Search Results (1,885)

The study aims to investigate the Health-Related Quality of Life (HRQOL) in lung cancer survivors, comparing it with the HRQOL of survivors of other types of cancer, analyzing its association with clinically significant distress, and exploring the modulating role of sociodemographic, clinical, and psychosocial variables. A total of 141 lung cancer survivors who had completed treatment with curative intent and were disease-free completed the Quality of Life in Adult Cancer Survivors questionnaire (QLACS), the Brief Symptom Inventory-18 (BSI-18), the Medical Outcomes Study–Social Support Survey (MOS-SSS), and the Utrecht Proactive Coping Competence scale (UPCC). Several multivariate analyses of variance (MANOVA) were performed to address the study objectives. Statistical analysis was performed using IBM SPSS Statistics 22.0. The overall HRQOL of lung cancer survivors did not differ from the HRQOL of hematologic, breast, and gynaecologic cancer survivors and was lower than that of colorectal, head/neck, prostate, and melanoma cancer survivors. HRQOL was associated with clinically significant distress. Younger age, female sex, lower levels of proactive coping, and less positive social interaction were independently associated with worse HRQOL in lung cancer survivors. The overall HRQOL of lung cancer survivors is among those with the poorest HRQOL compared with other cancer survivors’ groups. The modifiable nature of the psychosocial variables that characterize the risk profile (with the exception of sociodemographic ones) allows for the establishment of more ambitious goals than the simple establishment of subgroups on which to prioritize care. The team of professionals involved in the care of lung cancer survivors should also provide intervention strategies that improve their well-being. Full article

Physical activity (PA) can provide protective benefits for prostate cancer (PCa) survivors. Healthcare practitioners are ideally positioned to promote PA to their PCa patients. This study was designed to identify how practitioners have advised and supported their PCa patients to try and overcome barriers to PA. A secondary aim was to identify if there were differences in the types of PA advice provided based on practitioner specialty and number of years in practice. Participants were 13 healthcare practitioners from Auckland, New Zealand, who provide biomedical (urology, oncology) and allied health services (physiotherapy) to men who have received a diagnosis of PCa. Participants were individually interviewed and data were analyzed using an inducive thematic approach. Three main themes and four sub-themes were identified. Physical activity advice did not appear to differ based on practitioner specialty or length of time in practice; rather, PA advice was provided to help counteract the associated side effects of specific PCa treatments. Verbal information, encouragement and resources were provided to help support PA. Specialist cancer nurses can provide long-term PA advice and support. Individualized exercise programs through physiotherapy can benefit men receiving active PCa treatment, as well as men in remission experiencing treatment-related side effects. Full article

Background: Metronomic chemo-endocrine therapy combining fulvestrant with metronomic VEC (vinorelbine, cyclophosphamide, and capecitabine)—the FulVEC regimen—demonstrated promising activity in an initial cohort of 38 patients with advanced ER+/HER2− breast cancer (JCM 2023). Here, we present an extended analysis of 72 consecutive patients, with a focus on a novel hypothesis: that treatment-emergent adverse events (AEs) requiring dose modification serve as a surrogate for sufficient pharmacological exposure in metronomic combination chemotherapy. Methods: Retrospective analysis of 72 consecutive patients with metastatic ER+/HER2− breast cancer treated with FulVEC at Jagiellonian University Hospital between 2018 and 2024. Efficacy endpoints included progression-free survival (PFS), overall survival (OS), and biochemical response, as assessed by CA15-3 dynamics. Patients were stratified by AE severity requiring intervention (grade 0: no modification; grade 1: dose reduction; and grade 2: treatment delay). The association between AE grade and efficacy outcomes was assessed using Spearman’s correlation, the log-rank test, and the chi-square test. Results: The median PFS was 8.5 months, and the median OS was 18.0 months. The biochemical benefit rate (any CA15-3 decline) was 81.6%. No statistically significant differences in efficacy were observed according to prior exposure to CDK4/6 inhibitors, fulvestrant, or cytotoxic components of the FulVEC regimen. A monotonic dose–response relationship was observed across AE grade categories: non-progression rates increased from 73.2% (grade 0) to 84.2% (grade 1) and 91.7% (grade 2); biochemical benefit rates from 68.4% to 90.9% and 100.0%; and median CA15-3 reduction deepened from −34% to −44% and −52%, respectively (Spearman r = 0.258 and p = 0.043 for AE grade vs. treatment duration). Formal log-rank comparisons of PFS and OS across the three AE-grade categories did not reach statistical significance (p = 0.583 and p = 0.743, respectively), reflecting the limited size of the treatment-delay subgroup (n = 12); the dose–response signal should, therefore, be regarded as exploratory. No patient required permanent treatment discontinuation due to toxicity. Conclusions: The extended FulVEC cohort confirms durable activity and a reproducible, manageable safety profile in a heavily pretreated population, including CDK4/6i-refractory patients. The exploratory, hypothesis-generating observation of a dose–response gradient between AE severity and clinical outcomes raises the possibility that treatment-emergent AEs may, in some patients, reflect adequate pharmacological exposure to the metronomic regimen. Given confounding by treatment duration and survivor bias, and the absence of pharmacokinetic data, this hypothesis requires prospective validation and does not, at this stage, support any change to current treatment practice. Full article

