Modifiable risk factors for weight loss after cancer treatment in Korean gastric cancer survivors.

PURPOSE: Weight loss is a critical problem in gastric cancer survivor (GCS) associated with worse prognosis and quality of life. Nevertheless, modifiable factors related to weight loss of GCS seem limited. We investigated the factors with significant weight loss including dietary pattern change in GCS. METHODS: In this cross-sectional study, Korean cancer survivors were recruited from two university-affiliated hospitals from 2014 to 2017. Overall, 591 GCSs were analyzed by preoperative body mass index levels. Significant and severe weight loss was defined as a weight reduction of more than 5% and 10%, respectively. RESULTS: Around 68.7% and 35.0% of GCS reported significant and severe weight loss, respectively. Age and surgery type were the important factors related to significant weight loss in total. In preoperative overweight or obese subjects, sex and surgery type were the risk factors for weight loss. Total food intake reduction was the only modifiable factor of significant weight loss (adjusted odds ratio (aOR) 1.78, 95% confidence interval (CI) 1.19-2.64), particularly in preoperative normal or underweight GCS (aOR 2.62, 95% CI 1.44-4.78). Increasing vegetable and salt reduction was found to be related to a lower risk of significant weight loss. The impact of reducing processed meat on weight loss differed by degree of weight loss and preoperative BMI level. CONCLUSIONS: Changing food consumption was the important modifiable factor related to significant weight loss which was more evident in preoperative underweight or normal GCS. Thus, further specific dietary recommendation is necessary for them to prevent significant weight loss. IMPLICATIONS FOR CANCER SURVIVORS: In order to prevent significant weight loss, dietary modification should be provided to GCS to ensure that total food intake does not decrease.

Factors Associated with Long-Term Dietary Supplement Use among Korean Breast Cancer Survivors: A Cross-Sectional Study.

PURPOSE: The factors associated with the dietary supplement (DS) use of Asian breast cancer survivors in consideration of the duration of use and types of DS have not been well established. METHODS: We recruited 693 Korean female breast cancer survivors at two university-affiliated hospitals and collected study data through a self-administered questionnaire and a review of medical records. A multiple logistic regression analysis was conducted to evaluate the multivariable-adjusted association between DS use and study variables. RESULTS: The prevalence of any (≥2 weeks) and long-term (≥6 months) DS use among study participants was 48.2% and 12.0%, respectively. Education level, alcohol use, adequate physical activity (≥150 min/week), and time lapse after cancer diagnosis were positively associated with any DS use. Among DS users, as compared with short-term (≥2 weeks and <6 months) users, long-term users were more likely to have a higher cancer stage, more diverse cancer treatment modalities, a shorter time since cancer diagnosis, and lower fear of cancer recurrence. When we repeated the analysis for each DS type, time lapse after cancer diagnosis showed a consistently inverse association with long-term use of the most frequently consumed DS (multivitamins, followed by vitamin D/calcium, vitamin C, and omega-3). The number of cancer treatment modalities was positively associated with the long-term use of multivitamins and vitamin D/calcium. Alcohol consumption and low bone mineral density were positively associated with long-term vitamin D/calcium use. CONCLUSIONS: The factors associated with DS use differed by the duration of DS use and specific DS type. Long-term DS use was more frequently associated with cancer-related factors.

Current Status and Physicians' Perspectives of Childhood Cancer Survivorship in Korea: A Nationwide Survey of Pediatric Hematologists/Oncologists.

BACKGROUND: Data on the status of long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) in Korea is lacking. This study was conducted to evaluate the current status of LTFU care for CCSs and relevant physicians' perspectives. METHODS: A nationwide online survey of pediatric hematologists/oncologists in the Republic of Korea was undertaken. RESULTS: Overall, 47 of the 74 board-certified Korean pediatric hematologists/oncologists currently providing pediatric hematology/oncology care participated in the survey (response rate = 63.5%). Forty-five of the 47 respondents provided LTFU care for CCSs five years after the completion of primary cancer treatment. However, some of the 45 respondents provided LTFU care only for CCS with late complications or CCSs who requested LTFU care. Twenty of the 45 respondents oversaw LTFU care for adult CCSs, although pediatric hematologists/oncologists experienced more difficulties managing adult CCSs. Many pediatric hematologists/oncologists did not perform the necessary screening test, although CCSs had risk factors for late complications, mostly because of insurance coverage issues and the lack of Korean LTFU guidelines. Regarding a desirable LTFU care system for CCSs in Korea, 27 of the 46 respondents (58.7%) answered that it is desirable to establish a multidisciplinary CCSs care system in which pediatric hematologists/oncologists and adult physicians cooperate. CONCLUSION: The LTFU care system for CCS is underdeveloped in the Republic of Korea. It is urgent to establish an LTFU care system to meet the growing needs of Korean CCSs, which should include Korean CCSs care guidelines, provider education plans, the establishment of multidisciplinary care systems, and a supportive national healthcare policy.

