Showing papers in "Journal of Cancer Survivorship in 2009"
TL;DR: The data indicate that cognitive impairment can be problematic for survivors, with many asserting that it is their most troublesome post treatment symptom, and suggests that greater attention needs to be focused on this arena of survivorship.
Abstract: Mild cognitive impairment following chemotherapy is one of the most commonly reported post treatment symptoms by breast cancer survivors. This deterioration in cognitive function, commonly referred to as “chemobrain” or “chemofog,” was largely unacknowledged by the medical community until recent years. Although chemobrain has now become the subject of more vigorous exploration, little is known about this specific phenomenon’s psychosocial impact on breast cancer survivors. This research documents in-depth the effects that cognitive impairment has on women’s personal and professional lives, and our data suggest that greater attention needs to be focused on this arena of survivorship. The results are based on an in-depth qualitative study of 74 white and African American breast cancer survivors in California who experience post-treatment side effects. The data reported herein were obtained through the use of focus groups and in-depth interviews. Our data indicate that cognitive impairment can be problematic for survivors, with many asserting that it is their most troublesome post treatment symptom. Survivors report diminished quality of life and daily functioning as a result of chemobrain. Respondents detail a range of coping strategies that they are forced to employ in order to manage their social and professional lives. Chemobrain significantly impairs a proportion of cancer survivors, at great cost to them economically, emotionally, and interpersonally. This suggests that more research needs to be conducted on the psychosocial ramifications of post treatment symptoms in order to inform the efforts of the medical and mental health communities as well as the support networks of survivors. A better and broader understanding of the effects of cognitive impairment both in the medical community and among lay people could pave the way for improved social and psychological services for this population.
435 citations
TL;DR: Racial/ethnic differences in quality of life exist during the cancer survivorship period, and Latinas with low acculturation are a particularly vulnerable subgroup.
Abstract: Introduction
Most studies on quality of life of breast cancer survivors have not had adequate representation of ethnic minorities. The purpose of this study was to determine whether racial/ethnic differences in quality of life exist between white, African American, and Latina women in the early stages of survivorship.
148 citations
TL;DR: There is strong support for the development and use of SCPs for bowel cancer survivors and there is some variation in opinion regarding ideal content of the SCP, who might prepare it, and how it might be discussed and utilised.
Abstract: Increasing numbers of people survive cancer beyond diagnosis and treatment. Many survivors have ongoing needs and they may encounter fragmented, poorly coordinated follow up care. Survivorship care plans (SCP) have been promoted as a key aspect of survivorship care. This study aimed to survey key stakeholders in the care of people with colorectal cancer (survivors, primary care providers and hospital-based healthcare professionals) regarding follow-up and SCP. In study 1, cancer survivors completed a questionnaire regarding their follow-up and experiences during survivorship. Participants’ primary care physicians completed a phone interview regarding proposed SCP elements. A subgroup of survivors reviewed a sample SCP and participated in a phone interview regarding this. In study 2, healthcare professionals working with colorectal cancer patients completed a questionnaire regarding follow-up and proposed elements of a SCP. Twenty survivors completed the questionnaire, 14 primary care providers completed a phone interview and 12 survivors reviewed the sample SCP. Ninety-five healthcare professionals (30 medical professionals and 65 nurses) completed the questionnaire. There was strong support for core elements of the SCP. Additionally, nurses and survivors expressed support for supportive care and psychosocial elements. There was lack of consensus regarding who should prepare and discuss the SCP. There is strong support for the development and use of SCPs for bowel cancer survivors. There is some variation in opinion regarding ideal content of the SCP, who might prepare it, and how it might be discussed and utilised. Overcoming identified barriers to implementing SCPs for bowel cancer survivors is necessary for high quality cancer care.
123 citations
TL;DR: The majority of women in this study, particularly those who were Hispanic, elderly, or unemployed, experienced persistent symptoms, most commonly fatigue and muscle aches.
Abstract: Introduction
Relatively few studies of breast cancer survivors have included nonwhite women or women who do not speak English.
90 citations
TL;DR: Future studies of exercise and breast cancer prognosis should target obese women for participation, as well as women just beginning to contemplate participation and its benefits after a cancer diagnosis.
