative incidence of COVID‐19 in cancer survivors was similar to that in the general population, despite their slightly higher probability of being tested. Cancer survivors had a greater risk of hospitalisation and death once infected, especially if aged

Although family members play an important role in various aspects of coping with cancer and are significantly affected by it, little is known about their perspectives regarding return to work (RTW). This study explored attitudes and experiences of cancer survivors' family members related to cancer survivors' RTW. The present study consists of a qualitative research design, employing in-depth semistructured interviews with first-degree family members (N = 21) of cancer survivors who were approached through online social networks: spouses, children, parents and siblings. Grounded theory techniques were used for data analysis. Four themes emerged from the interviews: (a) the family's cautious voice in return-to-work decision making; (b) work-home imbalance; (c) inhibiting or promoting the effect of work on the recovery process and (d) expectations and appreciation of unconditional workplace support. The findings suggest that psychosocial and health care professionals should help family members play an active role in the decision of RTW. Professionals should also prepare family members for potential costs of RTW for the family and help them develop realistic expectations regarding workplace support of the cancer survivor.

The effect of a history of cancer on the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is poorly understood.From the Osaka Acute Coronary Insufficiency Study (OACIS) registry in Osaka, Japan, we enrolled the case data of a total of 3499 patients with AMI treated with PCI between 1998 and 2014, of whom 462 had a cancer history (cancer group, 13.2%) and 3037 did not (non-cancer group, 86.8%). All of the cases were followed for up to five years from discharge.The Kaplan-Meier curve and multivariate analysis using Cox proportional hazards models revealed that all-cause mortality was significantly higher in the cancer group than in the non-cancer group (adjusted hazard ratio [HR], 2.43; P < 0.001). Deaths from cardiac, cancer, and other causes were treated as competing events, and competing analysis using the cumulative incidence function (CIF) and Fine-Gray model revealed that mortality due to cancer was higher in the cancer group than in the non-cancer group, whereas cardiac mortality was similar between the two groups. The incidences of cardiovascular events, including stroke, recurrent infarction, and heart failure requiring readmission, were also similar between the two groups, although the Kaplan-Meier analysis and univariate Cox proportional hazards model revealed that the incidence of stroke was higher in the cancer group than in the non-cancer group.A history of cancer increased all-cause and cancer mortality among patients with AMI treated with PCI, although it was not associated with cardiovascular events.

AIM This study systematically assesses the awareness of, utilisation of and satisfaction with psychosocial care for adolescents and young adult (AYA) cancer survivors in aftercare. METHODS Survivors between 18 and 39 years were surveyed in aftercare. Awareness of, utilisation of and satisfaction with psychological counselling (PC), social-legal counselling (SLC) and other psychosocial care (OPC) were measured using self-developed questionnaires. Multivariate analyses were conducted to determine factors correlated with awareness and use of psychosocial care. RESULTS Five hundred and fourteen survivors participated; the mean age at diagnosis was 29.6 years (SD = 6.14). 54% of cancer survivors were aware of PC, 45% of SLC and 24% of OPC. Those who possessed knowledge about these services used it to a considerable extent (63%-74%), and the majority (66%-75%) was highly satisfied. No common factors could be found that increase the likelihood of being aware of these three services (R2 = 0.028-0.138). Female gender (OR = 2.08-2.18) and high anxiety (OR = 1.19-1.38) were identified as common factors that increase the likelihood of utilising psychosocial services (R2 = 0.160-0.395). CONCLUSION AYA who are aware of psychosocial services in aftercare are motivated to use them and express high satisfaction with use. For the utilisation of psychosocial services, anxiety and female gender can be identified as common factors. The visibility of psychosocial services for aftercare should be increased given the high number of unaware AYA survivors. The active and repeated addressing of psychosocial issues and regular provision of information (e.g., written guides on survivorship) by caregivers should be made a standard of care for AYA cancer survivors.

