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Long-term Cancer Survivorship

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426).

Deadline for manuscript submissions: closed (30 May 2015) | Viewed by 131105

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Special Issue Editor

Prof. Dr. Jane M. Armer

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Guest Editor

Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri–Columbia, Columbia, MO, USA
Interests: long-term cancer survivorship; living well after cancer; overall adjustment following cancer diagnosis and treatment; biopsychosocial factors associated with well-being following cancer; post-breast cancer lymphedema assessment and management

Special Issue Information

Dear Colleagues,

Cancer is a complex disease. Because of successes in screening, early detection, and individualized oncology treatments, cancer is increasingly seen as a chronic condition. Both acute treatment and long-term management require the dedication of a multidisciplinary team of clinicians and researchers, as well as continuing patient engagement and empowerment.

This Special Issue on survivorship focuses on the long-term aspects of living with cancer, and covers a time period from diagnosis, through treatment, and into the years beyond. Topics span biopsychosocial factors, the self-management of symptoms and co-morbidities, lifestyle changes, future survivorship risks, and considerations at the individual, family, and health system levels.

Prof. Dr. Jane M. Armer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (14 papers)

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Research

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440 KiB

Open AccessArticle

Complexities of Adherence and Post-Cancer Lymphedema Management

by Pamela L. Ostby and Jane M. Armer

J. Pers. Med. 2015, 5(4), 370-388; https://doi.org/10.3390/jpm5040370 - 16 Nov 2015

Cited by 32 | Viewed by 8406

Abstract

Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Measurement Issues in Anthropometric Measures of Limb Volume Change in Persons at Risk for and Living with Lymphedema: A Reliability Study

by Dorit Tidhar, Jane M Armer, Daniel Deutscher, Chi-Ren Shyu, Josef Azuri and Richard Madsen

J. Pers. Med. 2015, 5(4), 341-353; https://doi.org/10.3390/jpm5040341 - 30 Sep 2015

Cited by 33 | Viewed by 8174

Abstract

Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist is very high (scaled standard error of measurements (SEMs) for an arm and a leg volume were 0.82% and 0.64%, respectively) and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Patterns of Obesity and Lymph Fluid Level during the First Year of Breast Cancer Treatment: A Prospective Study

by Mei R. Fu, Deborah Axelrod, Amber A. Guth, Jason Fletcher, Jeanna M. Qiu, Joan Scagliola, Robin Kleinman, Caitlin E. Ryan, Nicholas Chan and Judith Haber

J. Pers. Med. 2015, 5(3), 326-340; https://doi.org/10.3390/jpm5030326 - 03 Sep 2015

Cited by 32 | Viewed by 9395

Abstract

Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8%) or overweight (32.4%), while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4–8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1%) maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4–8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Prospective Lymphedema Surveillance in a Clinic Setting

by Janet Chance-Hetzler, Jane Armer, Maggie Van Loo, Blake Anderson, Robin Harris, Rebecca Ewing and Bob Stewart

J. Pers. Med. 2015, 5(3), 311-325; https://doi.org/10.3390/jpm5030311 - 25 Aug 2015

Cited by 20 | Viewed by 11574

Abstract

The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ); (2) referral to LE management with limb volume increase (LVI) and/or LBCQ symptoms; and (3) cost of LE management at lower LVI (≥5%–≤10%) versus traditional (≥10%). Findings revealed a visit timeframe mean of 40.3 min (range = 25–60); 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9–18.9). LBCQ symptoms and LVI were significantly (p < 0.001) correlated to LE referral; six of the nine patients referred (67%) displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings). Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention

by Sherri G. Homan, Shumei Yun, Bob R. Stewart and Jane M. Armer

J. Pers. Med. 2015, 5(3), 296-310; https://doi.org/10.3390/jpm5030296 - 06 Aug 2015

Cited by 1 | Viewed by 7030

Abstract

Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups’ questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study

by Mei R. Fu, Deborah Axelrod, Amber A. Guth, Charles M. Cleland, Caitlin E. Ryan, Kristen R. Weaver, Jeanna M. Qiu, Robin Kleinman, Joan Scagliola, Joseph J. Palamar and Gail D'Eramo Melkus

J. Pers. Med. 2015, 5(3), 229-242; https://doi.org/10.3390/jpm5030229 - 26 Jun 2015

Cited by 95 | Viewed by 10823

Abstract

Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors’ quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher’s exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2–4, and only 7.4% had 5–8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients’ self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients’ quality of life. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment

by Jennifer M. Hulett, Jane M. Armer, Bob R. Stewart and Ausanee Wanchai

J. Pers. Med. 2015, 5(2), 174-190; https://doi.org/10.3390/jpm5020174 - 28 May 2015

Cited by 20 | Viewed by 9285

Abstract

This study explored breast cancer survivors’ perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants’ comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Establishing and Sustaining a Prospective Screening Program for Breast Cancer-Related Lymphedema at the Massachusetts General Hospital: Lessons Learned

by Cheryl Brunelle, Melissa Skolny, Chantal Ferguson, Meyha Swaroop, Jean O'Toole and Alphonse G. Taghian

J. Pers. Med. 2015, 5(2), 153-164; https://doi.org/10.3390/jpm5020153 - 20 May 2015

Cited by 50 | Viewed by 8635

Abstract

There has been an increasing call to prospectively screen patients with breast cancer for the development of breast cancer-related lymphedema (BCRL) following their breast cancer treatment. While the components of a prospective screening program have been published, some centers struggle with how to initiate, establish, and sustain a screening program of their own. The intent of this manuscript is to share our experience and struggles in establishing a prospective surveillance program within the infrastructure of our institution. It is our hope that by sharing our history other centers can learn from our mistakes and successes to better design their own prospective screening program to best serve their patient population. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessCommunication

