Understanding and Addressing LGBTQ+ Cancer Health Disparities.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) cancer survivors disproportionately experience physical and mental health comorbidities compared with their heterosexual and cisgender counterparts. A recent study by Waters and colleagues evaluates associations between LGBTQ+ identity and physical and mental health comorbidities and activity limitations using Behavioral Risk Factor Surveillance System data. Consistent with previous work, their findings suggest that LGBTQ+ survivors have higher odds of several chronic conditions, including asthma, depressive disorders, heart attacks, kidney disease, stroke, and diabetes, as well as reporting disabilities related to vision and cognition and difficulty with activities of daily living, including walking, dressing, and running errands. Waters and colleagues expand on previous work by providing estimates separately for sexual orientation and gender identity. Their results for lesbian, gay, and bisexual survivors were similar to those for LGBTQ+ survivors overall. In novel findings, they report much stronger associations between identifying as transgender or gender nonconforming and nearly all comorbidities compared with cisgender survivors, including those who identify as lesbian, gay, or bisexual. This commentary advocates for the importance of future work considering the drivers of disparities in cancer outcomes based on sexual orientation and gender identity. See related article by Waters et al., p. 1405.

Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study.

BACKGROUND: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. OBJECTIVE: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. METHODS: Data from 957 cancer survivors from the Health Information National Trends Survey-Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. RESULTS: Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. CONCLUSIONS: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion.

Accessibility of and Barriers to Long-Term Follow-Up Care for Childhood Cancer Survivors.

Importance: Childhood cancer survivorship programs and long-term follow-up (LTFU) practices are inadequate in most regions of China. Objective: To understand the clinician and caregiver perceptions of LTFU care and to identify barriers to adherence to LTFU care in mainland China. Design, Setting, and Participants: This survey study had a 2-phase sequential mixed-methods approach, consisting of a cross-sectional survey followed by semistructured interviews. Participants included oncology clinicians recruited through an educational seminar on LTFU and caregivers recruited through convenience sampling. Data were collected from November 2022 to September 2023. Main Outcomes and Measures: The clinician survey and interview focused on the standards and resources for LTFU care at their practicing institution and barriers to the coordination of LTFU care. For caregivers, the survey and interview focused on their awareness of and participation in LTFU care and their opinions on future LTFU care visits. Results: A total of 101 clinicians (28 [27.7%] male; 73 [72.3%] female; 46 [45.6%] aged >40 to 50 years) completed the survey (response rate: 90.2%) representing 32 institutions from 22 provinces. As for the caregivers' survey, 164 eligible participants (36 [22.0%] male; 128 [78.0%] female) were recruited (response rate: 20.2%). The majority of the caregivers had received a high school or greater education (96 [56.7%]) and were parents of CCSs diagnosed with leukemia (67 [40.9%]), lymphoma or solid tumors (47 [28.7%]), or conditions requiring hematopoietic stem cell transplantation (50 [30.5%]). Most clinicians (74 [73.3%]) reported providing late effects care, yet only 10 (13.5%) had a dedicated follow-up clinic for CCSs. Two-thirds (64 [63.4%]) reported that the LTFU plan for each survivor is solely determined by their clinical judgment. In structured interviews, all doctors admitted to deviating from published guidelines due to challenges in implementing screening recommendations in their settings. Barriers to providing LTFU services included patient-related factors (76 [75.2%]), survivor knowledge deficits (61 [60.4%]), and the absence of dedicated LTFU clinics (61 [60.4%]). Among caregivers responding to the survey, 60 (36.6%) had never heard of late effects. Overall, 22 of 26 caregivers (84.6%) who participated in the interviews were not aware of potential late effects, although 17 (68.0%) could articulate existing conditions and symptoms that their children were experiencing. Conclusions: In this mixed-methods study involving clinicians and caregivers, substantial disparities in the uniformity and accessibility of LTFU in China were observed, suggesting the imperative need for a standardized approach to LTFU care for survivors. This includes advocating for establishment of dedicated clinics, alongside an emphasis on enhanced education and training for both clinicians and caregivers.

Effects of Physical Activity on Cardiotoxicity and Cardio respiratory Function in Cancer Survivors Undergoing Chemotherapy: A Systematic Review and Meta-Analysis.

