Cancer Survivor

On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD) to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identi...

Psychological interventions for adult cancer patients have primarily focused on reducing stress and enhancing quality of life. However, there has been expanded focus on biobehavioral outcomes—health behaviors, compliance, biologic responses, and disease outcomes—consistent with the Biobehavioral Model of cancer stress and disease course. The author reviewed this expanded focus in quasi-experimental and experimental studies of psychological interventions, provided methodologic detail, summarized findings, and highlighted novel contributions. A final section discussed methodologic issues, research directions, and challenges for the coming decade.

Background: Women with cervical cancer now have relatively good 5-year survival rates. Better survival rates have driven the paradigm in cancer care from a medical illness model to a wellness model, which is concerned with the quality of womenLs lives as well ...

On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD) to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identi...

Improvements in cancer treatment have changed the way in which cancer is viewed and experienced. However, these same treatments have led to numerous early and late effects, including the loss of fertility. Infertility can influence the biologic and psychologic health of both male and female survivors. Reproductive science can now offer methods to address this concern and provide promising new approaches that may eliminate or mitigate this treatment-related outcome. For current and future reproductive options to serve the needs of survivors more fully, health providers must understand the complexities of infertility as well as their role in delivering answers their patients require. This review will discuss what is known about the causes and experience of infertility among cancer survivors as well as the forms of fertility preservation available.

Goals of work Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or supportive care needs. Materials and methods One hundred and fifty-four cancer survivors who were 1–11 years post diagnosis and disease-free and their partners completed mailed questionnaires. Main results A positive relationship was found between psychological distress and supportive care needs both within and between partner and survivor samples. Partners reported high levels of anxiety and supportive care needs, most frequently concerning relationships and the impact of the cancer illness. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time although partners demonstrated psychological resilience and reported positive outcomes. Predictors of distress and unmet needs were explored: physical QOL, relationship satisfaction, and total needs contributed to variability in partners’ distress; relationship satisfaction and total needs were associated with survivors’ distress. Distress and relationship satisfaction were associated with partners’ unmet needs; only distress was associated with survivors’ unmet needs. Conclusions Partners are not merely providers of support, but need support themselves many years after a cancer diagnosis and in the context of apparently cured disease. The quality of the dyadic relationship may be critical in determining both partner and survivor distress and needs, and may prove a useful target for psychosocial interventions.

There are many male and female patients of young age diagnosed with some form of invasive cancer. With current treatment regimens, including aggressive chemotherapy, radiotherapy, bone marrow transplantation, and surgery, the cure rate for some malignancies now is very high. These treatments, however, can lead to gonadal failure and permanent infertility. Fertility preservation is a significant concern for such men and women faced with cancer treatment. Several alternatives have been attempted in an effort to preserve fertility in young women undergoing cancer treatment. Although ovarian tissue cryopreservation has recently been the focus of intense investigation, cryopreservation of embryos and mature oocytes has several advantages over ovarian tissue preservation. Also there are some strategies for minimizing female gonadal toxicity caused by cancer therapy including use of radiation shields, transposition of the ovaries out of the irradiation field, and suppression of ovaries by ...

May AM, van Weert E, Korstjens I, Hoekstra-Weebers JE, van der Schans CP, Zonderland ML, Mesters I, van den Borne B, Ros WJ. Monitoring training progress during exercise training in cancer survivors: a submaximal exercise test as an alternative for a maximal exercise test?To examine the use of a submaximal exercise test in detecting change in fitness level after a physical training program, and to investigate the correlation of outcomes as measured submaximally or maximally.A prospective study in which exercise testing was performed before and after training intervention.Academic and general hospital and rehabilitation center.Cancer survivors (N=147) (all cancer types, medical treatment completed ≥3mo ago) attended a 12-week supervised exercise program.A 12-week training program including aerobic training, strength training, and group sport.Outcome measures were changes in peak oxygen uptake (Vo2peak) and peak power output (both determined during exhaustive exercise testing) and submaximal heart rate (determined during submaximal testing at a fixed workload).The Vo2peak and peak power output increased and the submaximal heart rate decreased significantly from baseline to postintervention (P<.001). Changes in submaximal heart rate were only weakly correlated with changes in Vo2peak and peak power output. Comparing the participants performing submaximal testing with a heart rate less than 140 beats per minute (bpm) versus the participants achieving a heart rate of 140bpm or higher showed that changes in submaximal heart rate in the group cycling with moderate to high intensity (ie, heart rate ≥140bpm) were clearly related to changes in VO2peak and peak power output.For the monitoring of training progress in daily clinical practice, changes in heart rate at a fixed submaximal workload that requires a heart rate greater than 140bpm may serve as an alternative to an exhaustive exercise test.

While the population in the western world is aging and cancer survival rates are increasing, there is a lack of knowledge concerning factors affecting social support and its relation to coping and distress among older patients. The aim of the current study is to assess the impact of marital status and gender upon levels of psychological distress, coping, and social support among middle-aged and older unmarried (divorced/widowed) and married colorectal cancer patients. Samples of 339 male and female colorectal patients were recruited from three major cancer centers in Israel. Participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; psychological distress, coping styles and social support were assessed using four self-report standardized instruments. Two-way MANOVAs and Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficient were used to assess the relationships between the study variables. High levels of distress were found among unmarried and male patients. Married men reported on significantly higher levels of spouse support than married women. Family support was correlated with psychological distress only among married patients. Surprisingly, spiritual-religious support was found to be correlated among some of the study groups with Helplessness and Fatalism. The results support the assumption that married patients cope better with cancer than unmarried patients and that women cope better than men. These differences may be related to the cultural mores of Israeli society in which men are expected to play the &amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;hero&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; role or to a generally lower ability of men to use social support and of unmarried patients to get family support. Practical conclusions in terms of intervention are discussed.

Cancer survivors constitute 3.5% of the United States population, but second primary malignancies among this high-risk group now account for 16% of all cancer incidence. Although few data currently exist regarding the molecular mechanisms for second primary cancers and other late ...

In this article, research-based strategies used in a web-based study to assess the impact of participation in cancer-related mailing lists on cancer survivors and caregivers are highlighted. The paper presents alternative methods of measuring response rates in Internet surveys. Response rate estimation, based on American Association for Public Opinion Research guidelines, ranged between 15% and 24.9% for the study. Several strategies were implemented to increase survey participation and reduce item nonresponse. Few participants opted for a telephone survey as an alternative to a web-administered design (mixed-mode administration). Using time-stamp data to diagnose places in the questionnaire where respondents prematurely exited or broke off survey participation, we were able to decrease premature break offs. A lottery was also implemented to increase response rates. The experience of obtaining institutional review board approval for the lottery is also described. Preliminary data indicate slight increases in response rates subsequent to implementing the lottery.

We demonstrate the utility of partitioning the spiritual well-being (SpWB) construct into spiritual and religious components using results from a study of the relationship of existential well-being to health-related quality of life (HRQOL) in a sample of 237 cancer survivors. Existential and religious well-being were measured using the FACIT-Sp-12 and HRQOL was measured using the mental and physical component scores of the SF-12. In hierarchical linear regression analyses, existential well-being fully mediated religious well-being's effect on HRQOL and explained unique variance in both the mental and physical HRQOL domains, controlling for demographic, disease, and psychosocial variables previously shown to impact HRQOL. Religious well-being was not predictive of HRQOL. Copyright © 2007 John Wiley & Sons, Ltd.