Young adult cancer survivors struggle to get back to normal

Cancer survivors often talk about wanting to get back to normal, but a new study indicates many young adults who survived the disease struggle with attaining this goal two years after their initial diagnosis.

The longitudinal study is among the first seeking to understand the social functioning among adolescents and young adults who have had cancer.

The research is important to help these young survivors better reintegrate into society,” said study co-author Brad Zebrack, a professor of social work at the University of Michigan.

Researchers collected data from 215 cancer patients aged 14 to 39 years who visited five medical facilities nationwide between March 2008 and April 2010. Patients completed a self-report measure of social functioning within the first four months of diagnosis, and again at 12 months and 24 months later. They also answered questions about their social interactions with family and friends, psychological needs and mental health.

Thirty-two percent of the survivors reported consistently low social functioning over time – and some had been off treatment. Zebrack and colleagues say this could stem from the transition from treatment to off-treatment survivorship, a time fraught with new challenges to a cancer survivor, including the negative impact on finances, body image, work plans, relationship with spouse/significant other and plans for having children.

In addition, those reporting low scores on social functioning also had high levels of distress, possibly reflecting an impaired ability to reintegrate into social activities due to the effects of cancer, the study showed.

This finding highlights the need to screen, identify and respond to the needs of high-risk adult-young adolescent patients at the time of diagnosis and then monitor them over time,” said Zebrack, an expert with the U-M Institute for Healthcare Policy & Innovation. “They are likely the ones most in need of help in managing work, school and potentially problematic relationships with family members and friends.”

Current research indicates that young adult cancer patients benefit from support programs that put them in touch with other young adult cancer survivors.

They do not find being in a support group with ‘people my grandma’s age’ to be all that helpful,” said Olga Husson, the study’s lead author and a researcher at Radboud University Medical Center in the Netherlands.

The study’s other authors were Christine Aguilar of the University of Texas Health Science Center, Brandon Hayes-Lattin of the Oregon Health and Science University and Steve Cole of HopeLab Foundation.

The study appears online in the journal Cancer.

Husson et al. Cancer in adolescents and young adults: Who remains at risk of poor social functioning over time? Cancer. 2017;123(14):2743-2751. doi: 10.1002/cncr.30656 [Abstract]

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Cancer ‘prehabilitation’ can reduce complications and improve treatment outcomes

Time between diagnosis and treatment provides ‘window of opportunity’ to optimize health

For patients with cancer, “prehabilitation”— interventions given between the time of diagnosis and the start of treatment—has the potential to reduce complications from treatments and improve physical and mental health outcomes, according to a report in the August American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists.

“A growing body of evidence supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments,” write Drs. Julie K. Silver and Jennifer Baima of Harvard Medical School. Their article, titled Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes, is the first comprehensive review of the topic.

“There is a rather long and impressive history of using prehabilitation to improve orthopedic surgical outcomes,” Dr. Silver comments. “Our new review shows that there is a unique opportunity to help many people who have been newly diagnosed with cancer to improve their physical and emotional outcomes.”

Cancer Prehabilitation—Getting Patients in Best Possible Shape for Treatment

The goal of cancer prehabilitation is to prevent or lessen the severity of anticipated treatment-related problems that could lead to later disability. Immediately after diagnosis, patients undergo physical and psychological assessments to establish their baseline level of function and identify any current impairment, and provide targeted interventions to reduce the risk and severity of future impairments.

Traditionally, pretreatment interventions focused on aerobic conditioning to build patients’ general strength and stamina. But recent studies have shown that more directed interventions can improve outcomes in patients with specific cancers: for example, swallowing exercises before surgery for head or neck cancer, smoking cessation to improve breathing function before lung cancer surgery, or pelvic floor exercises to reduce problems with urinary incontinence after surgery for prostate cancer.

Some studies have shown that prehabilitation interventions, individually or in combination, can increase the range of treatment options, lower complication rates, and improve physical and mental health outcomes. Benefits include a reduced risk of hospital readmission and lower health care costs.