Breast cancer (BC) surgery often reduces upper limb range of motion (ROM), negatively affecting quality of life. Since most research focuses on early recovery, this study investigates differences in ROM between the surgical (SA) and non-surgical (NS) arms in BC survivors and between recent (<2.5 years—RS) and non-recent (>2.5 years—NR) surgery groups. Upper limb kinematics (flexion–extension, abduction, internal–external rotation) were recorded using inertial measurement units in 26 BC survivors (age: 48.92 ± 7.89 years; stature: 1.57 ± 0.05 m; mass: 66.59 ± 14.07 kg; BMI: 27.14 ± 5.71 kg/m²). ROM, angular velocity, and movement smoothness were analyzed. The SA group demonstrated reduced ROM during flexion (p = 0.023) and extension (p = 0.005) compared to the NS group. Within the RS group, the SA group exhibited lower ROM (p = 0.005), reduced peak angular velocity (p = 0.008), and average angular velocity (p = 0.006) during extension compared with the NR group. Additionally, the average extension angular velocity of the arm among the NS group was higher in the RS group than in the NR group. BC surgery causes persistent upper limb kinematic impairments, mainly during flexion and extension, which can be observed up to six years after surgery. Therefore, early and continuous tailored physical exercise is highly recommended to mitigate these long-term functional deficits. Full article

Background: Immune fitness (IF) reflects the body’s ability to mount appropriate immune responses. Monitoring IF could improve tailored treatment in oncological rehabilitation. The Immune Status Questionnaire (ISQ) and the Single-Item Scale (SIS) were developed to assess IF, but their clinimetric properties in cancer rehabilitation remain unknown. Aims: To evaluate the construct validity, responsiveness, and correlation between the ISQ and the SIS in oncological rehabilitation. Methods: The study population included people participating in oncological rehabilitation during or within one year after medical treatment. Data were collected prospectively via questionnaires. Construct validity and responsiveness were assessed through predefined hypotheses, including correlations with fatigue, sleep problems, malnutrition risk, activity impairment, and physical functioning. Results: In total, 97 individuals were included in the analyses. Median ISQ and SIS scores were 8/10 and 7/10, respectively. Correlations ranged from r = −0.21 to r = −0.50. Only the SIS correlations with fatigue and physical functioning, and the ISQ correlation with fatigue, met the predefined thresholds. Responsiveness hypotheses were not confirmed. Conclusions: The ISQ and the SIS demonstrated low construct validity and responsiveness in this population. IF scores were higher than expected. Correlations showed links between fatigue, physical functioning, and IF. Future research should develop tools tailored to the complex immune disturbances experienced by cancer survivors. Full article