INTRODUCTION: The aim of this study is to characterize health related quality of life (HRQOL) in Japanese patients after bladder cancer surgery and to perform cross-cultural comparison between Japanese and American patients. METHODS: Firstly, we cross-sectionally assessed HRQOL of 371 patients in Japan using the Bladder Cancer Index (BCI-Japanese). HRQOL of the four groups of patients (native bladder without intravesical therapy, native bladder with intravesical therapy, cystectomy with ileal conduit, and cystectomy with neobladder) were assessed. Secondly, we compared the Japanese with the American cohort (n = 315) from the original BCI paper. After adjusting for age and gender, the differences in each BCI subdomain score was analyzed. RESULTS: Among Japanese patients, the urinary domain function score was significantly lower among the cystectomy with neobladder group, compared to the cystectomy with ileal conduit group (p

Background: Food insecurity can negatively impact adherence to and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19 associated food insecurity among cancer survivors to adults without a history of cancer and (2) examine determinants associated with COVID-19 related food insecurity among cancer survivors. Methods: We used nationally-representative data from the COVID-19 Household Impact Survey (n = 10,760), collected at three time points: April 20-26, May 4-10, and May 30-June 8 of 2020. Our primary exposure was cancer survivor status, based on participant’s self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized on how often (response options: often true, sometimes true, never true) participants reported the following: “We worried our food would run out before we got money to buy more” or “The food that we bought just didn't last, and we didn't have money to get more”; respondents were categorized as food insecure if they chose often true or sometimes true. We also examined use of food pantry assistance or Supplemental Nutrition Assistance Program benefits during the pandemic period; respondents were also categorized as food insecure if they received or applied for these benefits. We compared reported food insecurity among cancer survivors to other U.S. adults using Chi-square tests. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Results: Thirty-two percent of cancer survivors were food insecure. Cancer survivors aged 30-44 years and those aged ≥60 were more likely to report being food insecure compared to respondents without a history of cancer in the same age categories (30-44 years, 59.9% versus 41.2% p = 0.01, ≥60 years 27.2% versus 20.2%, p = 0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults without a high school diploma and no history of cancer (87.0% versus 64.1%, p = 0.001). In examining determinants of food insecurity among cancer survivors, adults aged 45-49 years when compared to those ages ≥60 (aPR = 1.54, 95% CI 1.16-2.03), adults with no high school diploma (aPR = 2.63, 95% CI 1.53-4.50) or a high school degree (aPR = 1.94, 95% CI 1.08-3.49) compared to those with a baccalaureate or above, adults with an annual household income Citation Format: Marlene Camacho-Rivera, Jessica Y. Islam, Denise C. Vidot. Disparities in food insecurity among cancer survivors during the U.S. COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S10-04.

PURPOSE. Supporting the health of cancer survivors and their families from diagnosis through survivorship is a recognized priority. However, the extent to which health promotion efforts after the completion of acute treatment attend to the needs of adult survivors and families is unclear. This systematic scoping review summarizes the key characteristics of post-treatment lifestyle interventions aiming to improve diet, physical activity, and/or weight-related outcomes for adult cancer survivors and family members. METHODS. We retrieved relevant studies from six databases using keywords. Studies were appraised for quality and limited to English-language, peer-reviewed journal articles published in or after 2005. RESULTS. A total of 2,376 articles were obtained from the databases; 14 main articles (and 2 supplemental articles) representing 14 unique interventions were retained for our analysis. Most interventions were designed to modify aspects of participant diet and physical activity (in combination) or physical activity alone; cited Social Cognitive Theory as a guiding or interpretative framework; typically included survivors of multiple cancer types; and were limited to one type of familial relationship (e.g., spouse/partner, sister). Where reported, intervention samples were predominantly White. CONCLUSIONS. Few post-treatment interventions concurrently target cancer survivor and family member’s positive lifestyle behaviors. Positive findings highlight the potential for expanding this area of intervention research and increasing understanding of individual and familial factors that contribute to successful post-treatment family interventions. IMPLICATIONS FOR CANCER SURVIVORS. Promoting cancer survivors’ healthy behaviors within the family context could capitalize on existing support networks and improve the health of family members in supportive roles.

