Search Results (1,389)

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728–131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010–1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment. Full article

Cervical cancer is one of the leading causes of mortality in women of reproductive age. In recent years, the development of preventive and therapeutic strategies has significantly increased survival rates. While this represents an important medical achievement, it has also raised a major social issue regarding the need to ensure an adequate quality of life for surviving patients. Many of these women are left without their reproductive capacity at an age when their desire for motherhood has not yet been fulfilled. Infertility or subfertility in cancer survivors is actually a growing problem, complicated by the current trend of increasingly delaying pregnancy. The psychological effects of this issue can be devastating, sometimes even more so than the cancer diagnosis itself. Although today fertility-sparing surgeries can ensure excellent reproductive outcomes with minimal oncological risk, obstetric sequelae remain significant, and affected women often require specialized care pathways. Additionally, adequate counselling is still not provided to all patients who cannot access fertility-sparing treatments and who find themselves without hope. Reproductive medicine is therefore facing the modern challenge of offering concrete options to help these patients realize their desire for motherhood. The aim of this article is to provide an overview of the therapeutic options available to young women facing an early- or later-stage diagnosis of cervical cancer. Full article

Background/Objectives: This study aims to investigate the association of movement behaviors with irisin, sclerostin, and bone turnover markers in young pediatric cancer survivors. Methods: A total of 116 young pediatric cancer survivors (12.1 ± 3.3 years; 42% female) were recruited. Time spent in movement behaviors over at least seven consecutive 24 h periods was measured by accelerometers (wGT3x-BT accelerometer, ActiGraph). Blood samples were collected at rest and serum was analyzed for irisin, sclerostin, cross-linked telopeptide of type I collagen (CTX), procollagen type I amino-terminal propeptide (P1NP), total osteocalcin (OC), alkaline phosphatase (ALP), 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, phosphorous, and magnesium. Results: Irisin and sclerostin were not significantly correlated with bone turnover markers. Sedentary time was negatively correlated with the P1NP (r = −0.411, p = 0.027) and total OC (r = −0.479, p = 0.015) Z-scores, whereas moderate-to-vigorous physical activity was positively correlated with the P1NP (r = 0.418, p = 0.024) and total OC (r = 0.478, p = 0.016) Z-scores. Moreover, total physical activity was positively correlated with the total OC Z-score (r = 0.448, p = 0.025). Finally, the uncoupling index [CTX/P1NP] was positively correlated with sedentary time (r = 0.424, p = 0.012) and negatively correlated with light physical activity (r = −0.352, 0.041). Conclusions: Reducing sedentary time and increasing physical activity may favor bone formation over resorption in young pediatric cancer survivors. Full article

Survival rates for childhood cancer survivors (CCS) have improved, although they display a risk for early frailty due to the long-term effects of chemo/radiotherapy, including early aging. This study investigates antioxidant defenses and oxidative damage in mononuclear cells (MNCs) from CCS, comparing them with those from age-matched and elderly healthy individuals. Results show impaired antioxidant responses and increased oxidative stress in CCS MNCs, which exhibited uncoupled oxidative phosphorylation, leading to higher production of reactive oxygen species, similar to metabolic issues seen in elderly individuals. Key antioxidant enzymes, namely glucose-6-phosphate dehydrogenase, hexose-6-phosphate dehydrogenase, glutathione reductase, glutathione peroxidase, catalase, and superoxide dismutase, showed reduced activity, likely due to lower expression of nuclear factor erythroid 2–related factor 2 (Nrf2). This imbalance caused significant damage to lipids, proteins, and DNA, potentially contributing to cellular dysfunction and a higher risk of cancer recurrence. These oxidative and metabolic dysfunctions persist over time, regardless of cancer type or treatment. However, treatment with N-acetylcysteine improved Nrf2 expression, boosted antioxidant defenses, reduced oxidative damage, and restored oxidative phosphorylation efficiency, suggesting that targeting the redox imbalance could enhance long-term CCS health. Full article

This study uses the Q methodology to investigate the subjective perceptions of social reintegration among cancer survivors in their 20s and 30s. We organised a Q population through a pilot study and interviews and finalised 40 Q sample items. For P sample representativeness, we used purposive sampling and selected 12 individuals by age and cancer type. After a Q sorting process, we conducted a key factor analysis using Ken-Q Analysis Desktop Edition. We identified four types of P samples based on their perceptions and noted the main characteristics of each type. We characterised Type 1 as “recovery of presence through social reintegration seeking”, Type 2 as “confusion in social reintegration due to social prejudices”, Type 3 as “psychosocial support in the process of social reintegration”, and Type 4 as “blessing in disguise for post-traumatic growth”. The results suggest a need for practical and institutional support reflecting cancer survivors’ characteristics by type. This study provides basic data that researchers could use to develop coaching and counselling services to support the social reintegration of cancer survivors in their 20s and 30s. Full article