Factors Associated with Sleep Disorder among Korean Cancer Survivors: A Cross-Sectional Study.

BACKGROUND: The factors associated with sleep disorder are controversial. This study aimed to evaluate the prevalence of sleep disorder and the factors associated with sleep disorder among Korean adult cancer survivors. METHODS: In this cross-sectional study, we collected data on sleep problems as outcome variables, and sociodemographic and clinical information as predictor variables from cancer survivors at two university-affiliated hospitals. Sleep disorder was defined as "a difficulty in sleep initiation or sleep maintenance at least 3 times a week that started after a cancer diagnosis." Multiple logistic regression analysis was performed with odds ratios (OR) and 95% confidence intervals (95% CI) to evaluate the factors associated with sleep disorder. RESULTS: The participants were 1,893 Korean cancer survivors (mean age, 58.1 years; females 68.0%). The prevalence of sleep disorder among male and female cancer survivors were 16.5% and 20.3%, respectively. An increase of age by 1-year was associated with a 1.04 (95% CI, 1.01-1.07; P=0.011) times higher risk of sleep disorder in males, while an inverse association was found in females. In female survivors, high fear of cancer recurrence (FCR), high anxiety, menopause, and high EuroQol Visual Analog Scale were associated with 1.45 (95% CI, 1.06-1.98; P=0.020), 1.78 (95% CI, 1.25-2.55; P=0.002), 1.70 (95% CI, 1.08-2.67; P=0.022), and 0.59 (95% CI, 0.43-0.82; P=0.002) times higher risk of sleep disorder, respectively. In male survivors, living with a spouse/or partner was associated with 57% (95% CI, 0.20-0.95; P=0.036) lower risk of sleep disorder. Analyses of cancer sites showed that the factors associated with sleep disorder varied across cancer sites. CONCLUSION: One-fifth of adult cancer survivors had sleep disorder. Age, menopausal status, FCR, anxiety, living with a spouse or partner, and quality of life were independently associated with sleep disorder in Korean cancer survivors.

Factors Associated with Dietary Habit Changes in Korean Stomach Cancer Survivors after Cancer Treatment.

The current nutritional guidelines for stomach cancer survivors (SCSs) mainly focus on the influence of the surgical resection of the stomach, with limited guidance regarding a wider range of food options. We aimed to investigate the factors associated with healthier dietary changes in Korean adult SCSs. This cross-sectional study assessed dietary pattern changes after cancer treatment for 11 food categories, using a self-administered questionnaire. A 'healthier dietary change' was operationally defined as a reduced consumption of red and processed meat, grains, salt, and burnt food, and an increased consumption of poultry, fish, vegetables, fruits, legumes, and dairy products. Among a total of 624 SCSs, approximately 60% of participants reported dietary changes in a healthier direction in three or more food categories, while 9.1% reported no changes. There was no significant difference in dietary habit changes between surgery types. Multivariable adjusted analysis showed that elderly and long-term survivors were inversely associated with a healthier dietary change. SCSs with a higher level of educational achievement and income were more likely to make healthier changes in their intake of processed meat, vegetables, fruits, burnt food, or salt. SCSs with higher levels of fear of cancer recurrence, anxiety, or depression were more likely to follow healthier dietary changes regarding fish, meat, fruits, grains, or burnt food. Change in dietary pattern varied across different food items, and was associated with various characteristics of SCSs. It is crucial to repeatedly provide SCSs with information about healthier dietary patterns, considering their sociodemographic, clinical, and psychological characteristics.

Self-reported physical activity behaviors of childhood cancer survivors: comparison to a general adolescent population in Korea.