Background: Lymphoma is the most common hematologic malignancy diagnosed in active-duty service members (ADSMs). Service members treated for lymphoma often face uncertainty regarding their fitness for duty, which carries implications for individual careers and force readiness. In this retrospective, exploratory study we aimed to (1) determine the proportion of previously deployed ADSMs who deployed after a lymphoma diagnosis, and (2) characterize those deployments. Methods: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) cases diagnosed between 2001 and 2022 were identified from the Defense Health Agency Cancer Registry using International Classification of Diseases for Oncology, Third Edition histology codes. Deployment variables were obtained from the Defense Manpower Data Center. Analysis was restricted to service members who were on active duty at diagnosis and had a history of deployment; those who had never deployed were excluded. This study was exempt from full institutional review board review. Results: A total of 866 previously deployed ADSMs with lymphoma were identified (455 HL, 411 NHL). Of these, 119 (13.7%; 95% CI 11.6–16.2) deployed after their lymphoma diagnosis, including 86 of 455 with HL (18.9%; 95% CI 15.6–22.8) and 33 of 411 with NHL (8.0%; 95% CI 5.8–11.1). HL survivors were significantly more likely than NHL survivors to deploy after diagnosis (p < 0.001). The mean interval from diagnosis to deployment was 5.1 years (SD 3.7) for HL and 4.5 years (SD 2.3) for NHL. As of 2022, all 119 individuals were alive at last follow-up. Conclusions: Among previously deployed ADSMs with lymphoma, roughly one in six deployed after their diagnosis and treatment, typically within five years. These findings indicate that deployment after lymphoma treatment is achievable for a significant subset of service members, highlighting both the success of cancer care in military treatment facilities and the favorable impact of modern oncologic care on operational readiness. Full article

Background/Objectives: Cancer survivors admitted to inpatient rehabilitation suffer from a complex burden of interrelated physical and psychological symptoms. While mean-level improvements during rehabilitation are well-documented, it remains unknown whether rehabilitation modifies the underlying structure of symptom interconnections—the symptom network—beyond reducing individual symptom scores. This study aimed to characterize symptom network structure at admission and discharge of a 21-day inpatient cancer rehabilitation program based on cancer-related physical symptoms and psychosocial functioning, formally compare network topology across timepoints, identify structurally central treatment targets, and assess the transdiagnostic generalizability of findings. Methods: Secondary analysis of routinely collected, electronic patient-reported outcome (PRO) data from 5066 cancer survivors (mean age 60.3 years, SD 12.2; 64.2% female; most frequent diagnoses: breast cancer = 36.9%, hematological malignancies = 10.4%; prostate cancer = 8.5%) admitted to a single-center inpatient rehabilitation program was performed between January 2017 and November 2022. The EORTC QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS) questionnaires were utilized. Bayesian Gaussian Graphical Models were estimated at admission (T0) and discharge (T1) across 17 symptom and functioning domains using Bayesian Model Averaging (15,000 iterations). Edge-level change was quantified via posterior distributions of pairwise differences with 95% Highest Density Intervals. Node-level changes were assessed using Bayesian paired t-tests. Centrality was quantified by Expected Influence and Bridge Expected Influence. Results: Patients showed clinically meaningful improvements across all 17 domains during rehabilitation (all Bayes Factors >10; posterior probability of direction >99.9%). The largest standardized effects were observed for emotional functioning (Cohen’s d = 0.76), global health status (d = 0.69), and fatigue (d = 0.53). These improvements were clinically meaningful for a substantial proportion of patients: 62% improved by at least the minimal important difference in fatigue and 58% in emotional functioning, and the proportion of patients with probable anxiety fell from 15% to 6% and probable depression from 10% to 4%. Emotional functioning and anxiety were the most central domains in the symptom network—most strongly connected to the rest of patients’ symptom burden—at both admission and discharge. Despite the clinical improvements, the overall architecture of symptom interconnections changed little (83% of connections were unchanged). This indicates that the severity of symptoms was mitigated while the structure linking them together remained largely intact. The one connection that strengthened was that between impaired social functioning and financial difficulties (Δ = −0.112). Structural findings were consistent across ten cancer types (leave-one-out r > 0.80 in seven of ten). Conclusions: Over the course of inpatient cancer rehabilitation, patients showed large improvements against a background of largely stable symptom network architecture. Emotional functioning and anxiety occupy structurally central positions at both admission and discharge, identifying them as candidate domains warranting further investigation for network-informed rehabilitation. These findings provide a novel structural perspective on oncological rehabilitation and a framework for developing more targeted intervention strategies. Full article

