Background: More than 100,000 individuals in the United States are survivors of advanced prostate cancer, defined as metastatic hormone sensitive (mHSPC) or castration resistant prostate cancer (CRPC). This growing, vulnerable population could be uniquely susceptible or responsive to factors that are associated with overall survival. We investigated the associations of marital status and living arrangements with overall survival among individuals with advanced prostate cancer in the International Registry for Men with Advanced Prostate Cancer (IRONMAN). Methods: We included 2,347 men (ages 40-96 years, median 70 years) with advanced prostate cancer recruited between 2017 and October 2022. Cox proportional hazards models estimated adjusted hazard ratios (adjusted HR) and 95% confidence intervals (CI) for the associations between marital status (married vs. not married), living arrangement (living alone vs. not living alone) and all-cause mortality, mutually adjusting for marital status and living arrangement and potential confounders (disease state [mHSPC vs. CRPC], country of enrollment, age at enrollment, race, education, employment status, smoking status, family history of prostate cancer, prostate specific antigen level at enrollment, and Gleason score). We conducted stratified analyses by disease state (mHSPC vs. CRPC), age (<70 vs. ≥70 years), and country of enrollment (North America vs. others). Results: This study included 1524 (65%) participants with mHSPC and 809 (35%) with CRPC. 1690 (77%) were married and 338 (16%) lived alone. Over the follow-up period (maximum: 52 months, median: 6 months, IQR: 13 months), we observed 451 deaths, with 313 deaths among married individuals and 59 deaths among those who lived alone. Overall, married individuals had better survival compared to those not married (adjusted HR: 0.52; 95% CI 0.35, 0.78), while those living alone had better survival compared to those not living alone (adjusted HR: 0.48; 95% CI: 0.29, 0.80). The protective association between being married and survival is stronger among those with mHSPC (adjusted HR: 0.42; 95% CI: 0.24, 0.71) compared to those with CRPC (adjusted HR: 0.72; 95% CI: 0.35, 1.49) and stronger among those with ages 70 or older (adjusted HR: 0.43; 95% CI: 0.25, 0.74) compared to those younger than 70 (adjusted HR: 0.71; 95% CI: 0.36, 1.43). Conclusion: Being married was associated with better survival among advanced prostate cancer survivors. While living alone was also associated with better survival, this finding should be interpreted with caution as there may be residual confounding by socioeconomic status or physical functioning. Citation Format: Naiyu Chen, Colleen B. McGrath, Caroline I. Ericsson, Jane B. Vaselkiv, Michelle O. Sodipo, Emily M. Rencsok, Konrad H. Stopsack, Daniel J. George, Karen A. Autio, Dana E. Rathkopf, Kathryn L. Penney, Lorelei A. Mucci. Marital status, living arrangement, and overall survival among individuals with advanced prostate cancer in the IRONMAN cohort. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6489.
Introduction: The COVID-19 pandemic has disrupted the lives of cancer survivors who may be at higher risk than people without cancer of other adverse health outcomes. For many individuals, a cancer diagnosis leads to lower physical activity and change in mental health status. Modifiable health behaviors, such as consumption of a healthy diet, can positively affect cancer survivorship outcomes. Aim: To investigate the individual-level changes in diet and supplement use among male cancer survivors during the COVID-19 pandemic and compared to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Diet and supplement use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Further, outcomes were dichotomized to reflect whether a change was healthful or unchanged/unhealthful; for example, lower fast food consumption was classified as a healthful change. To assess the associations between cancer survivors and other men, logistic regression was used, adjusting for age, race, pre-pandemic body mass index, pre-pandemic physical activity, and other health information. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Across all eligible men (median age: 78 years), there were considerable proportions of men engaging in healthful changes following the start of the pandemic in intake of fast food (19% decreased), sugary drinks (14% decreased), fresh fruit (26% increased), fresh vegetables (19% increased), fish (13% increased), and red meat (12% decreased) consumption. Similar changes in diet were reported on the second follow-up questionnaire. For most foods, a similar percentage of cancer survivors and individuals without a history of cancer increased healthy eating. Findings from multivariable logistic regression models were reflective of higher odds of cancer survivors to engage in a healthful diet change for unhealthy food categories (i.e., less fast food, less frozen food), though none of which were statistically significant. There was little change in supplement use during the pandemic, except for 6% who started use of vitamin D supplements between the baseline and first follow-up questionnaire. Conclusion: Our findings suggest that older men engaged in healthful diet changes during the COVID-19 pandemic, without noticeable differences among cancer survivors. Citation Format: Alaina H. Shreves, Colleen B. McGrath, Konrad Stopsack, Lilian Cheung, Ann Fisher, Edward Giovannucci, Sarah Markt, Eric Rimm, Lorelei Mucci. Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 440.