PURPOSE: Adequate physical activity (PA) can significantly contribute to the prevention of undesirable health outcomes in childhood cancer survivors (CCS). This study aimed to identify the patterns of PA and related factors in Korean CCS. METHODS: Study subjects were 184 adolescents selected from an ongoing cohort study of Korean CCS and 1,840 sex- and school grade-matched controls randomly selected from the participants of the 2019 Korea Youth Risk Behavior Web-based Survey. Information on PA and sedentary behaviors was collected by self-administered questionnaire. We estimated body mass index (BMI)-adjusted odds ratio (OR) and 95% confidence interval (CI) for the advisable healthy behaviors of CCS compared with healthy controls using conditional logistic regression analysis. In addition, the associations of advisable healthy behaviors of CCS with sociodemographic and clinical factors were estimated using multiple logistic regression analysis. RESULTS: CCS were less likely to be physically active than controls, but this finding was evident only in males. The ORs (95% CIs) for regular exercise, moderate intensity PA, vigorous intensity PA, and walking were 0.42 (0.27-0.65), 0.39 (0.24-0.63), 0.53 (0.33-0.84), and 0.64 (0.42-0.98), respectively, in male CCS compared with same-sex controls. Compared with same-sex controls, male CCS were 4.60 times and female survivors were 15.19 times more likely to sleep longer than 8 h a day. Among CCS, males were 2.92 times and 3.07 times more likely to perform moderate intensity PA and muscle-strengthening exercise, respectively, than female. Higher BMI (OR: 1.16), highest family income (OR: 3.98), and a caregiver who performed regular exercise (OR: 2.08) were positively associated with vigorous intensity PA of CCS. With increasing time after treatment completion, the probability of engaging in sedentary activity for less than 6 h per day decreased (OR = 0.89, 95% CI 0.79-1.00). CONCLUSION: Korean adolescent CCS were physically inactive compared with control adolescents. Several sociodemographic factors such as sex, family income, caregiver PA, and obesity level were associated with PA behaviors of CCS. IMPLICATIONS: Strategic effort would be needed to increase physical activity of childhood cancer survivors in adolescent period with consideration of various sociodemographic factors found in this study.

Parent caregivers' preferences and satisfaction with currently provided childhood cancer survivorship care.

PURPOSE: The aim of this study was to investigate the level of satisfaction of parent caregivers of childhood cancer survivors (CCSs) with currently provided survivorship care and their preferences for survivorship care provider. METHODS: Study subjects were parent caregivers recruited at three hospitals in Korea. Study data were collected from self-administered questionnaires and medical records. We assessed parent caregivers' levels of satisfaction with specific survivorship care contents and preferred types of survivorship care provider among oncologists, primary care physicians (PCPs), and institutional general physicians (IGPs). Factors associated with parent caregivers' preferences for survivorship care provider were evaluated by multiple logistic regression analysis. RESULTS: 680 parent caregivers (mother 62.1% and father 37.9%) of 487 CCSs (mean age at diagnosis: 6.9 ± 5.1 years; mean time since treatment completion 5.4 ± 4.4 years) were included. Parent caregivers' dissatisfaction was the highest with screening for second primary cancer, followed by psychosocial problem management. Higher educational level of parent caregiver, parent caregiver's higher level of dissatisfaction with currently provided care, higher age of CCSs at cancer diagnosis, history of receiving hematopoietic stem cell transplant, and longer time lapse after cancer treatment were significantly associated with parent caregivers' higher preference for PCPs or IGPs than oncologists. Parent caregiver's multiple comorbidities and higher fear of cancer recurrence were associated with parent caregivers' higher preference for oncologists than PCPs or IGPs. Around 80% of parent caregivers recognized that a shared care system was helpful for promoting the health of CCSs. CONCLUSION: Parent caregivers were substantially dissatisfied with currently provided care, especially regarding the health issues not directly associated with the primary cancer. Parent caregivers' preferences for survivorship care provider is influenced by multiple factors, including age and survival time of CCSs, characteristics of parent caregivers, satisfaction level with care, and specific survivorship care contents. IMPLICATIONS FOR CANCER SURVIVORS: The findings of our study suggest that shared survivorship care for CCSs with consideration of specific care contents can complement the current oncologist-led survivorship care system.

Association between Serum Lipid Levels and Sensorineural Hearing Loss in Korean Adult Population.