A Patient-Centered Perspective on Cancer Survivorship

by Brad Zebrack

J. Pers. Med. 2015, 5(2), 91-95; https://doi.org/10.3390/jpm5020091 - 15 Apr 2015

Cited by 3 | Viewed by 7120

Abstract

Survivorship is a complicated notion because people often confuse a process of survivorship with a mythic identity of being a cancer survivor. This confusion may be a distraction to addressing the real-life struggles and challenges experienced by all people diagnosed with cancer. A more expansive perspective of survivorship, one that attends to patients’ physical, psychological, social, spiritual, and existential challenges throughout a continuum of care, would be more in line with what is known empirically about people’s experiences with cancer. In an effort to gain a patient-centered perspective on cancer, and one that emphasizes multiple dimensions of cancer survivorship, the author reports findings from a non-scientific social media poll (via Facebook and personal emails) in which survivors and colleagues working in the field of cancer survivorship answered the question: What does cancer survivorship mean to you? The comments are enlightening and useful for guiding the development of a patient-centered, and, thus, more comprehensive, approach to caring for people affected by cancer. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Neurocognitive Outcomes and School Performance in Solid Tumor Cancer Survivors Lacking Therapy to the Central Nervous System

by Caroline Mohrmann, Jennifer Henry, Marnie Hauff and Robert J. Hayashi

J. Pers. Med. 2015, 5(2), 83-90; https://doi.org/10.3390/jpm5020083 - 10 Apr 2015

Cited by 22 | Viewed by 7525

Abstract

School performance in patients who have received therapy for childhood cancers has been studied in depth. Risk factors have historically included cranial radiation, intrathecal chemotherapy, and high doses of chemotherapy, including methotrexate and cytarabine. Leukemia and brain tumor survivors who receive such therapy have been the primary focus of this area of investigation. Extracranial solid tumor cancer patients lacking such risk factors have historically been expected to have normal school performance. We examined the medical records of 58 young pediatric extracranial solid tumor patients who lacked CNS-directed therapy or other known risk factors for cognitive impairment to evaluate the incidence of reported difficulties or abnormalities in neuropsychological testing. Thirty-one percent of patients were found to have at least one reported difficulty or abnormality. Of note, 34% of patients with Wilms tumor possessed difficulties compared to 23% of patients with other extracranial solid tumors. Extracranial solid tumor cancer survivors without known risk factors for school performance difficulties appear to have a higher incidence of problems than expected. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessArticle

Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

by Joanne Lester, Gaurav Pahouja, Barbara Andersen and Maryam Lustberg

J. Pers. Med. 2015, 5(2), 50-66; https://doi.org/10.3390/jpm5020050 - 25 Mar 2015

Cited by 56 | Viewed by 11812

Abstract

Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

Review

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650 KiB

Open AccessReview

The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis

by Peeranuch LeSeure and Supaporn Chongkham-ang

J. Pers. Med. 2015, 5(4), 406-439; https://doi.org/10.3390/jpm5040406 - 19 Nov 2015

Cited by 66 | Viewed by 11359

Abstract

The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessReview

Behavioral Symptoms after Breast Cancer Treatment: A Biobehavioral Approach

by Christopher Fagundes, Angie LeRoy and Maryanne Karuga

J. Pers. Med. 2015, 5(3), 280-295; https://doi.org/10.3390/jpm5030280 - 03 Aug 2015

Cited by 27 | Viewed by 8498

Abstract

Being diagnosed and treated for breast cancer is emotionally and physically challenging. Breast cancer is the most commonly diagnosed cancer and the second leading cause of death for women in the United States. Accordingly, women with a breast cancer history are the largest group of female cancer survivors. Psychological stress substantially augments adverse autonomic, endocrine, and immune discharge, including enhanced production of proinflammatory cytokines. Importantly, inflammation is a key biological mechanism underlying the symptom cluster of pain, depression, fatigue, and sleep disturbances; there is also good evidence that inflammation contributes to breast cancer recurrence. Stress may exert direct effects on psychological and physiological risk processes. In this review, we take a biobehavioral approach to understanding predictors and mechanisms underlying somatic symptoms in breast cancer survivors. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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Open AccessReview

Lifestyle Factors in Cancer Survivorship: Where We Are and Where We Are Headed

by Namrata Vijayvergia and Crystal S. Denlinger

J. Pers. Med. 2015, 5(3), 243-263; https://doi.org/10.3390/jpm5030243 - 02 Jul 2015

Cited by 76 | Viewed by 10758

Abstract

Advances in early detection and curative therapies have led to an increased number of cancer survivors over the last twenty years. With this population comes the need to evaluate the late and long term effects of cancer treatment and develop recommendations about how to optimally care for these survivors. Lifestyle factors (diet, body weight, physical activity, and smoking) have been linked to a higher risk of many medical comorbidities (cardiovascular, metabolic, etc.). There is increasing evidence linking these factors to the risk of developing cancer and likely cancer-related outcomes. This link has been studied extensively in common cancers like breast, colon, prostate, and lung cancers through observational studies and is now being prospectively evaluated in interventional studies. Realizing that survivors are highly motivated to improve their overall health after a diagnosis of cancer, healthy lifestyle recommendations from oncology providers can serve as a strong tool to motivate survivors to adopt health behavior changes. Our article aims to review the evidence that links lifestyle factors to cancer outcomes and provides clinical recommendations for cancer survivors. Full article

(This article belongs to the Special Issue Long-term Cancer Survivorship)

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