Background/Objectives: Dietary habits are important modifiable factors influencing survival among cancer patients. The dietary quality among cancer survivors may differ from those of the general population and may vary according to age at cancer diagnosis. This study aimed to compare dietary quality between cancer survivors and the general population and to examine whether age at diagnosis is associated with dietary quality. Methods: This retrospective cross-sectional study used data from 8706 adults aged ≥ 30 years (641 cancer survivors and 8065 controls) from the 2019–2021 Korea National Health and Nutrition Examination Survey. Dietary quality was assessed using the Diet Quality Index-International (DQI-I; range 0–100). Survey-weighted multiple linear regression models were used to compare DQI-I scores between cancer survivors and controls. Subgroup analyses were stratified by age at diagnosis, and quadratic age terms were included to assess nonlinear associations. All analyses accounted for the complex survey design. Results: Cancer survivors had significantly higher mean DQI-I scores than controls (69.1 ± 0.4 vs. 66.1 ± 0.2; p < 0.001). Among survivors diagnosed before age 50, dietary quality was significantly higher in those currently under 65 years than in controls (mean difference +3.02, 95% CI 1.44–4.60), but notably lower in those aged ≥ 65 years (−3.18, 95% CI −6.16 to −0.20). In contrast, survivors diagnosed at age ≥ 50 consistently showed higher dietary quality than controls across all age groups (+3.76, 95% CI 2.83–4.68). Conclusions: While cancer survivors generally exhibit better dietary quality than the general population, this positive trend was not observed among younger-onset survivors in older age groups. These findings suggest that age at cancer diagnosis may be associated with dietary quality and highlight the need for sustained, age-specific nutritional support strategies in cancer survivorship. Full article

Burkitt lymphoma (BL) is an aggressive B-cell lymphoma endemic in children in regions of sub-Saharan Africa, where its incidence geographically overlaps holoendemic Plasmodium falciparum malaria and poorly controlled childhood Epstein–Barr virus (EBV) infection. Despite decades of research, the precise mechanistic synergy between these two pathogens remains incompletely defined. This review synthesizes current epidemiological, immunological, and molecular evidence to propose an integrated model for the etiology of endemic BL. We outline a paradoxical, dual-edged relationship wherein EBV infection during infancy may provide a short-term child survival advantage against severe malaria while simultaneously increasing the long-term oncogenic risk in B-cells infected by EBV. P. falciparum infection triggers polyclonal B-cell activation, increasing the probability of an activation-induced cytidine deaminase (AID)-mediated c-MYC translocation in proportion to the recurrent parasite burden. Concurrently, EBV expands within this B-cell pool and modulates the host immune response, potentially through viral interleukin-10 (vIL-10), to prevent lethal malarial inflammation. At the cellular level, EBV provides a critical “second hit” when it establishes latency I infection that rescues c-MYC-translocated B-cells from apoptosis. This framework explains why BL manifests as a “tumor of malaria survivors,” peaking in incidence years after the highest-risk period for malaria mortality. Ultimately, this model underscores that malaria control is a critical form of cancer control and highlights key future directions for validating these pathways in prospective clinical studies. Full article

