Health burden in cancer survivors: below the tip of the iceberg

Brauer, Eden R.; Ganz, Patricia A.

doi:10.1038/s41571-019-0226-0

Cited by 4 publications

(4 citation statements)

References 10 publications

(10 reference statements)

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“…52 Previous literature tried to describe postchemotherapy changes in QOL, albeit most of it did not comprehensively explore long-term patterns, only captured population averages, or was focused on specific symptoms. 6,7,14,15 Here, we present several elements of novelty, providing a nuanced description of QOL trajectories 4 years after diagnosis, comprehensively assessing overall and specific QOL metrics, and offering insight into the characteristics of latent subpopulations with persistent deterioration.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…6 Downstream effects of adjuvant BC treatments include substantial impact on general well-being, physical functioning, and vitality, and alterations in cognition, metabolism, and sexuality. [7][8][9] Chemotherapy is associated with poorer emotional and social functioning, body-image issues, increased likelihood of unemployment after cancer, and persisting conditions including fatigue, neuropathy, and menopausal symptoms. [10][11][12][13] There is, however, considerable interindividual variability in the longitudinal trajectory of patient-reported outcomes (PROs), 14 which may be obscured by a description of the average population level.…”

Section: Introductionmentioning

confidence: 99%

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Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy

Meglio

Havas

Gbenou

et al. 2022

JCO

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PURPOSE We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors. METHODS Female stage I-III breast cancer patients receiving chemotherapy in CANTO (CANcer TOxicity; ClinicalTrials.gov identifier: NCT01993498 ) were included. Trajectories of QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–C30 Summary Score) and associations with trajectory group membership were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively. RESULTS Four trajectory groups were identified (N = 4,131): excellent (51.7%), very good (31.7%), deteriorating (10.0%), and poor (6.6%) QOL. The deteriorating trajectory group reported fairly good baseline QOL (mean [95% CI], 78.3/100 [76.2 to 80.5]), which significantly worsened at year-1 (58.1/100 [56.4 to 59.9]) and never recovered to pretreatment values through year-4 (61.1/100 [59.0 to 63.3]) postdiagnosis. Healthy behaviors were associated with better performing trajectory groups. Obesity (adjusted odds ratio [aOR] v lean, 1.51 [95% CI, 1.28 to 1.79]; P < .0001) and current smoking (aOR v never, 1.52 [95% CI, 1.27 to 1.82]; P < .0001) at diagnosis were associated with membership to the deteriorating group, which was also characterized by a higher prevalence of patients with excess body weight and insufficient physical activity through year-4 and by frequent exposure to tobacco smoking during chemotherapy. Additional factors associated with membership to the deteriorating group included younger age (aOR, 1-year decrement 1.01 [95% CI, 1.01 to 1.02]; P = .043), comorbidities (aOR v no, 1.22 [95% CI, 1.06 to 1.40]; P = .005), lower income (aOR v wealthier households, 1.21 [95% CI, 1.07 to 1.37]; P = .002), and endocrine therapy (aOR v no, 1.14 [95% CI, 1.01 to 1.30]; P = .047). CONCLUSION This latent-class analysis identified some patients with upfront poor QOL and a high-risk cluster with severe, persistent postchemotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of chemotherapy and preserve QOL, including early addressal of behavioral concerns and provision of healthy lifestyle support programs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy

Meglio

Havas

Gbenou

et al. 2022

JCO

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“…However, this gain in years of life is not followed with gains in quality of life (QOL). Older cancer survivors have a high prevalence of functional and cognitive impairment, comorbidities, and geriatric syndromes [ 7 – 10 ]. The National Academy of Medicine (NAM; previously Institute of Medicine) has stated that the needs of this population “are complex due to functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support.” [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Cancer survivorship challenges of rural older adults: a qualitative study

Arana-Chicas,

Prisco,

Sharma

et al. 2023

BMC Cancer

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Background Although research has advanced the field of oncologic geriatrics with survivors to assess their cancer-related needs and devise patient-centered interventions, most of that research has excluded rural populations. This study aimed to understand the survivorship challenges and recommendations in the perspective of rural older adults. Methods This was a qualitative study that explored the survivorship challenges and recommendations of rural older adults who have completed curative intent chemotherapy for a solid tumor malignancy in the 12 months prior to enrollment in the present study. Results Twenty-seven older adult survivors from rural areas completed open-ended semi-structured interviews. The mean age was 73.4 (SD = 5.0). Most participants were non-Hispanic White (96.3%), female (59.3%), married (63.0%), and had up to a high school education (51.9%). Rural older survivors reported a general lack of awareness of survivorship care plans, communication challenges with healthcare team, transportation challenges, financial toxicity, psychological challenges, and diet and physical challenges. Rural older survivors recommend the provision of nutritional advice referral to exercise programs, and social support groups and for their healthcare providers to discuss their survivorship plan with them. Conclusions Although study participants reported similar survivorship challenges as urban older adult survivors, additional challenges reported regarding transportation and consideration of farm animals have not been previously reported. Heightened awareness of the survivorship needs of rural older adults may result in better survivorship care for this population.

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