Introduction: Physical activity, as a promising complementary therapy, has shown considerable potential for reducing chemotherapy-related cardiotoxicity (CTRCT) and enhancing cardiorespiratory function (CRF). This study aimed to systematically assess the effects of physical activity on CTRCT and CRF in various cancer survivors receiving chemotherapy. Methods: A systematic review and meta-analysis was conducted. A literature search was conducted across 8 databases from inception to January 2024 and was limited to the English and Chinese languages. Statistical analysis was conducted using RevMan 5.3 and Stata 17.0 software. Results: Sixteen randomized controlled trials (RCTs) were included in the systematic review and 15 RCTs were included in the meta-analysis. Among various cancer survivors undergoing chemotherapy, physical activity markedly increased absolute oxygen uptake (VO2peak or VO2max; WMD = 292.99, 95% confidence interval [CI]:87.87 to 498.12, P = .005), with significant effects of subgroup analysis at 4 to 10 weeks (P = .02) or over 16 weeks (P < .01), moderate-to-high or high intensity training (both P < .0001), patients with breast cancer (P = .009) and reported CTRCT (P = .007); relative VO2peak or VO2max(WMD = 3.30, 95%CI: 2.02 to 4.58, P < .00001), with significant effects of subgroup analysis at 10 to 16 weeks or over 16 weeks, moderate-to-high or high intensity training, patients with breast cancer, with or without reported CTRCT and exercise during chemotherapy (all P < .01); E/A values (WMD = 0.11, 95%CI:0.03 to 0.18, P = .007) and flow-mediated dilatation (WMD = 2.71, 95%CI:1.49 to 3.94, P < .0001). Compared to the control group, physical activity had no significant improvement in E/e' values (P = .50), NT-proBNP (P = .12), hs-cTn (P = 3.83), left ventricular ejection fraction (WMD = 2.89, 95%CI: -3.28 to 9.06, P = .36) with non-significant effects being independent of exercise intensity or duration, with or without CTRCT and cancer types (all P > .05), and global longitudinal strain (WMD = 0.37, 95%CI: -0.20 to 0.94, P = .20) with non-significant effects being independent of exercise duration and cancer types(both P > .05). Conclusions: Physical activity may be an effective complementary therapy to improve CRF and CTRCT in various cancer survivors, particularly during medium to long duration and moderate-to-high and high intensity exercise with concurrent chemotherapy.

Barriers to Surveillance Mammography Adherence in Korean Breast Cancer Survivors.

OBJECTIVES: To identify barriers to surveillance mammography adherence in Korean breast cancer survivors (BCSs), which is crucial for early detection of recurrence and new cancers. SAMPLE & SETTING: 195 BCSs were recruited from a breast cancer clinic and its support groups at a South Korean hospital. METHODS & VARIABLES: This descriptive study used a cross-sectional design. Participants completed a self-administered multi-instrument survey based on a comprehensive framework for adherence, including individual characteristics, symptoms, quality of life, cognitive appraisal, social support, and healthcare system factors. RESULTS: Having had a mammogram within the past year was considered adherent (n = 177), and no mammography within the past year was considered nonadherent (n = 18). Logistic regression revealed that longer time since diagnosis (p < 0.001), greater depression (p = 0.024), and higher health services utilization (p < 0.001) were predictors of lower mammography adherence (chi square = 76.618, p < 0.001, R2 = 58%). IMPLICATIONS FOR NURSING: This is the first study to identify depression as a barrier to surveillance mammography in BCSs, suggesting that depression screening and treatment may be important for increasing adherence.

HPV Status and Oral Health Symptom Patterning During Treatment and Survivorship in Patients With Head and Neck Cancer: A Longitudinal Analysis.