Background: Physical exercise is strongly recommended for breast cancer survivors due to its beneficial effects on physical function, metabolic health, and quality of life. Lactate, traditionally considered a metabolic byproduct of glycolysis, is increasingly recognized as a signaling molecule involved in metabolic regulation and exercise adaptation. However, exercise-induced circulating lactate responses in breast cancer survivors remain poorly characterized. The aim of this systematic review and exploratory meta-analysis was to synthesize and critically appraise current evidence on exercise-induced circulating lactate responses in breast cancer survivors Methods: A systematic review and exploratory meta-analysis were conducted according to PRISMA guidelines and prospectively registered in PROSPERO (CRD42024504288). PubMed, Scopus, and Web of Science were searched to identify controlled trials investigating exercise-induced changes in circulating lactate concentrations in breast cancer survivors. Random-effects meta-analysis was performed using pooled mean differences. Results: Among 173 screened records, four studies met eligibility criteria for qualitative synthesis and three contributed to quantitative analysis. Pooled results demonstrated no statistically significant effect of exercise on circulating lactate concentrations (weighted mean difference: 0.03 mmol/L; 95% CI: −0.24 to 0.31; p = 0.81), with low heterogeneity (I² = 31.1%). Considerable variation was observed across exercise protocols, intervention duration, and lactate assessment timing. Conclusions: Exercise-induced circulating lactate responses in breast cancer survivors appear modest and inconsistently reported across available studies. Current evidence remains limited by small sample sizes and methodological heterogeneity. These findings provide a physiological overview of lactate responses to exercise in breast cancer survivorship and highlight the need for standardized exercise interventions and metabolic outcome assessment in future research. Full article

Cancer and atherosclerotic cardiovascular disease (ASCVD) represent two of the leading causes of death worldwide. Increasingly, these two are being recognized as biologically related conditions rather than entirely segregated disease states. In addition to traditional risk factors such as aging, smoking, and obesity, chronic inflammation may be a key factor connecting the two illnesses. Endothelial dysfunction, oxidative stress, plaque progression, and thrombosis are all facilitated by inflammatory signaling in ASCVD. Similar pathways are known to contribute to cancer growth and invasion. Emerging epidemiologic data demonstrate increased cancer incidence among patients with cardiovascular disease, while cancer survivors and recipients of cardiotoxic therapies exhibit accelerated vascular disease. This narrative review aims to describe the bidirectional relationship between ASCVD and cancer. Targeting shared pathways using statins, colchicine, canakinumab, IL-6 inhibition, and lifestyle modification may provide dual benefits. Future biomarker-guided trials with integrated cardiovascular and oncologic endpoints are needed to clarify causality and optimize prevention and management. Full article

Survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) are at risk of developing long-term adverse effects after survival. This study examined observed proportions of perceived mental distress, fatigue, and executive function (EF) impairment in adult childhood cancer survivors (CCSs) of ALL, AML, and NHL. Secondly, it examined the association between perceived EF impairment and mental distress or fatigue. Participants (n = 132; 57% female) were recruited from two major Norwegian hospitals. Self-report questionnaires included the Behavior Rating Inventory of Executive Function, Adult Version, the Hopkins Symptom Checklist-25, and the Fatigue Severity Scale. Proportions exceeding established clinical thresholds were calculated, and groups were compared using Pearson’s chi-squared test and Newcombe confidence intervals. Overall, 49% and 41% of participants met the clinical thresholds for depression and anxiety; 43% for fatigue; and 28% for EF impairment. Perceived EF impairment was significantly associated with mental distress and fatigue. Mental distress, fatigue, and EF impairment are commonly reported and distressing late effects among CCSs of ALL, AML, and NHL. Follow-up care focusing on neurocognitive and psychological outcomes is important for the long-term functioning and well-being of this survivor group. Targeted neurocognitive rehabilitation may represent a key component of follow-up care. Full article