Abstract: To examine predictors of exercise adherence in breast cancer survivors. Seventy-five breast cancer survivors were randomly assigned to exercise (n = 37) or usual care (n = 38). Demographic, prognostic, physiologic, and psychosocial information was collected at baseline and 6 months. The exercise goal was 30 min of exercise 5 days/week for 6 months. Women randomized to exercise participated in moderate-intensity recreational exercise for 123 ± 52 min/week (81% of the prescribed 150 min/week) over 6 months. Baseline variables associated with better adherence were lower body mass index (BMI), smaller waist circumference, higher amounts of physical activity 6 months prior to enrollment, being in the preparation vs. contemplation Stage of Change and higher FACT-B breast cancer subscale score. After adjusting for these variables, lower BMI and higher Stage of Change continued to be associated with better adherence (p < 0.05). Future studies of exercise and breast cancer prognosis should target obese women for participation, as well as women just beginning to contemplate participation and its benefits after a cancer diagnosis.
59 citations
TL;DR: The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor’s specific total care needs, including all comorbidities.
Abstract: Long term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors. Longitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities. Unadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially. The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor’s specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population. Our study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.
57 citations
TL;DR: Examination of bidirectional relations between fear of the future and distress as well as intrusion and avoidance among breast cancer survivors at 3, 7, 11, and 15 months after diagnosis shows that decreases in distress over time lead to a reduction of fear ofThe future but that changes in fear do not lead to changes in distress.
Abstract: Fear of the future is one of the most stressful aspects of having cancer. Research to date has conceptualized fear of the future as a precursor of distress or stress-response symptoms. Yet it is equally plausible that distress would predict increased fear of the future or that they would have a reciprocal influence on each other. The purpose of the present study was to examine the bidirectional relations between fear of the future and distress as well as intrusion and avoidance among breast cancer survivors at 3, 7, 11, and 15 months after diagnosis. We used a bivariate latent difference score model for dynamic change to examine these bidirectional relationships among 146 early-stage breast cancer survivors. Using Lisrel version 8.80, we examined four models testing different hypothesized relationships between fear of the future and distress and intrusion and avoidance. Based on model fit evaluation, our data shows that decreases in distress over time lead to a reduction of fear of the future but that changes in fear do not lead to changes in distress. On the other hand, there is no relationship between changes in fear of the future and intrusion and avoidance over time. Ongoing fear of the future does not appear to be a necessary condition for the development of stress-response symptoms. Implications for Cancer Survivors: Future studies need to explore the role of distressing emotions in the development and exacerbation of fear of the future among cancer survivors.
54 citations
TL;DR: These studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer.
Abstract: Survivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of skeletal disorders. We performed a comprehensive search, using various Internet-based medical search engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of cancer and cancer therapies. One-hundred-forty-two publications, including journal articles, books, and book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate, platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A, NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and described. Skeletal effects of hyperparathyroidism, vitamin D deficiency, gastrectomy, hypophosphatemia, and hyperprolactinemia resulting from cancer therapies were also described. The publications researched during this review both highlight and emphasize the association between cancer therapies, including chemotherapy and radiotherapy, and skeletal dysfunction. These studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer. Further studies are needed to better address the skeletal needs of cancer survivors.
54 citations
TL;DR: Some of the salient issues surrounding the care of cancer survivors are described, and models of survivorship care that are being developed in individual Centers of Excellence (COE) as well as in the overall Network are examined.
Abstract: The LIVESTRONG™ Survivorship Center of Excellence Network consists of eight National Cancer Institute-designated Comprehensive Cancer Centers funded by the LAF between 2004 and 2008. The Network was created to accelerate the pace of progress in addressing the needs of the growing survivor community. This paper will briefly describe some of the salient issues surrounding the care of cancer survivors, and examine models of survivorship care that are being developed in individual Centers of Excellence (COE) as well as in the overall Network. As the recommendations and policies for optimal survivorship care have to be feasible and relevant in the community setting, each COE is partnered with up to three community affiliates. Through these partnerships, the community affiliates develop survivorship initiatives at their institutions with support and guidance from their primary COE.