Cancer prehabilitation seems more effective when it includes both physical and psychological interventions. Providing psychosocial support immediately after diagnosis has improved treatment outcomes for patients with prostate, breast, and ovarian cancer. Future studies may show that prehabilitation can increase patients’ ability to complete their recommended treatment—thus improving their chances of survival.

Drs. Silver and Baima emphasize that cancer prehabilitation should follow an individualized approach, “identifying current and anticipating future impairments as a critical first step in improving healthcare outcomes and decreasing costs.” They liken cancer prehabilitation to a puzzle, with individual approaches put together in combinations that best meet the needs of the individual patient.

While patients may fear that delaying cancer treatment may reduce their risk of survival, there’s typically some waiting period before treatment begins. This time—whether it’s a few days or a few weeks—may provide a “window of opportunity” for prehabilitation interventions to address physical and psychological issues. Drs. Silver and Baima write, “Newly diagnosed cancer patients are often seeking ways to become immediately involved in their care that may go beyond decision making about upcoming treatments.”

Studies have begun to show that physical and psychological prehabilitation interventions can reduce treatment-related complications, decrease length of hospital stay and/or readmissions, increase available treatment options for patients who would not otherwise be candidates, and quickly facilitate return of patients to the highest level of function possible. Drs. Silver and Baima highlight the need for further studies to identify the most effective prehabilitation interventions: “those that improve patient health outcomes and reduce direct and indirect healthcare costs.”

“This review provides an exciting ‘jumping-off point’ for cancer researchers to look more closely at how to improve outcomes from the moment of diagnosis onward,” Dr. Silver adds. “We hope it will serve to highlight this exciting area of research and to show clinicians that there are key opportunities right now to improve cancer care.”

Silver and Baima (2013). Cancer prehabilitation: An opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Amer. J. Phys. Med. Rehab.92: 715-727 doi: 10.1097/PHM.0b013e31829b4afe [Article]

Menopause symptoms worse in cancer survivors

Cancer survivors were twice as likely to experience severe menopausal symptoms compared to women who have not had cancer, a new Australian study has found.

The study ( published in Menopause, the Journal of the North American Menopause Society) was led by the University of Melbourne and the Royal Women’s Hospital Melbourne, with the King Edward Memorial Hospital and the University of Western Australia.

Lead author, Dr Jennifer Marino of the University of Melbourne and the Royal Women’s Hospital said the study was the biggest of its kind to assess the impact of menopausal symptoms on the quality of life of cancer survivors.

“Our study showed for the first time, that cancer survivors experienced more severe and frequent menopausal symptoms (such as hot flushes and night sweats) than patients who did not have cancer,” Dr Marino said.

More than 151,000 (around one in 25) women in Australia are cancer survivors with more than one third of those are breast cancer survivors.

Almost 1,000 cancer survivors (mostly breast cancer) and 155 non-cancer patients aged 40 to 60, who attended the Menopause Symptoms After Cancer Clinic at the King Edward Memorial Hospital in Western Australia, were surveyed to determine a range of factors including severity of menopausal symptoms, impact on quality of life and sexual function.

Cancer survivors had twice as many hot flushes (six compared with three in 24 hours) and were twice as likely to report severe or very severe flushes as non-cancer patients. More than 200 cancer survivors reported experiencing more than 10 flushes a day.

Interestingly, the mental health of cancer survivors appeared to be better than the non-cancer patients.

“The study revealed the cancer survivors were less troubled by symptoms of anxiety and depression than women attending the menopause service who had never had cancer,” Dr Marino said.

Senior author Professor Martha Hickey said menopausal symptoms were a frequent and distressing effect of cancer treatments in women.

“In women with hormone sensitive cancer such as breast cancer, effective treatments reduce estrogen levels and this commonly leads to menopausal symptoms,” she said.

Co-author Professor Christobel Saunders, Deputy Head of the University of Western Australia School of Surgery, said the findings were significant in providing an improved understanding of the nature and impact of menopause on cancer survivors while also highlighting the need for better support services for menopausal women without cancer.

Marino et al., (2013). Nature and severity of menopausal symptoms and their impact on quality of life and sexual function in cancer survivors compared with women without a cancer history. Menopause, EPub Ahead of Print doi:10.1097/GME.0b013e3182976f46 [Abstract]