BACKGROUND: Hearing loss (HL) has been suggested to be associated with impaired microcirculation of the inner ear. This cross-sectional study aimed to evaluate an association between HL and serum lipid levels. METHODS: The study comprised 10,356 Korean adults who participated in the fifth Korea National Health and Nutrition Examination Survey (2010-2012). We defined HL as the average hearing thresholds exceeding 25 dB at predetermined frequency levels by pure tone audiometry. Serum lipid levels were measured using an enzymatic assay. The associations between lipid levels and HL were evaluated using a multiple logistic regression model after adjusting for covariates including age, sex, hypertension, diabetes, smoking status, alcohol, physical activity, educational level, household income, and noise exposure. Stratified analyses were performed to examine the effect of the covariates on the association between lipid levels and HL. RESULTS: The high-density lipoprotein cholesterol (HDL-C) level was inversely associated with high-frequency (HF)-HL, with an odds ratio (95% confidence interval) of 0.78 (0.64-0.96) for 1-mmol/L increase in the HDL-C level. Neither the triglyceride nor the low-density lipoprotein cholesterol level was associated with HF-HL. For low-frequency HL, association with any of the serum lipid components was absent. A stratified analysis showed that the inverse association between HDL-C levels and HF-HL was evident (P trend <0.05) in some subjects with specific characteristics such as older age (≥65 years), female sex, non-hypertensive state, and non-regular physical activity. However, a significant interaction between HDL-C levels and all of the stratified variables was absent (P for interaction >0.05). CONCLUSION: The HDL-C level has a linear inverse association with the risk of HF-HL. Given the known protective role of HDL-C against atherosclerotic changes, this finding seems to support the concept of impaired microcirculation in the inner ear as a mechanism for HF-HL.

Exploring socio-demographic, physical, psychological, and quality of life-related factors related with fear of cancer recurrence in stomach cancer survivors: a cross-sectional study.

BACKGROUND: Stomach cancer is one the most common neoplasms with high mortality. However, fear of cancer recurrence (FCR) in stomach cancer survivors has been scarcely evaluated. Thus, the aim of this study was to evaluate FCR and factors related to FCR in Korean stomach cancer survivors. METHODS: A total of 363 stomach cancer survivors who had completed primary treatment and had no metastasis or recurrence were recruited between September 2014 and March 2017 regardless of time lapse after the initial diagnosis. FCR was assessed using the Korean version of the FCR Inventory (FCRI). Participants were divided into two groups; clinical FCRI group (score of severity subscale of FCRI ≥ 13) and non-clinical FCRI group (the scores < 13). Socio-demographic factors, cancer stage, treatment, psychological factors, health-related quality of life (HRQoL), and health promotion and disease prevention behaviors were obtained using a self-administered questionnaire supplemented with face-to-face interview to fill out incomplete information. Factors associated with FCR were evaluated using linear regression analysis and multiple logistic regression analysis after adjusting for age, sex, cancer stage, time since cancer diagnosis, family cancer diagnosis, and comorbidities. RESULTS: Average (standard deviation) time interval between cancer diagnosis and study participation was 7.3 (3.2) years. The distribution of socio-demographic and cancer-related factors did not differ according to the level of FCR. The higher FCRI level was associated with lower levels of social support (ß: -0.190, p < 0.001), lower emotional function (ß: -0.356, p < 0.001), more severe fatigue (ß: 0.333, p < 0.001), more sleep problems (ß: 0.299, p = 0.002), higher anxiety (ß: 0.443, p < 0.001), and higher depression (ß: 0.207, p < 0.001). However, clinical level of FCR was not associated with health promotion and disease prevention behaviors. CONCLUSIONS: FCR in stomach cancer survivors was associated with social, psychological, and HRQoL factors rather than demographic, socioeconomic, or cancer-related factors. This finding suggests that careful attention to FCR is necessary to provide more comprehensive survivorship care for stomach cancer survivors.

Effect of smoking reduction, cessation, and resumption on cancer risk: A nationwide cohort study.