47 citations
TL;DR: Patients treated on clinical trials are an important potential source for examining the late effects of cancer treatments and mechanisms should be established for prospective long-term follow-up to identify and understand the frequency and type of late effects associated with cancer treatments.
Abstract: Introduction
With the growing number of adult cancer survivors, there is increasing need for information that links potential late and long term effects with specific treatment regimens. Few adult cancer patients are treated on clinical trials; however, patients previously enrolled in these trials are an important source of information about treatment-related late effects.
44 citations
TL;DR: Based upon the RNL index, the vast majority of long-term survivors of childhood lower extremity bone tumors adapt well to their environment and the majority do not report moderate or severe difficulties with social integration.
Abstract: Introduction
Adult survivors of childhood lower-extremity bone tumors may experience physical and psychosocial late effects that impact physical performance, global function and quality of life. The identification of survivors at greatest risk for poor outcomes will inform potential intervention targets.
TL;DR: Women with a hospital record of congestive heart failure significantly less often received chemotherapy or radiation following breast conserving surgery, and women who received adjuvant therapy were more likely to have new comorbidities.
Abstract: To describe comorbidities in breast cancer patients at diagnosis and examine factors associated with self-reported comorbidities 30 months post-diagnosis. Nine hundred forty one of 1,171 women had a medical record abstract and a follow-up survey in the Health, Eating, Activity and Lifestyle Study. We compared our breast cancer cohort to a contemporaneous nationally-representative sample of age, race/ethnicity and education matched women without cancer (n = 865). Breast cancer patients did not have substantially more comorbidities than women without breast cancer. Women with a hospital record of congestive heart failure significantly less often received chemotherapy or radiation following breast conserving surgery. In multivariate analysis, women who received chemotherapy alone (OR = 3.2; 95% CI: 1.5–6.8), chemotherapy plus radiation (OR = 1.9; 95% CI: 1.02–3.7) or radiation plus tamoxifen (OR = 1.9; 95% CI: 1.1–3.2) were significantly more likely to report at least one new comorbid condition following breast cancer diagnosis than women who received no chemotherapy, tamoxifen or radiation. Overall, women who received adjuvant therapy were more likely to have new comorbidities. Comorbidities were not substantially different in breast cancer patients than the non-cancer matched controls. Future research should focus on efforts to minimize comorbidities related to chemotherapy and other combination therapy.
TL;DR: Results of this qualitative analysis indicate that interventions to support the efforts of breast cancer survivors who are interested in breastfeeding are warranted and a need for improved access to information and support and greater sensitivity to the obstacles faced by breast cancer Survivors.
Abstract: Introduction
This is an exploratory, qualitative investigation of breast cancer survivors’ experiences with breastfeeding. Previous studies have focused on the physiology of lactation after surgery and treatment, but have not explored factors influencing breastfeeding decisions and behavior.
TL;DR: An effort to assess the impact of cancer in this young survivor population through the development of a new Impact of Cancer (IOC) instrument by assessing the instrument’s psychometric properties in a large representative group of young cancer survivors.
Abstract: Background
Thirty years of psychosocial oncology research have detailed issues having significant impact in both pediatric and adult populations; yet, few studies have captured the subtle and unique ways in which cancer impacts, disrupts and in some instances promotes the growth and development of adolescents and young adults with a cancer history. This paper reports the initiation of an effort to assess the impact of cancer in this young survivor population through the development of a new Impact of Cancer (IOC) instrument.
TL;DR: The survivorship concerns of women with mutations of BRCA1/2; with and without a diagnosis of cancer were determined and included issues related to risk reduction procedures, psychological and emotional impacts, and impact on family and social relationships.
Abstract: Introduction
Five to 10% of breast cancers are caused by inherited mutations of the BRCA1/2 genes. Knowledge of inherited risk for cancer has potential for psychosocial consequences. The purpose of this review is to determine the survivorship concerns of women with mutations of BRCA1/2; with and without a diagnosis of cancer.
TL;DR: Results suggest that time can attenuate the distress of DP on HRQL and Psycho-educational programs could help to increase patients’ sense of empowerment and personal control should DP occur.