OBJECTIVES: To describe longitudinal oral health symptom patterns of patients receiving concurrent chemotherapy and radiation therapy for head and neck cancer (HNC) and examine associations between phenotypic characteristics, including human papillomavirus (HPV) status and oral health symptoms. SAMPLE & SETTING: A pilot retrospective longitudinal chart review (N = 270) of patients with HNC at a northeastern U.S. regional cancer institute. METHODS & VARIABLES: HPV status and oral health symptoms (pain, mucositis, taste alteration, xerostomia, dysphagia, and candidiasis) were examined during treatment (six weeks) and survivorship (three months). Latent transition analysis was conducted across each time point. RESULTS: The latent transition analysis revealed classes with moderate to high symptom expression persisted into survivorship. The HPV-negative phenotype had higher symptom expression across treatment and survivorship. IMPLICATIONS FOR NURSING: Patients with HPV-negative HNC may require early intervention, while considering social determinants of health to attenuate symptom expression and improve outcomes.

Feasibility Study of Adverse Childhood Experiences, Treatment-Related Sequelae, and Inflammatory Markers in Breast Cancer Survivors.

OBJECTIVES: To explore the incidence of adverse childhood experiences (ACEs) in breast cancer survivors and potential associations with long-term treatment-related sequelae. SAMPLE & SETTING: English-speaking breast cancer survivors three or more years from diagnosis with complete treatment response (N = 120) were recruited prior to scheduled survivorship clinic visits. METHODS & VARIABLES: Participants in this cross-sectional observational feasibility study rated anxiety, depression, fatigue, sleep disturbance, cognitive issues, resilience, and ACEs (experienced prior to age 18 years). Blood samples were analyzed for inflammatory and epigenetic biomarkers. RESULTS: ACEs assessment was feasible. Higher ACE scores correlated with greater fatigue, anxiety, and depression, and with lower cognitive function (p < 0.05). Resilience was positively associated with cognitive function and negatively associated with fatigue, anxiety, and depression. IMPLICATIONS FOR NURSING: There is evidence for the impact of ACEs on long-term treatment-related sequelae in women with breast cancer. Oncology nurses should consider incorporating ACEs assessment into the workflow for women receiving survivorship care.

Psychiatric disorders among survivors of childhood acute lymphoblastic leukemia in Denmark and Sweden.

BACKGROUND: The diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) may impact mental health. We investigated the long-term risk of psychiatric disorders among survivors of ALL in a population-based cohort study. METHODS: We identified patients diagnosed with ALL in Denmark and Sweden before age 20 during 1982-2008. Survivors of ALL (n = 2026), their siblings (n = 3027), and population comparison subjects (n = 9713) were followed for hospital contacts for psychiatric disorders from 5 years after ALL diagnosis (or corresponding index date) until 2017. RESULTS: By age 30, the absolute risk of psychiatric hospital contacts was 19.9% (95% confidence interval [CI]: 17.9-22.1) for ALL survivors, 18.5% (95% CI: 16.9-20.2) for siblings, and 18.3% (95% CI: 17.3-19.2) for population comparison subjects. Overall, survivors were at higher risk of any psychiatric disorders than siblings (hazard ratio [HR] = 1.25; 95% CI: 1.04-1.50), and population comparison subjects (HR = 1.20; 95% CI: 1.06-1.35). The subgroup of survivors (n = 332) who received a hematopoietic stem cell transplantation (HSCT) and/or had a relapse were at highest risk of psychiatric disorders (HR = 2.07; 95% CI: 1.26-3.41 compared to siblings; HR = 1.67; 95% CI: 1.25-2.23 compared to population comparison subjects). CONCLUSIONS: The overall absolute risk of psychiatric hospital contacts among ALL survivors was close to that in siblings and population comparison subjects. The modestly increased relative risk was mainly driven by the subgroup of survivors who received HSCT and/or had a relapse. Our findings are reassuring for the large subgroup of ALL survivors without HSCT or relapse, and provide novel insight on both absolute and relative risk of hospital contacts for psychiatric disorders.

Fear of Cancer Recurrence in Adult Survivors of Childhood Cancer.