BACKGROUND: The objective of this study was to investigate the effects of reduction, cessation, and resumption of smoking on cancer development. METHODS: The authors identified 893,582 participants who currently smoked, had undergone a health screening in 2009, and had a follow-up screening in 2011. Among them, 682,996 participated in a third screening in 2013. Participants were categorized as quitters, reducers I (≥50% reduction), reducers II (<50% reduction), sustainers (referent), or increasers (≥20% increase). Outcome data were obtained through December 31, 2018. RESULTS: Reducers I exhibited a decreased risk of all cancers (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.93-0.99), smoking-related cancers (aHR, 0.95; 95% CI, 0.92-0.99), and lung cancer (aHR, 0.83; 95% CI, 0.77-0.88). Quitters had the lowest risk of all cancers (aHR, 0.94; 95% CI, 0.92-0.96), smoking-related cancers (aHR, 0.91; 95% CI, 0.89-0.93), and lung cancer (aHR, 0.79; 95% CI, 0.76-0.83). In further analysis with 3 consecutive screenings, additional smoking reduction (from reducers II to reducers I) lowered the risk of lung cancer (aHR, 0.74; 95% CI, 0.58-0.94) in comparison with sustainers. Quitting among reducers I further decreased the risk of all cancers (aHR, 0.90; 95% CI, 0.80-1.00), smoking-related cancers (aHR, 0.81; 95% CI, 0.81-0.92), and lung cancer (aHR, 0.66; 95% CI, 0.52-0.84) in comparison with sustainers. Smoking resumption after quitting, even at a lower level, increased the risk of smoking-related cancers (aHR, 1.19; 95% CI, 1.06-1.33) and lung cancer (aHR, 1.48; 95% CI, 1.21-1.80) in comparison with sustained quitting. CONCLUSIONS: Smoking cessation and, to a lesser extent, smoking reduction decreased the risks of cancer. Smoking resumption increased cancer risks in comparison with sustained quitting. LAY SUMMARY: Worldwide, tobacco use is the single leading preventable risk factor for cancer and cancer death. This study examined the effects of reduction, cessation, and resumption of smoking on cancer development by measuring smoking behavior repetitively. Although smoking reduction has a substantial cancer prevention benefit for those who cannot quit, cessation should be encouraged whenever possible. Quitters should be monitored to ensure that they do not resume smoking.

Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study of 10 Million People.

Background: It is unclear if cigarette smoking and alcohol consumption are associated with thyroid cancer risk. Our aim was to explore for any associations between cigarette smoking and alcohol consumption with thyroid cancer, after adjusting for potential confounders. Methods: Using data from the Korean National Health Insurance database, we retrospectively identified individuals aged ≥20 years who participated in the 2009 health screening program and were followed until 2017. We estimated the adjusted hazard ratio (aHR) for the risk of thyroid cancer using a Cox proportional hazard model, adjusted for age, sex, regular exercise, monthly income, body mass index, diabetes mellitus, and dyslipidemia. Results: During a mean follow-up period of 8.33 ± 0.57 years, of 9,699,104 participants, 89,527 (0.9%) were diagnosed with thyroid cancer. Compared with those who never smoked, current smokers had a lower risk of thyroid cancer (aHR: 0.74, 95% confidence interval [CI]: 0.72-0.76), while ex-smokers did not (aHR: 0.98, 95% CI: 0.96-1.01). There was no significant dose-response relationship with regard to daily amount smoked, duration of smoking, or pack-years. A reduced risk of thyroid cancer was observed in subjects who reported the following categories of alcohol intake (compared with none): mild (aHR: 0.92, 95% CI: 0.90-0.93), moderate (aHR: 0.86, 95% CI: 0.84-0.89), and heavy (aHR: 0.86, 95% CI: 0.82-0.89). Inverse associations with thyroid cancer risk were observed regarding the number of drinking episodes per week and the number of drinks per occasion. A submultiplicative effect of smoking and alcohol consumption was observed (p-interaction <0.001). Conclusions: We observed that thyroid cancer risk was inversely associated with smoking and alcohol consumption, with a significant interaction between these variables.

Factors associated with the comprehensive needs of caregivers of childhood cancer survivors in Korea.