Abstract: Introduction
The number of cancer survivors experiencing disease progression (DP) is increasing with the number of cancer survivors. However, little is known whether DP affects health-related quality of life (HRQL) of long-term cancer survivors. We aimed therefore to compare the health status (HS) and HRQL of DP and disease-free (DF) survivors up to 15 years after initial diagnosis.
TL;DR: The utility of post-surgery assessment may help identify those in need for problem-solving training to improve these outcomes at 1 year, and future studies need to determine the impact of interventions tailored to levels of problem-Solving styles in cancer survivors over time.
Abstract: Emotional care of the breast cancer patient is not well understood; this lack of understanding results in both a high cost to the patient, as well as the health care system. This study examined the role of problem-solving style as a predictor of emotional distress, adjustment to breast cancer, and physical function immediately post-surgery and 12 months later. The sample consisted of 121 women diagnosed with breast cancer and undergoing surgery as a primary treatment. The survivors completed a measure of problem-solving style and three outcome measures immediately post-surgery, as well as at 1 year later. There was a 95.6% retention rate at 1 year. Multiple hierarchical regressions revealed, after controlling for patient demographics and stage of cancer, that problem-solving style (particularly personal control) was associated with emotional distress, adjustment to chronic illness, and physical function immediately following surgical intervention. In addition, a more positive problem-solving style was associated with less emotional distress, but not a better adaptation to a chronic illness or physical functioning 12 months later; the Personal Control again was the best single predictor of the emotional distress, adding 10% of the variance in predicting this outcome. The utility of post-surgery assessment may help identify those in need for problem-solving training to improve these outcomes at 1 year. Future studies need to determine the impact of interventions tailored to levels of problem-solving styles in cancer survivors over time. Understanding the role of problem solving style in breast cancer survivors deserves attention as it is associated with emotional distress immediately and one year after medical intervention. Problem-solving style should be evaluated early, and interventions established for those most at risk for emotional distress.
TL;DR: Perceived likelihood of colorectal cancer is an important target for further study and intervention to increase coloreCTal cancer surveillance among survivors.
Abstract: Clinical practice guidelines recommend ongoing testing (surveillance) for colorectal cancer survivors because they remain at risk for both local recurrences and second primary tumors. However, survivors often do not receive colorectal cancer surveillance. We used the Health Belief Model (HBM) to identify health beliefs that predict intentions to obtain routine colonoscopies among colorectal cancer survivors. We completed telephone interviews with 277 colorectal cancer survivors who were diagnosed 4 years earlier, between 2003 and 2005, in North Carolina. The interview measured health beliefs, past preventive behaviors, and intentions to have a routine colonoscopy in the next 5 years. In bivariate analyses, most HBM constructs were associated with intentions. In multivariable analyses, greater perceived likelihood of colorectal cancer (OR = 2.00, 95% CI = 1.16–3.44) was associated with greater intention to have a colonoscopy. Survivors who already had a colonoscopy since diagnosis also had greater intentions of having a colonoscopy in the future (OR = 9.47, 95% CI = 2.08–43.16). Perceived likelihood of colorectal cancer is an important target for further study and intervention to increase colorectal cancer surveillance among survivors. Other health beliefs were unrelated to intentions, suggesting that the health beliefs of colorectal cancer survivors and asymptomatic adults may differ due to the experience of cancer.
TL;DR: Elderly cancer survivors with somatic comorbidity had significantly higher BMI, more performed minimal physical activity, had more somatic symptoms, used more medication, and had more frequently seen a medical doctor than survivors without somaticComorbidities.