Nocardia is an emerging bacterial disease that often affects patients with compromised immune systems. As the number of patients undergoing solid organ transplants continues to rise, and as more cancer survivors are treated with long-term immune-modifying agents, corticosteroids, and immunosuppressive medications, organisms that typically pose no harm are becoming a public health concern. Carbapenems are usually a second-line therapy in the setting of Nocardia infections. We present the case of a patient who had an immunocompromised status and was diagnosed with Nocardia farcinica, which showed in vitro resistance to carbapenems. The symptoms were non-specific and had a common presentation with headache, fatigue, and a nonresponsive cough to usual cough drugs, although the infection was disseminated and had severe CNS and ocular involvement. The clinical course worsened when the carbapenem was withdrawn and markedly improved when it was re-administered, although the initial antibiogram showed resistance to carbapenems. Despite the observed in vitro resistance in the laboratory, the re-administration of carbapenems was beneficial, as both inflammatory markers and clinical status showed improvement. This was based on clinical judgment, which carefully evaluated the associated risks and benefits. Also, this raises the question of potential risks to develop real resistance to carbapenems of some Nocardia species, which could pose a significant challenge to healthcare. It could become a serious healthcare problem in the future and should prompt active environmental testing. Full article

Background/Objectives: Cancer-related cognitive impairment (CRCI) is common and distressing for young adult (YA) cancer survivors; however, subjective CRCI is often attributed to psychological distress rather than true cognitive change. Thus, we aimed to generate hypotheses regarding potential common biobehavioral mechanisms of CRCI and psychological distress. Methods: We conducted semi-structured interviews with YA cancer survivors in peak years for frontal neurocognitive development (ages 18–30), and we asked them to describe their experiences with cognitive and mental health changes during and after treatment for their cancer. An applied thematic analysis was used to identify themes. Results: The participants were 20 YA cancer survivors who were, on average, 23 years old at diagnosis and 26 years old when interviewed. Five themes emerged regarding the connection between cognitive and mental health: depressed mood after diagnosis that decreased mental engagement, cancer-related anxiety consumed cognitive resources during treatment, a bidirectional “downward spiral” during treatment, frustration with forgetfulness, and self-criticism about long-term cognitive limitations. Additionally, participants described receiving minimal information about evidence-based strategies for managing CRCI. Conclusions: Future research is needed to examine common neurological mechanisms among symptoms of depression, anxiety, and CRCI and to address gaps in survivorship care for YA survivors with CRCI. Cognitive–behavioral interventions may address both cognitive and mental health. Full article

Purpose: To characterize dietary patterns and examine associations with cross-sectional and longitudinal changes in quality of life (QOL) over approximately one year after colorectal cancer (CRC) diagnosis. Methods: The ColoCare Study is an international, multi-center, prospective cohort study of newly diagnosed CRC survivors of any stage. A subset of participants with CRC in the United States completed patient-reported outcome measures at 6- and 12-months post-enrollment, including the Food Frequency Questionnaire (FFQ) and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Dietary patterns at 6 months (around the time of treatment completion) were identified using Principal Component Analysis (PCA) with varimax rotation. Adherence scores were calculated for participants within each dietary pattern, with higher scores indicating higher adherence. Mixed models were used to examine the effect of each dietary pattern on changes in QOL at 6- and 12-month follow-ups, controlling for cancer stage, biological sex, body mass index (BMI), smoking status, and age. Results: Participants (N = 174) were, on average, 56 ± 14 years old and were mostly female (51.5%), stage III or IV (51.7%), never smokers (60.2%), non-Hispanic (97.1%), and White (83.3%) with a BMI of 27.9 ± 6.1 kg/m². PCA revealed two emerging dietary patterns: “Western diet”, characterized by processed meats, refined grains, and sugars, and “Prudent diet” characterized by lean proteins, fruits, and vegetables. Higher adherence to a Western diet was associated with worse social functioning at 6-month follow-up (FE = −12.6, p = 0.010). Loss of appetite from 6 to 12 months was associated with higher adherence to both the Western and Prudent dietary patterns (FE = 1.5, p = 0.044; FE = 1.3, p = 0.046, respectively). Neither dietary pattern was associated with global QOL score at 6- or 12-month follow-up (p’s > 0.05). Conclusions: Among CRC survivors in the United States, the Western diet was concurrently associated with worse social functioning. Loss of appetite was reported by CRC survivors following both dietary patterns, suggesting that loss of appetite may be a global experience for CRC survivors during this timeframe. Further research is needed to understand specific social challenges experienced by CRC survivors and develop supportive care interventions to address appetite and nutritional concerns. Full article