PURPOSE: Caregivers of childhood cancer survivors (CCS) have diverse needs, which should be addressed to provide comprehensive cancer care. We aimed to evaluate the unmet needs of caregivers of CCS. METHODS: The subjects were 700 caregivers recruited at three major hospitals in South Korea. We collected study data using self-administered questionnaires and a thorough review of medical records. We assessed the unmet needs of caregivers using the comprehensive needs assessment tool for cancer caregivers and evaluated factors associated with the highest tertile range of unmet needs by multiple logistic regression analysis. RESULTS: The greatest unmet needs of caregivers had to do with healthcare staff, followed by information. Compared with father-caregivers, mother-caregivers had greater unmet needs related to health and psychological problems, family/social support, and religious/spiritual support, with odds ratios (95% confidence interval) of 3.79 (2.52-5.69), 3.17 (2.09-4.81), and 1.69 (1.14-2.50), respectively. Compared with caregivers of the youngest CCS (< 6 years), caregivers of CCS aged 12-18 years and caregivers of the oldest CCS (≥ 19 years) respectively showed 2.62 (1.24-5.52) and 3.18 (1.34-7.55) times greater unmet needs for information. Caregivers of CCS who received haematopoietic stem-cell transplantation had a 2.01-fold (1.14-3.57) greater need for practical support. CONCLUSION: Caregivers of CCS had substantial unmet needs required for comprehensive care for CCS. Several individual characteristics of caregivers and their children were significantly associated with greater unmet needs of the caregivers. IMPLICATIONS FOR CANCER SURVIVORS: Personalized support based on the characteristics of both CCS and their caregivers is required to provide comprehensive care for CCS.

The Association between the Use of Dietary Supplement and Psychological Status of Cancer Survivors in Korea: A Cross-Sectional Study.

BACKGROUND: Dietary supplements (DS) use is known to be common among cancer survivors. However, detailed information on the factors influencing DS use seems insufficient, including cancer-related and psychological factors. METHODS: Study subjects were 1,852 Korean adult cancer survivors recruited from cancer survivor clinic of two university-affiliated hospitals. Data were collected retrospectively through review of medical records and self-administered questionnaires. Psychological factors were assessed using Hospital Anxiety and Depression Scale (HADS) and Fear of Cancer Recurrence Inventory-Short Form. Factors associated the DS use were evaluated by multiple logistic regression analysis after adjusting for covariates. RESULTS: The prevalence of long-term DS use was 15.7% in overall (17.5% in female and 11.6% in male). Female survivors were 3.14 times (95% confidence interval [CI], 1.89-5.22) more likely to use DS than male. In male cancer survivors, ever-smoking and previous radiotherapy were positively associated with DS use. In females, breast cancer survivors were 0.32 times less likely to use DS compared with stomach cancer survivors, and survivors with family history of cancer were 1.39 times more likely to use DS than those without. After adjusting for sociodemographic, clinical, and lifestyle factors, survivors with anxiety (HADS ≥8) used DS 1.38 times (95% CI, 1.01-1.91) more frequently, compared with those without anxiety. CONCLUSION: Diverse factors such as female sex, cancer treatment modality, smoking history, family history and anxiety status were associated with DS use in Korean cancer survivors. Targeted strategies with consideration of these factors are needed for counseling DS use for cancer survivors.

A cross-sectional study of factors associated with influenza vaccination in Korean cancer survivors.

OBJECTIVE: To investigate factors associated with influenza vaccination in cancer survivors. METHODS: Study subjects were 1,945 Korean adult cancer survivors. Through medical record review and self-administered questionnaires, social and medical information was collected. Influenza vaccination was defined as ever having received a flu vaccine between one year before cancer diagnosis and the survey date. Multiple logistic regression analysis was used to evaluate factors associated with influenza vaccination. RESULTS: Overall, 60.8% of study subjects had received an influenza vaccination. Younger survivors had a significantly lower vaccination rate than did the elderly survivors (80.22% vs. 54.73%). In younger survivors, longer time elapsed since cancer diagnosis, lifestyle modification counselling during cancer treatment, adequate physical exercise (≥150 min/week) and complementary medication use were positively associated with vaccination, whereas extra-pulmonary cancers, multimodality (≥3) cancer treatment and higher educational achievement were inversely associated. In elderly survivors, fewer factors had a positive (adequate physical exercise) or inverse (multimodality cancer treatment and current smoking) association with influenza vaccination. CONCLUSION: Influenza vaccination rate was suboptimal, especially among younger cancer survivors. Targeted strategies are necessary to improve influenza vaccination in cancer survivors with consideration of individual characteristics such as age, lifestyle, cancer treatment modality, cancer type and education level.

Relationship Between Daily Sedentary Behaviors and Metabolic Syndrome in Middle-Aged Adults: Results from a Health Survey in Taean-Gun, Republic of Korea.