Abstract: The associations of lifestyle factors, somatic symptoms, mental distress, and somatic comorbidity in elderly cancer survivors have not been well studied. This study examines these associations among elderly cancer survivors (age ≥65 years) in a population-based sample. A cross-sectional comparative study of Norwegian elderly cancer survivors. Combining information from The Norwegian Cancer Registry, and by self-reporting, 972 elderly cancer survivors were identified, of whom 632 (65%) had somatic comorbidity and 340 did not. Elderly cancer survivors with somatic comorbidity had significantly higher BMI, more performed minimal physical activity, had more somatic symptoms, used more medication, and had more frequently seen a medical doctor than survivors without somatic comorbidity. In multivariable analyses, unhealthy lifestyle and higher somatic symptoms scores were significantly associated with cancer cases with somatic comorbidity. In univariate analyses those with somatic comorbidity were significantly older, had lower levels of education, higher proportions of BMI ≥ 30, less physical activity, poorer self-rated health, higher somatic symptoms score, more mental distress, had more frequently seen a medical doctor last year, and more frequently used daily medication. Our outcome measures of lifestyle, somatic symptoms and mental distress were all significantly associated with somatic comorbidity in elderly cancer survivors, however only lifestyle and somatic symptoms were significant in multivariable analyses. In elderly cancer survivors not only cancer, but also somatic comorbidity, deserve attention. Such comorbidity is associated with unhealthy lifestyles, more somatic symptoms and mental distress which should be evaluated and eventually treated.
TL;DR: Overall, the competing demands of cancer diagnosis and treatment did not reduce mammography rates, and these events were associated with increased rates among previous non-users.
Abstract: Colorectal cancer survivors remain at risk for breast cancer Thus, it is important to determine if screening mammography rates are reduced by the diagnosis and treatment of incident colorectal cancer Mammography rates among 7,666 67–79 year-old stage 0-III colorectal cancer survivors were compared with rates among 36,433 age-, race/ethnicity-, SEER area-matched women controlling for pre-diagnosis mammography, stage, chemotherapy, income, co-morbidities, treatment in teaching hospital, number of physician visits, and gynecologist visits In the first 2 years after diagnosis, the survivors’ rate (497/100) was 42% higher than the controls’ (476/100), p < 0001 It was 75% higher in the next 2 years, 545/100 versus 497/100, p < 0001 The higher rates resulted from significantly greater rates among survivors without prior mammography, 309/100, compared with their controls (253/100) in the first 2 years, for example (OR = 123, 95% CI = 115–132) The strongest predictors of post-diagnosis mammography were pre-diagnosis mammography (OR = 576, 95% CI = 519–638), visiting a gynecologist (OR = 183, 95% CI = 155–216), chemotherapy (OR = 161, 95% CI = 140–186), and more than nine physician visits Increasing Charlson scores and cancer stage were associated with lower mammography rates Overall, the competing demands of cancer diagnosis and treatment did not reduce mammography rates, and these events were associated with increased rates among previous non-users The low mammography rate among survivors with no history of a prior mammogram means that the physicians treating these women must emphasize the need for such care
TL;DR: Although future intentions to smoke differed according to cancer status, the relationship between tobacco-related risk factors and future smoking intentions appeared to be similar among preadolescents with and without cancer.
Abstract: Introduction
To compare preadolescents with and without cancer on current smoking status, future intentions to smoke, and tobacco-related risk factors, as well as to explore the relationship between cancer status and tobacco-related variables with intentions.
TL;DR: There are a range of dermatologic issues experienced by adult childhood cancer survivors, and in this non-representative sample, 50% of the survivors sought specialized care from a dermatologist for their concern.
Abstract: Common late effects experienced by childhood cancer survivors include: thyroid disturbances, pulmonary compromise, heart failure, and secondary neoplasms Dermatologic issues have been largely unexplored This descriptive study consisted of an 8 item self-reported questionnaire on dermatologic issues and the Dermatology Life Quality Index Participants reported dermatological issues that presented anytime after their diagnosis of cancer Over a seven month period, 166 survivors seen in a specialized program for adult survivors of childhood cancer housed within an adult cancer center received a cover letter either through the mail or in the clinic setting which explained the purpose of the study A total of 78 survivors completed the study with an average age of 297 years (range 19–46) and an average time since their diagnosis of 192 years (range 6–46) Dermatological issues were reported by 590% of survivors and 50% saw a dermatologist at least once for these concerns Nine survivors (115%) reported a skin cancer and ten (1282%) were affected by alopecia Additionally, 26 (333%) of survivors reported scars related to cancer therapy as a dermatological issue, and 99% of survivors reporting scars said they did not resolve with time There are a range of dermatologic issues experienced by adult childhood cancer survivors In our non-representative sample, 50% of the survivors sought specialized care from a dermatologist for their concern Additional research is needed to more clearly understand the extent of dermatologic issues and their impact upon quality of life in childhood cancer survivors Childhood cancer survivors may frequently seek care from primary care providers It is important for these providers to be aware of the risks associated with cancer treatments
TL;DR: Judging from the relative differences in confidant use, the effect of diagnosis of non-metastatic breast cancer on natural support-seeking behaviour over time is at least as strong among spouses as among their wives.