There are growing discussions regarding the term “cancer survivor,” particularly how patients with cancer relate to it. To assess how individuals diagnosed with colorectal cancer (CRC) perceive the term “cancer survivor.” We conducted an international cross-sectional study and, using social media, invited individuals who were ≥18 years; received a diagnosis for CRC; and can communicate in English. We administered an online survey comprising both quantitative (e.g., multiple choice) and qualitative (e.g., open-ended) questions. We used logistic regression to assess determinants of participants’ perspectives towards the term “cancer survivor.” Qualitative responses were analyzed using content analysis. In all, 539 participants with CRC completed the survey, including 122 (22.6%) undergoing treatment and 417 (77.4%) who completed treatment. Participants who had completed treatment were four times more likely to relate with term “cancer survivor” compared to those undergoing treatment (adjusted odds ratio (aOR), 4.0; 95% confidence interval (CI) 2.4 to 6.7). Participants diagnosed with CRC ≥50 years were also more likely to relate with the term compared to those diagnosed < 50 years (aOR, 1.88; 95% (CI) 1.2 to 3.0). Analysis of open-ended survey responses revealed aversion, discomfort, indifference, reluctance, and acceptance as themes which capture the spectrum of feelings towards the term “cancer survivor.” Perspectives of individuals with CRC towards the term “cancer survivor” differ according to treatment status and age of diagnosis. Our study amplifies voices of the CRC community towards reconsideration of the term “cancer survivor”, considering the implications of treatment status and age in highlighting the importance of language.

PURPOSE: Despite growing evidence supporting the benefits of yoga for cancer-related symptom management, yoga usage among cancer survivors is low. To translate the evidence of yoga benefits into community practice, it is critical to understand interest in yoga as well as barriers and preferences that influence yoga usage among cancer survivors. METHOD: We conducted a cross-sectional survey study among cancer survivors, 18 years or older, with a primary diagnosis of cancer, and receiving treatment or follow-up care at outpatient clinics at five regional academic cancer center sites. We collected data and performed bivariate and multivariable analyses on self-reported yoga usage, interest in and barriers to practicing yoga, as well as preferred location and time for yoga practice. RESULTS: Of 857 participants, 70.0% had never practiced yoga and 52.3% were interested in practicing yoga. Among those interested, 52.5% had never practiced yoga. Lower interest was independently associated with being male (odds ratio [OR]=0.30, 95% confidence interval [CI]=0.20 – 0.44, p

The National Cancer Institute has supported cancer survivorship science for many years, yet few funded studies have examined the needs of individuals living with cancer that is advanced or has metastasized. This report analyzes currently active National Institutes of Health (NIH) grants focused on survivorship for patients living with advanced or metastatic cancers to identify emerging research topics in this population and gaps in current science. A search of all NIH research grants that received funding in Fiscal Year 2020 focused on this population was conducted, excluding grants with a primary focus on end-of-life care, tumor progression or staging and grants for which the only outcome was survival. A total of 25 active grants met the inclusion criteria. Most were funded using the R01 grant mechanism and included a range of cancer types and topics such as palliative/supportive care, psychosocial support, health services, and symptom sequelae. Although currently funded grants focus on several important topics, gaps in the portfolio remain. There is a need to enhance the grant portfolio of research studies focused on the longitudinal examination of unmet needs, models of care delivery, impact of innovative therapies, and the impact of financial hardship for individuals living with advanced or metastatic cancer. This review of current NIH studies suggests a need for expanded research on individuals living with advanced or metastatic cancer. Moving forward, enhancing research focused on key gap areas will be critical to improve care and outcomes for this growing population.