Importance: Fear of cancer recurrence is common among survivors of adult-onset cancer and associated with increased distress, functional impairment, and health care utilization. However, little is known about the prevalence and risk factors of fear of cancer recurrence among adult survivors of childhood cancer who are also at high risk for subsequent malignant neoplasms. Objective: To characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer. Design, Setting, and Participants: This cross-sectional investigation included participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort study of long-term childhood cancer survivors treated at 31 institutions between 1970 and 1999 across North America. Participants were recruited and completed psychosocial measures via online survey between October 2018 and April 2019. Cancer and treatment-related variables were abstracted from medical records. Data were analyzed from May 2023 to July 2024. Main Outcomes and Measures: Clinically significant fear of cancer recurrence was assessed via the Fear of Cancer Recurrence Inventory-Short Form. Poisson regression models estimated prevalence ratios (PRs) with 95% CIs adjusted for age and sex to examine the associations of demographic, disease, treatment, and psychosocial variables with fear of cancer recurrence. Results: The final sample included 229 adult survivors of childhood cancer (115 female [50.2%]; mean [SD] age, 39.6 [9.9] years; mean [SD] time since diagnosis, 31.7 [8.4] years). Among survivors, 38 (16.6%; 95% CI, 11.6%-21.6%) reported clinically significant fear of cancer recurrence, and an additional 36 (15.7%) reported high fear of cancer recurrence. Clinically significant fear of cancer recurrence was associated with unemployment (PR, 2.5; 95% CI, 1.3-4.8), presence of neurologic chronic health conditions (PR, 3.3; 95% CI, 1.8-6.1), treatment with pelvic radiation (PR, 2.9; 95% CI, 1.5-5.6), and amputation or limb sparing surgery (PR, 2.4; 95% CI, 1.2-4.9). Higher risk of clinically significant fear of cancer recurrence was also associated with having either elevated anxiety or depression (PR, 2.6; 95% CI, 1.2-5.9), having both elevated (PR, 3.2; 95% CI, 1.2-8.4), and perceived poor health status (PR, 3.0; 95% CI, 3.1-9.7). Conclusions and Relevance: Decades following treatment, one-third of childhood cancer survivors in this study reported elevated fear their cancer will recur or a subsequent malignant neoplasm will develop. Findings suggest that fear of cancer recurrence should be routinely screened, and clinically significant symptoms intervened upon as a part of survivorship care.

Association between statin usage and mortality outcomes in aging U.S. cancer survivors: a nationwide cohort study.

BACKGROUND: The population of Aging cancer survivors in the United States has surged to over 16.9 million. Research on the relationship between statin usage and post-cancer survival rates remains limited. AIMS: This study aims to investigate the association between statin use and various causes of mortality among aging cancer survivors. METHODS: We analyzed NHANES data from 1999 to 2018, Statin usage, both hydrophilic and lipophilic, was derived from NHANES prescription records. We utilized Cox proportional hazards models to associate statin utilization with mortality, differentiating causes of death according to statin type and patterns of use. RESULTS: Within a cohort of 2,968 participants, statin usage was categorized into non-users (1,738), hydrophilic statin users (216), and lipophilic statin users (982). Compared to those who did not use statins, individuals prescribed hydrophilic statins did not show a reduced risk of all-cause mortality (adjusted hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.72-1.41; P = 0.960), as outlined in Model 3. In contrast, the group receiving lipophilic statins exhibited a notable decrease in all-cause mortality risk (adjusted HR, 0.77; P = 0.003). Nonetheless, both hydrophilic and lipophilic statins were effective in diminishing the risk associated with cancer from its onset until death, with hydrophilic statins showing a greater level of efficacy. DISCUSSION: The potential of statins to reduce cancer-related mortality may provide avenues for targeted clinical interventions and management strategies. CONCLUSIONS: Our study reveals that the use of lipophilic statins is significantly associated with lower all-cause and cancer-cause mortality risks among aging cancer survivors.

Prostate cancer survivorship of Australian men living with prostate cancer: Patient support programs in Australia.

BACKGROUND: Treatment for prostate cancer (PC) is associated with adverse effects, especially in patients receiving androgen deprivation therapy (ADT). The Australian Government, non-governmental organisations and pharmaceutical companies responsible for marketing ADT have initiated and sponsored various strategic support programs for patients diagnosed with PC. OBJECTIVE: This professional article provides an overview of available PC patient support programs in Australia to assist general practitioners (GPs) to direct patient referrals and optimise clinical care. DISCUSSION: These PC support programs provide useful assistance on educational materials, decision support, clinical care management and referral to specialised services (eg continence advice, sexual health counselling and psychological support). More concerted efforts and smarter investment in PC survivorship programs are necessary to engage, educate and improve the lives of men living with PC more effectively.