Background/Objectives: Inpatient exercise-based rehabilitation has been shown to improve health-related quality of life (HRQOL) in cancer survivors. However, there is a lack of studies on the impact of community-based cancer rehabilitation programs on health-related quality of life, especially in Asian countries. Methods: This was a retrospective cohort study involving patients with cancer at an outpatient community-based rehabilitation center. There were 197 patients who were recruited and enrolled in a physician-led rehabilitation program which included physiotherapists, occupational therapists, nutritionists and exercise physiologists. Results: Most of the patients had a diagnosis of breast cancer (61.4%), while 76 (38.6%) had a diagnosis of other cancers. On initial assessment, we found a mean Distress Thermometer (DT) level of 3.37 (SD = 2.41) and a mean Functional Assessment of Cancer Therapy-General-7 Item Version (FACT-G7) score of 11.83 (SD = 4.01). On follow-up assessment after 3–6 months of rehabilitation, there was a significant reduction in mean DT level to 2.42 (SD = 2.25) and an improvement in mean FACT-G7 score to 13.09 (SD = 4.77). Multivariate regression analysis revealed that significant factors for improvement in FACT-G7 scores were age (p = 0.046) and number of exercise therapy sessions (p < 0.001). Conclusions: This study demonstrates the positive impact of a community-based cancer rehabilitation program on HRQOL among cancer patients. Full article

Background: The increasing survival rates among pediatric cancer patients underscore the critical need to understand the long-term psychosocial impacts of cancer treatments, such as cisplatin and carboplatin. While these treatments are lifesaving, they may pose risks to neurodevelopmental processes. Despite the substantial body of research highlighting cognitive impairments associated with cancer treatments, there remains a gap in understanding how these effects differ by sex. As sex differences could inform tailored interventions and support mechanisms for affected individuals, this pilot study aimed to examine the sex differences in neuropsychological outcomes in patients treated for brain cancer with cisplatin and/or carboplatin. Methods: Our study employed rigorous/structured neuropsychological assessments to evaluate executive functions in pediatric cancer survivors treated with cisplatin and/or carboplatin. We utilized the BRIEF and TOL tests to assess the key domains of executive function, including inhibitory control, cognitive flexibility, and problem-solving abilities. Additionally, psychosocial factors were evaluated using the Resiliency Scale to measure resilience and the PAT test to assess family psychosocial risk. Results: In our cohort of 17 patients, significant sex differences emerged, where males outperformed females in areas such as inhibitory control, impulse regulation, and strategic planning. Conclusions: These findings highlight the complexity of cognitive outcomes in pediatric cancer survivors. Understanding sex-specific differences is essential for developing tailored interventions that optimize cognitive and psychosocial outcomes. Future research should focus on larger cohorts and longitudinal studies to validate these findings and guide targeted interventions to improve survivorship outcomes. Full article

Background/Objectives: Dietary factors may significantly influence pain management in cancer survivors. However, a substantial gap exists regarding the relationship between nutrition and chronic pain in this population. This study examined differences in diet quality and dietary intake between breast cancer survivors (BCS) experiencing chronic pain and healthy controls (HC). It also aimed to understand the associations between dietary elements and pain-related outcomes within the BCS group. Methods: A case-control study was conducted with 12 BCS experiencing chronic pain and 12 HC (ages 18–65). Data collection included body composition, experimental pain assessments, pain-related questionnaires, and a 3-day food diary to calculate diet quality using the Healthy Eating Index-2015 (HEI-2015) and Dietary Inflammatory Index (DII). Statistical analyses evaluated group differences and associations between dietary factors and pain within the BCS group. Results: There were no significant differences in HEI-2015 scores between BCS and HC, but BCS had a significantly lower DII score (p = 0.041), indicating a more anti-inflammatory diet. BCS also showed higher intake of omega-3, vitamins B6, B12, A, D, and magnesium (p < 0.05). While total diet quality scores did not correlate with pain outcomes, several HEI-2015 and DII components, such as dairy, sodium, protein, vitamin C, and vitamin D, showed moderate positive or negative correlations with pain measures. Conclusions: Despite no overall differences in diet quality, BCS with chronic pain consumed more anti-inflammatory nutrients than HC. Complex correlations between specific dietary components and pain outcomes emphasise the need for further research to explore these links for chronic pain management in BCS. Full article