PurposeSurvival probability changes over time in cancer survivors. This study examined conditional survival in patients undergoing curative resection for non-small cell lung cancer (NSCLC).Materials and MethodsFive-year conditional recurrence-free survival (CRFS), conditional overall survival (COS), and conditional relative survival (CRS) up to 10 years after surgery were calculated in patients who underwent NSCLC resection from 1994 to 2016. These rates were stratified according to age, sex, year of diagnosis, pathological stage, tumor histology, smoking status, comorbidity, and lung function.ResultsFive-year CRFS increased from 65.6% at baseline to 90.9% at 10 years after surgery. Early differences in 5-year CRFS according to stratified patient characteristics disappeared, except for age: older patients exhibited persistently lower 5-year CRFS. Five-year COS increased from 72.7% to 78.3% at 8 years and then decreased to 75.4% at 10 years. Five-year CRS increased from 79.0% at baseline to 86.8% at 10 years. Older age and higher pathologic stage were associated with lower 5-year COS and CRS up to 10 years after surgery. Female patients, those with adenocarcinoma histology, non-smokers, patient without comorbidities and had good lung function showed higher COS and CRS.ConclusionCRFS improved over time, but significant risk remained after 5 years. CRS slightly improved over time but did not reach 90%, suggesting significant excess mortality compared to the general population. Age and stage remained significant predictors of conditional survival several years after surgery. Our conditional survival estimates should help clinicians and patients make informed treatment and personal life decisions based on survivorship status.

We examined cancer survivor worries about treatment, infection, and finances early in the U.S. COVID-19 pandemic.Closed- and open-ended online survey questions were collected from adult cancer survivors (N = 972).Logistic regression identified factors associated with treatment, infection, and financial worry. Thematic qualitative analysis generated information around participants' experiences and worries related to COVID-19 and healthcare.Characteristics including marital status, race/ethnicity, cancer type, time since last treatment, education, and age were associated with health and healthcare worry outcomes. Survivors commonly expressed uncertainty about future care, fears about in-person appointments, rationed COVID-19 care, recurrence due to care delays, and distress about untreated symptoms, including mental health issues.Early in the pandemic, survivors worried about and experienced cancer care delays, COVID infection, and how the pandemic would affect their prognosis.Healthcare professionals need to be aware of cancer survivors' concerns and uncertainties to provide appropriate care.

BACKGROUND: Young adult cancer survivors are at risk for subsequent human papillomavirus (HPV)-related malignancies. High-risk sexual behavior increases risk for HPV acquisition; HPV vaccination protects against infection. We aimed to determine the prevalence of sexual behaviors, factors related to high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among survivors. METHODS: Survivors at comprehensive cancer centers, aged 18–26 years and 1–5 years post-treatment, reported sexual behaviors and HPV vaccine initiation (i.e., ≥1 dose). Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with high-risk sexual behaviors (age at first intercourse

PURPOSE: To qualitatively explore exercise barriers and facilitators experienced by rural female cancer survivors from the program interventionist and recipient perspective for the purpose of enhancing exercise program implementation and uptake in rural settings. METHODS: A descriptive qualitative study design was utilized. Focus groups were conducted prior to implementation of an evidence-based exercise program by a rural non-research cancer clinical site. Nineteen rural female cancer survivors (mean age = 61.7 ± 10.9 years) and 11 potential interventionists (mean age = 42.3 ± 15.3 years) completed focus groups (stratified by participant role). Focus groups were audio recorded, transcribed, coded, and analyzed using inductive thematic analysis with NVivo 11. RESULTS: Cancer survivors identified twelve barrier themes (cancer specific adverse effects, lack of support, lack of knowledge, perceived negative aspects of exercise, cost, lack of resources, motivation, inconvenience, lack of program flexibility, time, weather, safety) and eight facilitator themes (knowledge, ease of access, resources, awareness, cost, options, organized, fun) related to exercise. Interventionists identified seven barrier themes (cost, transportation, lack of cancer survivor and interventionist knowledge, fear, motivation, lack of support, lack of resources) and four facilitator themes (resources, support, knowledge, motivation). Narratives revealed differing role-specific perspectives on shared themes between survivors and interventionists as well as potential implementation strategies for enhancing exercise participation and exercise program uptake among rural female cancer survivors. CONCLUSION: Exploring multi-level stakeholder perspectives on cancer survivors’ exercise needs and related strategies yields important information for organizations to consider when implementing exercise programs in rural contexts.