Cancer survivors' adherence to the American cancer society and American institute of cancer research dietary guidelines in Lebanon.

BACKGROUND: Adequate diet and lifestyle practices are postulated to improve health and enhance wellbeing of cancer survivors. Despite the heavy cancer burden in Lebanon, little is known about the diet quality of survivors. This cross-sectional study assessed the compliance of survivors in remission with the American Cancer Society/American Institute Research Fund (ACS/AICR) diet and physical activity guidelines. METHODS: Cancer survivors in remission for at least 3 months and attending oncology clinics in two referral centers in Beirut, Lebanon were recruited. Adherence to the ACS/AICR was assessed by examining the compliance to guidelines promoting fruits, vegetables and whole grain and discouraging elevated alcohol, meat and energy dense foods intake. Dietary data was assessed through food frequency and lifestyle questionnaires administered face to face and through phone interviews. Anthropometrics, food security and sociodemographic data was also collected. Univariate and bivariate descriptive and logistic regressions were used to determine predictors of adherence rates to the ACS/AICR score. RESULTS: A total of 268 participants were recruited (mean age = 59 ± 23 years, 83% females, 70% breast cancer). Mean time since remission was 3.2 ± 4 years and the majority (72%) had food insecurity. Low physical activity and overweight/obesity were present in 65% and 67% of the survivors, respectively. Median adherence score with the ACS/AICR score was 9.0 out of 15. The majority of survivors had complete adherence to the moderate meat and alcohol consumption guidelines. However, 98% were noncompliant with the whole grains' consumption guidelines. Cancer type, site of recruitment and education were the significant predictors of the ACS/AICR diet adherence score. CONCLUSION: This study highlights the elevated rates of overweight/obesity, physical inactivity and the alarmingly low adherence with the whole grains consumption guideline among cancer survivors in remission. Policy makers ought to use study findings to redirect government subsidization and educational interventions in the country and physicians should stress the importance of adherence to a healthy diet during remission through counseling and timely referral.

Healthcare use among cancer survivors during the COVID-19 pandemic: results from the SHARE COVID-19 Survey.

PURPOSE: To estimate the association between a previous cancer diagnosis and healthcare use during the COVID-19 pandemic among Europeans and Israelis individuals. METHODS: This cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. Cancer survivors (CS, n = 6409) were country-, sex-, age-, and education-matched (1:2) to non-cancer individuals (NC). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression. RESULTS: Overall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI 1.19-1.41) than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI 1.39-2.30). Likewise, CS had their medical appointments postponed more often (OR = 1.54, 95%CI 1.44-1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI 1.63-2.36) who reported higher economic difficulties (OR = 1.73, 95%CI 1.50-2.00) and those with no multimorbidity (OR = 1.85, 95%CI 1.62-2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI 1.26-1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI 1.47-5.01). CONCLUSION: CS were more likely to forgo medical treatment, report healthcare postponements, and be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Health-related quality of life and supportive care needs in young adult cancer survivors-a longitudinal population-based study.

PURPOSE: To examine health-related quality of life (HRQoL) and supportive care needs among young adult (YA) cancer survivors up to 3 years post-diagnosis. METHODS: A national cohort of individuals diagnosed at 18-39 years with breast, cervical, ovarian, or testicular cancer, lymphoma or brain tumor was approached with surveys at 1.5 (n = 1010, response rate 67%) and 3 (n = 722) years post-diagnosis. HRQoL was measured using the EORTC QLQ-C30. Scores were dichotomized using cut-off scores to predict supportive care needs in the Supportive Care Needs Survey-Long Form 59 (SCNS-LF59). Swedish cancer quality registers provided clinical data. Factors predicting need of support at 1.5 and 3 years post-diagnosis were identified using logistic regression. RESULTS: HRQoL improvements over time were trivial to small. At both time points, a majority of respondents rated HRQoL levels indicating supportive care needs. At 1.5 years post-diagnosis, the risk of having support needs was lower among survivors with testicular cancer (compared to lymphoma) or university-level education, and higher among those on treatment (predominantly endocrine therapy). At 3 years post-diagnosis, when controlling for previous HRQoL scores, most correlations persisted, and poor self-rated household economy and chronic health conditions were additionally associated with supportive care needs. CONCLUSION: A majority of YAs diagnosed with cancer rate HRQoL at levels indicating support needs up to 3 years post-diagnosis. Testicular cancer survivors are at lower risk of having support needs. Concurrent health conditions and poor finances are linked to lower HRQoL. More efforts are needed to provide adequate, age-appropriate support to YA cancer survivors.