Background: It is unclear whether sedentary behavior is associated with metabolic risk, being independent of physical activity and other possible confounders. This study aimed to evaluate an association between sedentary behaviors and metabolic syndrome (MetS). Methods: A community-based cross-sectional study was conducted in a total of 987 Korean adults aged 40 years or older. Information on study variables, including physical activity, awake and sitting time, and components of MetS, was collected by a self-administered questionnaire, physical measurement, and laboratory test. MetS was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III and Korean Society for the Study of Obesity. Multiple logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for MetS associated with absolute sitting time, high sedentary ratio (>0.5), and other selected covariates, including age, sex, smoking, alcohol intake, educational attainment, daily meal times, regular exercise, intensity of physical activities, and sleep and nap duration. Results: After considering other selected variables, the risk of MetS was found to be higher by about 54% among subjects who had a higher sedentary ratio (OR: 1.54, 95% CI: 1.04-2.28). Every hour increase in sitting time was associated with increased risk of MetS (OR: 1.05, 95% CI: 0.99-1.11) with borderline significance (P = 0.119). Conclusions: Sedentary behavior was independently associated with an increased risk of MetS, suggesting that efforts to reduce the sedentary time might be also important for metabolic health in addition to encouraging adequate physical exercise. Clinical trial number is not applicable to this study.

Factors associated with pneumococcal vaccination uptake by cancer survivors.

PURPOSE: This study aimed to evaluate factors associated with pneumococcal vaccination uptake (PVU) of cancer survivors. METHODS: A total of 2032 Korean adult cancer survivors diagnosed between June of 1975 and February of 2018 have participated. Information on PVU status and selected variables were collected through self-administered questionnaires and medical record review. Factors associated PVU were investigated using multiple logistic regression analysis. RESULTS: PVU rate markedly differed by age strata and cancer sites: 73.9% for elderly (≥ 65 years) survivors and 34.6% for younger (< 65 years) survivors and 73.4% for lung cancer survivors and 42.1% for non-lung cancer survivors. Regular physical exercise was associated with higher PVU in both age groups: Odds ratio (OR) and 95% confidence interval (CI) were 1.52 (1.20, 1.94) for younger and 1.78 (1.09, 2.90) for elderly survivors. Complementary medication use was positively associated with PVU with borderline significance in both age groups. However, the association of PVU with other factors differed between the two age groups. In younger survivors, a positive association with PVU was evident for longer time lapse after cancer diagnosis, chronic disease, and living with spouse/or partner, while cancer stage, educational achievement, and alcohol use were inversely associated PVU. On the other hand, multi-modality (≥ 3) cancer treatment was inversely associated with PVU only in elderly survivors. CONCLUSIONS: PVU of Korean cancer survivors was suboptimal in younger survivors and non-lung cancer survivors. Factors associated with PVU differed between younger and elderly survivors, and more diverse factors were identified for younger survivors. IMPLICATIONS FOR CANCER SURVIVORS: In order to promote adherence to PVU in cancer survivors, careful consideration of high-risk factors for non-immunization within cancer survivorship context would be necessary together with free-of-charge vaccination policy.

Novel mammogram-based measures improve breast cancer risk prediction beyond an established mammographic density measure.

Mammograms contain information that predicts breast cancer risk. We developed two novel mammogram-based breast cancer risk measures based on image brightness (Cirrocumulus) and texture (Cirrus). Their risk prediction when fitted together, and with an established measure of conventional mammographic density (Cumulus), is not known. We used three studies consisting of: 168 interval cases and 498 matched controls; 422 screen-detected cases and 1197 matched controls; and 354 younger-diagnosis cases and 944 controls frequency-matched for age at mammogram. We conducted conditional and unconditional logistic regression analyses of individually- and frequency-matched studies, respectively. We estimated measure-specific risk gradients as the change in odds per standard deviation of controls after adjusting for age and body mass index (OPERA) and calculated the area under the receiver operating characteristic curve (AUC). For interval, screen-detected and younger-diagnosis cancer risks, the best fitting models (OPERAs [95% confidence intervals]) involved: Cumulus (1.81 [1.41-2.31]) and Cirrus (1.72 [1.38-2.14]); Cirrus (1.49 [1.32-1.67]) and Cirrocumulus (1.16 [1.03 to 1.31]); and Cirrus (1.70 [1.48 to 1.94]) and Cirrocumulus (1.46 [1.27-1.68]), respectively. The AUCs were: 0.73 [0.68-0.77], 0.63 [0.60-0.66], and 0.72 [0.69-0.75], respectively. Combined, our new mammogram-based measures have twice the risk gradient for screen-detected and younger-diagnosis breast cancer (P ≤ 10-12 ), have at least the same discriminatory power as the current polygenic risk score, and are more correlated with causal factors than conventional mammographic density. Discovering more information about breast cancer risk from mammograms could help enable risk-based personalised breast screening.