Background: Symptoms of depression and anxiety are common among cancer patients. Physical activity interventions have been conducted to improve psychological outcomes in cancer patients. Our goal with this scoping review was to synthesize evidence on the association of exercise interventions on depression and anxiety symptom presentation among men diagnosed with a genitourinary cancer. Methods: We undertook a structured search of PubMed and Embase databases to identify physical activity interventional studies (randomized and non-randomized) and depression or anxiety among male genitourinary cancer patients. Study inclusion criteria included: studies must have been interventional, within a population of male genitourinary cancer patients (prostate, bladder, kidney, testicular), with reported quantitative measures of depression or anxiety, separately for individual cancer sites and males for non-male-specific cancer sites. Using these criteria, records underwent a first-stage title-and-abstract screen followed by a second-stage full-text screen. Records meeting all eligibility criteria were included. Following standardized data extraction, data were synthesized in narrative format. All study procedures were performed by two reviewers, with conflicts resolved by consensus. Results: The search yielded 1,465 records. Following screening, 22 studies met inclusion criteria and were included in the synthesis. Of the outcomes of interest, 21 studies assessed depression (20 prostate and 1 testicular cancer), 16 studies assessed anxiety (15 prostate and 1 testicular cancer), and 1 study assessed depression and anxiety combined (prostate cancer). No trials in kidney or bladder cancer met eligibility criteria. Exercise interventions in included trials ranged from high-intensity interval training (HIIT) to stretching-based practices. The included testicular cancer study found a non-significant between-group decrease in depression (effect = -0.2) and anxiety (effect = -1.6) scores following HIIT intervention. Nearly all studies in prostate cancer found improvements following the exercise intervention, several with statistically significant results. Of note, the results from 2 Qigong exercise interventions reported promising therapeutic benefits, with one study reporting a significant decrease in anxiety from baseline comparing Qigong vs stretching control interventions (p=0.003); results were non-significant for depression (p=0.09). Conclusion: Available evidence demonstrates suggests a beneficial impact of exercise interventions on reducing depression and anxiety symptoms in men with genitourinary cancer. More research is needed on the role of exercise interventions on psychological condition reporting in patients of kidney, bladder, and rarer genitourinary cancers. Citation Format: Sydney Grob, Colleen B. McGrath, Lorelei A. Mucci. Association between physical activity interventions after a genitourinary cancer diagnosis and incidences of depression and anxiety: A scoping study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5260.
Introduction: The COVID-19 pandemic has greatly disrupted the lives of cancer survivors. Beyond being at increased risk for COVID-19 infection and severe complications, cancer survivors may be at higher risk of other consequential health outcomes compared to those without a history of cancer. Engagement in physical activity has been shown to positively affect cancer survivorship outcomes, and as such, it is important to assess physical activity habits during the pandemic of cancer survivors. Aim: To investigate the individual-level physical activity among male cancer survivors during the COVID-19 pandemic and compare to men without cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Physical activity measures were analyzed descriptively between cancer survivors and individuals without a history of cancer. Outcomes were recoded dichotomously to reflect either: healthful (i.e., higher engagement since pandemic) vs unchanged/unhealthful behavior or high vs low engagement in an activity. Logistic regression models were employed to assess association with cancer survivor status and were adjusted for covariates such as age, race, pre-pandemic BMI, pre-pandemic physical activity, and other health information, as appropriate. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Of all eligible men (median age: 78 years) reporting on physical activity, over 50% walked for at least 2-3 hours per week, over 10% used a stationary bike for at least 1 hour per week, 14% engaged in yoga for at least 1 hour per week, and nearly 20% engaged in vigorous activity for at least 1 hour per week. Further, 42% engaged in high (1+ times per day) levels of mindfulness and 24% engaged in high (1+ times per day) levels of yoga. Engagement in vigorous physical activity was significantly lower among cancer survivors compared to individuals without a history of cancer (Chi-square p = 0.01). Conclusion: Our findings suggest older men had high engagement in physical activity during the COVID-19 pandemic, with vigorous physical activity engagement significantly lower in cancer survivors. Citation Format: Colleen B. McGrath, Alaina H. Shreves, Konrad Stopsack, Lilian Cheung, Ann Fisher, Sarah Markt, Lorelei A. Mucci. Physical activity among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 439.
Introduction: Cancer survivors may experience impacts on their psychosocial health and sleep quality due to the cancer diagnosis and severity as well as treatments. The COVID-19 pandemic has greatly disrupted the lives of cancer survivors, including those who are in treatment and those who are living cancer-free. A better understanding of psychosocial behaviors, sleep, and substance use is of timely importance. Aim: To better understand the individual-level psychosocial outcomes, sleep patterns, and substance use of cancer survivors during the COVID-19 pandemic, and compared to individuals without a history of cancer. Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Psychosocial presentations, sleep patterns, and substance use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Substance use and non-continuous sleep outcomes (e.g., trouble falling asleep) were recoded dichotomously and assessed via logistic regression to calculate odds ratios (OR) and 95% confidence Intervals (CI). Continuous psychosocial outcomes and sleep outcomes (e.g., hours slept last night) were analyzed via linear regression. Models were adjusted for covariates such as age, race, marital status, living arrangement, employment status, and other health information, as appropriate. Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Poor sleep quality was prevalent for all eligible men (median age: 78 years); 34% reported trouble falling asleep, 74% woke during the night, 50% woke too early without getting back to sleep, 59% needed a nap most or some of the time. Cancer survivors were significantly more likely to wake early and not get back to sleep (OR = 1.19, (1.00, 1.41)) and sleep a greater amount in the past week (+0.14 (0.03, 0.25) hours per day) compared to those without a history of cancer. Compared to those without a history of cancer, survivors were more likely to present with lower psychological wellbeing, higher post-traumatic stress, and higher stress and lower gratitude. Across all men, healthful changes in alcohol (decreased) use were observed at baseline (10% of men) and second follow-up (15% of men). At the first follow-up, cancer survivors were at significantly higher odds to regularly use CBD products compared to individuals without a history of cancer (OR: 1.63 (1.03, 2.55)). Conclusion: Among male cancer survivors, there were significant impacts in sleep patterns and substance use, and further understanding of the effects of such differences is needed. Citation Format: Colleen B. McGrath, Alaina H. Shreves, Konrad Stopsack, Lilian Cheung, Ann Fisher, Sarah Markt, Unnur Valdimarsdottir, Lorelei A. Mucci. Psychosocial outcomes, sleep, and substance use among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 438.
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