Abstract: We describe the frequency of, satisfaction with, and characteristics associated with confidant use among patients and their spouse in the year after diagnosis of non-metastatic breast cancer. In a prospective study of 308 women diagnosed in 1996–97 in Quebec and their spouses, participants were interviewed about confidant use 2 weeks, 3 and 12 months after treatment start. Study completion among eligible individuals was high (patients, 86%; spouses, 84%). Compared to before diagnosis when 55% of patients reported confiding in ≥1 individuals, 84% reported confiding since diagnosis when interviewed 2 weeks after treatment start (prevalence ratio (PR2 weeks) = 1.43, p < 0.0001). Spouses reported a greater increase in confiding (PR2 weeks = 1.97, p < 0.0001). Nonetheless, spouses were significantly less likely to report confidant use at any given time (PRs comparing spouses to patients: range 0.43–0.61). The primary confidant types with increases were nurses (both couple members) and physicians (patients). Most patients and spouses (84% to 93%) were satisfied with their confidant situation. At 3 months, the woman’s having ≥2 types of adjuvant therapy predicted greater confidant use in both partners. Judging from the relative differences in confidant use, the effect of diagnosis of non-metastatic breast cancer on natural support-seeking behaviour over time is at least as strong among spouses as among their wives. The majority of women and their spouses appear satisfied with their confidant situation, even in the first months after diagnosis when this type of support-seeking behaviour increased in both partners.
TL;DR: Declines in BMI in relation to ADT exposure may be reflective of unfavorable changes in body composition, especially decreased muscle mass, that is most pronounced in younger survivors.
Abstract: Introduction
The use of androgen deprivation therapy (ADT) for prostate cancer is on the rise, but its adverse side effects may include increased fat mass and decreased lean muscle mass. The net effect of ADT on BMI is unknown.
TL;DR: This journal is honored to publish the first paper on the LIVESTRONG Survivorship Center of Excellence Network whose mission it is to develop, provide, evaluate, and promulgate innovative models of health care.
Abstract: Studies confirm the limits of health care for survivors of many types of cancer. A recent population health study of quality care indicators using the National Cancer Data Base Infrastructure found that a little over half of the patients receiving radical prostatectomy or external beam radiation therapy for early stage prostate cancer had a follow up visit after treatment [1]. There is also evidence that preventative health care falls by the wayside, as subsequent visits to the doctor tend to focus primarily on the tumor and potential recurrence [2]. What about efforts to assist in maintaining overall health, well-being, and function? Don’t these outcomes reflect the World Health Organization’s definition of health; “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity?” [3] While not fully achievable for all, maintaining overall health and well-being seems a worthy goal to aspire to. Currently, achieving any of these goals is mainly left to the survivor [4]. It is daunting, even for someone who knows the vagaries of the health care system. Many elements need to be continuously tracked (e.g., general health, residual symptoms, well-being, overall function, and health behavior) and integrated into the cancer survivor’s health care even years after being cancer free [4]. This journal was launched to help facilitate such efforts and is committed to “fast tracking” manuscripts that systematically study these matters. Cancer survivors—those young and old, those with comorbidities, those of minority groups, those from various educational and economic backgrounds and with private or government supported health care—all experience the challenges of optimizing health over time. Fractionated health care continues to be the norm. However, innovative training efforts to help others establish quality programs of care for cancer survivorship have been designed and represent one promising way to expand quality services [5]. This journal is honored to publish the first paper on the LIVESTRONG Survivorship Center of Excellence Network whose mission it is to develop, provide, evaluate, and promulgate innovative models of health care. Through their efforts we will learn much about the elements and delivery of quality care for cancer survivors. In addition to these Centers of Excellence and the many other important initiatives around the world that will yield improvements in the future, we also need to find more immediate solutions. What about mobilizing the thousands of licensed health care providers currently working in communities across the world to positively impact the health of our current cancer survivor population? These providers represent a critical resource for improving health, well-being, and function in this ever-increasing population. Many health care providers are just beginning to define their potential role in improving outcomes in cancer survivors. Studies that determine the feasibility, costs, and outcomes of such grassroots clinical efforts would be most welcome in the Journal of Cancer Survivorship: Research and Practice. Comprehensive integrated care will continue to evolve in academic medical centers, community hospitals, and other settings. However, it is time we increase efforts even further and widen the network of providers in order to adequately address the patchwork of problems that cancer survivors face. Costly technology is generally not required in cancer survivorship care beyond cancer surveillance and of course, J Cancer Surviv (2009) 3:1–3 DOI 10.1007/s11764-009-0079-0
TL;DR: The findings may suggest a need for more extensive psychosocial follow-up after these gender-specific cancer forms in older women, but further research is clearly warranted.