Genome-Wide Association Study for the Identification of Novel Genetic Variants Associated with the Risk of Neuroblastoma in Korean Children.

PURPOSE: Neuroblastoma (NB) is the most common extracranial solid tumor found in children. To identify significant genetic factors for the risk of NB, several genetic studies was conducted mainly for Caucasians and Europeans. However, considering racial differences, there is a possibility that genetic predispositions that contribute to the development of NB are different, and genome-wide association study has not yet been conducted on Korean NB patients. MATERIALS AND METHODS: To identify the genetic variations associated with the risk of pediatric NB in Korean children, we performed a genome-wide association analysis with 296 NB patients and 1000 unaffected controls (total n = 1,296) after data cleaning and filtering as well as imputation of non-genotyped SNPs using IMPUTE v2.3.2. RESULTS: After adjusting for multiple comparisons, we found 21 statistically significant SNPs associated with the risk of NB (Pcorr < 0.05) within 12 genes (RPTN, MRPS18B, LRRC45, KANSL1L, ARHGEF40, IL15RA, L1TD1, ANO7, LAMA5, OR7G2, SALL4, and NEUROG2). Interestingly, out of these, 12 markers were nonsynonymous SNPs. The SNP rs76015112 was most significantly associated with the risk of NB (p = 8.1E-23, Pcorr = 2.3E-17) and was located in the RPTN gene. In addition, significant nonsynonymous SNPs in ADGRE1 were found in patients with MYCN amplification (rs7256147, p = 2.6E-05). In high-risk group, rs7256147 was observed as a significant SNP (p = 5.9E-06). CONCLUSION: Our findings might facilitate improved understanding of the mechanism of pediatric NB pathogenesis. However, functional evaluation and replication of these results in other populations are still needed.

Health behaviors of caregivers of childhood cancer survivors: a cross-sectional study.

BACKGROUND: Caregiving for childhood cancer survivors may be burdensome for caregivers and affect their physical health and health behaviors. However, studies examining health behaviors in caregivers of childhood cancer survivors are scarce. This study aimed to examine health behaviors of caregivers of childhood cancer survivors by comparing them with those of the general population, and analyze associated factors. METHODS: This study included 326 caregivers of childhood cancer survivors recruited from 3 major hospitals in South Korea and 1304 controls from the Korean National Health and Nutritional Examination Survey matched for age, sex, and education level. We compared health behaviors between the two groups by using conditional logistic regression analyses, and investigated factors associated with unhealthy behaviors in caregivers by using multiple logistic regression analyses. RESULTS: Caregivers were less likely to be physically inactive (aOR: 0.69, 95% CI: 0.51, 0.92) compared to controls, and this was more evident in women (aOR: 0.65, 95% CI: 0.45, 0.94). However, caregivers were more likely to be binge drinkers (aOR: 2.26, 95% CI: 1.73, 2.97), especially if they were men (aOR: 13.59, 95% CI: 8.09, 22.82). Factors associated with unhealthy behaviors in caregivers differed by the type of behavior. Current smoking risk was lower in female caregivers and in those with more comorbidities. Increasing age, female sex, higher education level, and lower household income were associated with lower risk of binge drinking. Higher household income and anxiety were associated with lower risk of physical inactivity, while depression was associated with higher risk of physical inactivity. CONCLUSIONS: Caregivers of childhood cancer survivors were more likely to engage in binge drinking, but less likely to be physically inactive. Strategies to promote adherence to desirable health behaviors in caregivers are needed with consideration of their socioeconomic and clinical factors, such as number of comorbidities.

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer.

BACKGROUNDS: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. METHODS: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <-10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. RESULTS: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. CONCLUSION: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.