Investigation of Psychometric Properties and Correlation with Psychological Distress after Hurricane Hazards in Puerto Rico.

BACKGROUND: Puerto Rico (PR) is highly vulnerable to hurricanes, which severely impact cancer survivors by causing healthcare disruptions and increasing stress. This study investigates the reliability and factor structure of the Hurricane Hazards Inventory (HHI) and its relationship with psychological distress among cancer survivors and non-cancer controls in PR. METHODS: Using secondary data from a longitudinal study following Hurricane Maria (HM), the baseline assessment included sociodemographic data from participants, HHI, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7). Statistical analyses involved descriptive statistics, Exploratory Factor Analysis (EFA), and Partial Least Squares Structural Equation Modeling (PLS-SEM). RESULTS: Among 260 participants, 78.7% were women, with a median age of 58.0 years. EFA reduced the HHI to 17 items grouped into three factors explaining 62.6% of the variance with excellent reliability (Cronbach's alpha 0.91). The three factors also showed good to excellent reliability (alpha 0.81 to 0.92). The median HHI score was 11.0 (range 4.0-26.5) out of 68. PLS-SEM revealed a direct effect of being a cancer survivor and tertiary hazards on depression and anxiety. CONCLUSION: The HHI is a valid and reliable tool for assessing mental health impact in cancer survivors after hurricanes. However, the study had limitations, including its small sample size and lack of control for all confounding variables. Future research with larger and more diverse samples is needed to further validate the HHI and examine its generalizability.

Changes in work status after cancer diagnosis and their associations with depressive symptoms among cancer survivors: findings from the Korean longitudinal study of ageing1.

PURPOSE: Cancer survivors encounter significant psychological suffering and are prone to develop depressive symptoms. Work contributes to personal fulfillment and social connections, and by doing so, enhances a cancer survivor's resilience against adversities. However, maintaining employment can be challenging for some cancer survivors. This research aimed to identify the association between changes in work status and depressive symptoms among cancer survivors in South Korea. METHODS: This study used the panel data from the Korean Longitudinal Study of Ageing (KLoSA) and included 199 cancer survivors-799 observations-aged 65 or younger, between 2005 and 2018. Changes in work status consisted of continuous unemployment or employment, quitting a job, and getting a job. We defined depressive symptoms as a CES-D-10 score of 10 or higher and a cut-off of 4 was utilized for sensitivity analysis. Multivariable generalized estimating equation was employed to estimate the odds ratio (OR), adjusting for the number of household members, education level, sex, age, marital status, occupations, cancer treatment, cancer type, catastrophic healthcare expenditure (CHE), and survivorship. Subgroup analysis and interaction between changes in work and cancer types were further explored. RESULTS: For depressive symptoms, the OR of the continuous unemployment group was 2.27 (95% CI = 1.10-4.69), and the OR of the group that quit a job was 2.20 (95% CI = 1.03-4.72), compared to the continuous employment group. As survivorship increased, the odds of depressive symptoms decreased (OR = 0.94, 95% CI = 0.89-1.00). CHE was associated with depressive symptoms (OR = 2.23, 95% CI = 1.18-4.20). In cancer types with a low tendency to depression, continuous unemployment was associated with depressive symptoms (OR = 3.19, 95% CI = 1.12-9.06). In sensitivity analysis, changes in work, survivorship, and CHE were consistently associated with depressive symptoms. CONCLUSIONS: Cancer survivors who quit a job or continued unemployment were more likely to experience depressive symptoms. The findings of this study imply that assistance for cancer survivors to continue a job or return to employment, including adjustment of workload and hours, may be helpful. Psychological care may be crucial, particularly in the early stage of cancer survivorship. Furthermore, support may be needed to alleviate the burden of healthcare expenditure.