Abstract: Introduction
Cancer’s impact on family formation in older adulthood is not well described. Marriage rates among older adults were therefore explored.
TL;DR: The patient was told that her cerebellum has been compromised and she will have balance and coordination problems and perhaps other functional changes as well from time to time, but anatomically things look completely stable.
Abstract: About two months ago I was walking in Georgetown on a perfectly sunny Sunday afternoon. The sidewalk I was on had no uneven sections, and it was dry with no ice or snow. Suddenly, I was falling forward. I attempted to catch myself and just could not coordinate my legs to stop the fall. I used my right arm and shoulder to break the fall and the sidewalk won out. As I sat up on the sidewalk I was in pain and found I could not move my arm. I decided I should to drive to an ER. After the Xray and it was clear that I didn’t break anything, I went home. After the fall I thought that perhaps I should have an MRI of my brain because I, like other brain tumor survivors, know the tumor can recur with no other fanfare than the occurrence of a symptom. For months prior to the fall I noticed my balance was off and it seemed like this was happening more often than in the past. I was walking with a slower and more intentional gait and when I stood upright I often swayed to the back losing balance and needing to brace myself with one foot. I thought both motor symptoms were something that may be related to my tumor or its treatment, but the problems were subtle. As with many cancer survivors while I am probably overly vigilant, I had previously just chalked these symptoms up to “changes I just need to live with.” In the back of my mind, I ignored both the imbalance and the fall until a few weeks ago. At that time, I noticed that for no apparent reason I was also hitting walls as I walked upstairs or turned corners. I thought this was strange and so, coupled with the events described earlier and this new experience, I wanted to know if there was any change in my MRI that might explain these mild balance symptoms. I arranged to reschedule my standard six month follow up and move up my MRI and clinic visit. On exam I had minor signs of balance problems but nothing out of the ordinary. The MRI was “extremely” stable as well. The neuro-oncology group requested a more detailed study of my cerebellum for this visit and that did not find anything remarkable either. Even the atrophy differences between the two lobes of my cerebellum had remained perfectly stable. This of course was great news, no evidence of tumor growth or for that matter any change. But what do I do about my balance problems? I was told when asking about the discrepancy that I need to realize that my cerebellum has been compromised (tumor, surgical resection, radiation, and chemotherapy), I will have balance and coordination problems and perhaps other functional changes as well from time to time, but anatomically things look completely stable. The explanation that was presented for the discrepancy between the MRI and my experience of the past several months made perfect sense to me and helped to calm my concerns. However the bottom line for me is that my balance/coordination is a problem. The staff performed a very complete work up. They addressed the pathology issue which is their responsibility. Recurrence was thoroughly investigated and ruled out. I am very appreciative. But what can I do about the balance problems? Do I see a balance specialist? Do I try to exercise on a balance board on my own? Do I see a neurologist? Do I see a physiatrist who has experience in the manageJ Cancer Surviv (2009) 3:73–74 DOI 10.1007/s11764-009-0090-5