Background: Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology. Objectives: In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field. Methods: We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments. Results: The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce. Conclusions: This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions. Full article

Background/Objectives: Advancements in breast cancer therapeutics, such as anthracyclines, are improving cancer survival rates but can have side effects that limit their use. Cardiotoxicity, defined as damage to the heart caused by cancer therapeutics, is characterised by a significant reduction in left ventricular ejection fraction (LVEF) and symptoms of cardiac dysfunction. Multiple oral supplements exist with antioxidant and anti-inflammatory properties that have the potential to lower cardiotoxicity risk and ameliorate the complications associated with left ventricular dysfunction. In this review, we evaluate the current status of using nutritional interventions to modulate cardiotoxicity. Methods: We used specific keywords to search for articles that met our predetermined inclusion and exclusion criteria to review the evidence and provide insights for future research. Results: Seven studies were identified as eligible for this review: six focused on oral supplementation strategies in breast cancer patients undergoing chemotherapy, and one focused on nutritional counselling and adherence to the Mediterranean diet in breast cancer survivors’ post-treatment. There was a significantly attenuated reduction in LVEF in five studies that monitored cardiometabolic health, and there were significant improvements in blood serum levels of cardiac biomarkers across all studies. Conclusions: Current evidence suggests that appropriate nutritional interventions, alongside chemotherapy, can modulate the risk of cardiotoxic side effects. This highlights the potential of oral antioxidant supplementation and Mediterranean diet counselling to decrease tertiary cancer therapy costs associated with cardiovascular complications. Full article

Background/Objectives: Breast cancer is the most common cancer among women globally, and it negatively impacts diet and quality of life, increasing the risk of recurrence. Adhering to World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) lifestyle guidelines, such as healthy eating habits and nutritional status, can help in primary and secondary cancer prevention. However, no questionnaire was found for self-assessment of these guidelines for the Brazilian population. The aim of this study is to carry out content validity, pilot, and usability testing of the self-administered digital instrument “PrevCancer” assessing adherence to the WCRF/AICR recommendations in Brazilian female breast cancer survivors. Methods: We conducted a psychometric study that involved the development of an instrument based on WCRF/AICR recommendations. Assessment of content validity involved the Content Validity Index (CVI) based on expert assessments (n = 7). The pilot study involved the System Usability Scale (SUS) after applying the developed instrument (n = 65) and anthropometric assessment for convergent validity by female participants (n = 55). The final usability test consisted of evaluating the satisfaction with the instrument of women with breast cancer (n = 14). Results: The “PrevCancer” instrument demonstrated good content (CVI = 1.0) as well as good usability and acceptability in the pilot study (mean SUS score = 88.1). The convergent validity stage demonstrated positive associations between the PrevCancer parameters and anthropometric parameters (p < 0.001). In the final usability study (mean SUS score = 90.3), participants’ receptivity to the instrument was excellent. Conclusions: The PrevCancer instrument had valid content and great usability by the target population, proving to be a useful tool for future cancer research. Full article

Background: In the last decades, the increasing number of adolescent and young adult (AYA) survivors of breast cancer (BC) has highlighted the cardiotoxic role of cancer therapies, making cardiovascular diseases (CVDs) among the most frequent, although rare, long-term sequalae. Leveraging innovative artificial intelligence (AI) tools and real-world data (RWD), we aimed to develop a causally interpretable model to identify young BC survivors at risk of developing CVDs. Methods: We designed and trained a Bayesian network (BN), an AI model, making use of expert knowledge and data from population-based (1036 patients) and clinical (339 patient) cohorts of female AYA (i.e., aged 18 to 39 years) 1-year survivors of BC, diagnosed in 2009–2019. The performance achieved by the BN model was validated against standard classification metrics, and two clinical applications were proposed. Results: The model showed a very good classification performance and a clear causal semantic. According to the predictions made by the model, focusing on the 25% of AYA BC survivors at higher risk of developing CVDs, we could identify 81% of the patients who would actually develop it. Moreover, a desktop-based app was implemented to calculate the individual patient’s risk. Conclusions: In this study, we developed the first causal model for predicting the CVD risk in AYA survivors of BC, also proposing an innovative AI approach that could be useful for all researchers dealing with RWD. The model could be pivotal for clinicians who aim to plan personalized follow-up strategies for AYA BC survivors. Full article