Background/Objectives: Clostridioides difficile infection (CDI) remains a major cause of morbidity and mortality, particularly among hospitalized older adults. This study evaluated the prognostic performance of routinely available inflammatory and nutritional biomarkers for predicting in-hospital mortality in patients with CDI. Methods: We conducted a retrospective observational study of 110 adults with confirmed CDI admitted to the Internal Medicine Department of a tertiary-care hospital in Athens, Greece, between January 2022 and December 2025. Demographic, clinical, and laboratory data obtained within 24 h of admission were analyzed. The prognostic value of the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), C-reactive protein-to-albumin ratio (CAR), and Prognostic Nutritional Index (PNI) was assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory performance of PNI. Results: Twenty-two patients (20.0%) died during hospitalization. Compared with survivors, non-survivors exhibited significantly higher NLR (p = 0.035), dNLR (p = 0.012), and CAR (p = 0.015) values, whereas serum albumin and PNI were significantly lower (both p < 0.001). In univariate analysis, dNLR, CAR, and PNI were associated with mortality. After adjustment for age, sex, length of stay, and cancer diagnosis, only PNI remained independently associated with in-hospital mortality (p = 0.018). PNI showed good predictive performance (p < 0.001). Conclusions: PNI is a simple, inexpensive, and readily obtainable biomarker independently associated with in-hospital mortality in CDI. These findings highlight the importance of immune-nutritional status in CDI and support the potential utility of PNI for early risk stratification in hospitalized patients. Full article

Background/Objectives: We examined whether guidance on dietary habits or nutrition-related problems from healthcare professionals during cancer treatment was associated with quality of life, after treatment. Methods: Cross-sectional data were drawn from the Icelandic Compass study, conducted in 2020–2021 among adults diagnosed with cancer in 2015–2019. The analysis included participants who had completed treatment for breast cancer (n = 341), prostate cancer (n = 137), or colorectal cancer (n = 132), for a total sample of 610 participants. Quality of life (QL) was assessed using the EORTC QLQ-C30 global health status/quality of life scale. Associations were examined using regression models adjusted for age, marital status, education, number of cancer treatments, stage at diagnosis, body mass index, tobacco and alcohol use, and comorbidities. Results: Overall, 26% of participants reported receiving sufficient guidance on general dietary habits during treatment and 19% on nutrition-related problems. On average, three years had passed since diagnosis. Among all participants, guidance on general dietary habits was associated with higher QL scores (β = 5.6; 95% CI: 0.8 to 10.5), as was guidance on nutrition-related problems (β = 5.7; 95% CI: 0.3 to 11.1). In subgroup analyses, statistically significant associations were observed among prostate cancer survivors for both dietary guidance (β = 12.4) and guidance on nutrition-related problems (β = 14.0), and among breast cancer survivors for guidance on nutrition-related problems (β = 8.4). Conclusions: Patient-reported sufficient discussions about dietary habits or nutrition-related problems during treatment were associated with slightly higher post-treatment QL scores. Full article

The emergence of immune checkpoint inhibitors, targeted therapies, CAR T-cell therapy, and antibody–drug conjugates has transformed modern oncology, significantly improving survival across a wide range of malignancies. However, these advances have also introduced a growing spectrum of endocrine and metabolic complications, redefining the scope of endocrine practice. Therapy-induced endocrinopathies, including thyroid dysfunction, hypophysitis, adrenal insufficiency, diabetes, pancreatitis, dyslipidemia, gonadal dysfunction, and metabolic syndrome, are recognized as clinically significant and often long-lasting consequences of cancer treatment. Unlike classical endocrine disorders, these conditions frequently present abruptly, display atypical clinical patterns, and require complex multidisciplinary management. This review explores the evolving field of oncoendocrinology, focusing on the mechanisms, clinical manifestations, and management of endocrine toxicities associated with novel cancer therapies. We also discuss the long-term endocrine sequelae of cancer treatment and the growing need for structured survivorship care and endocrine surveillance. In addition, we discuss future directions in oncoendocrinology, including predictive biomarkers, the need for treatment standardization, integrated care models, survivorship surveillance, and precision-based approaches to endocrine care. As cancer survival continues to improve, early recognition and long-term management of endocrine complications are becoming essential to optimizing both quality of life and overall outcomes in cancer survivors. Full article