Impact of Income on Physical Concerns, Help Seeking, and Unmet Needs of Adult Cancer Survivors.

Purpose: Cancer treatment can have consequences for individuals which may have profound impact on daily living. Accessing assistance can be problematic. This study explores associations between income and concerns, help-seeking, and unmet needs related to physical changes following cancer treatment. Method: A national survey was conducted with cancer survivors about experiences with follow-up care one to three years after treatment. We report a trend analysis describing associations between income and cancer survivors' concerns, help-seeking, and unmet needs related to physical changes after treatment. Results: In total 5,283 cancer survivors between 18 and 64 years responded, of which 4,264 (80.7%) indicated annual household income. The majority of respondents were survivors of breast (34.4%), colorectal (15.0%), and prostate (14.0%) cancers. Over 90% wrote about experiencing physical changes following cancer treatment. Survivors with low annual household incomes of less than $25,000 (CAN) reported the highest levels of concern about multiple physical changes and were more likely to seek help to address them. Conclusions: Cancer survivors can experience various physical challenges and unmet needs following cancer treatment and difficulty obtaining relevant help across all income levels. Those with low income are more severely affected. Financial assessment and tailored follow-up are recommended.

Objectif: le traitement du cancer peut avoir de profondes conséquences sur la vie quotidienne. Il peut être difficile d'accéder à de l'aide. La présente étude explore les associations entre le revenu et les inquiétudes, la demande d'aide et les besoins non respectés liés aux changements physiques après le traitement du cancer. Méthodologie: : les chercheurs ont mené une enquête nationale auprès des survivants du cancer sur leurs expériences des soins de suivi de un à trois ans après le traitement. Ils rendent compte d'une analyse des tendances qui décrit les associations entre le revenu et les préoccupations des survivants du cancer, la demande d'aide et les besoins non respectés liés aux changements physiques après le traitement. Résultats: au total, 5 283 survivants du cancer de 18 à 64 ans ont répondu, et 4 264 (80,7 %) ont précisé leur revenu familial annuel. La majorité des répondants étaient des survivants du cancer du sein (34,4 %), du cancer colorectal (15,0 %) ou du cancer de la prostate (14,0 %). Plus de 90 % ont écrit avoir vécu des changements physiques après le traitement du cancer. Les survivants dont le revenu familial annuel était inférieur à 25 000 $ CA étaient les plus inquiets des multiples changements physiques et les plus susceptibles de demander à l'aide pour les régler. Conclusions: les survivants du cancer peuvent vivre divers changements physiques et éprouver des besoins non respectés après le traitement d'un cancer, et éprouver de la difficulté à obtenir l'aide pertinente dans toutes les catégories de revenu. Ceux qui ont un faible revenu sont plus touchés. Il est recommandé de procéder à une évaluation financière et à un suivi adapté.

Relationship between income and concerns about physical changes and help-seeking by older adult cancer survivors: a secondary analysis.

OBJECTIVE: Globally, the number of older adults surviving cancer is anticipated to grow rapidly over the next decades. Cancer and its treatment can leave survivors with a myriad of challenges including physical changes which impact independence and quality of life. This project explored the relationship of income level with concerns and help-seeking for physical changes following treatment in older Canadian survivors of cancer. METHODS: A Canada-wide survey of community-dwelling survivors of cancer explored their experiences with survivorship care one to three years following completion of treatment. A secondary trend analysis examined the relationship of income with older adults' level of concern and help-seeking experiences regarding physical consequences they attributed to their cancer treatment. RESULTS: In total, 7,975 people aged 65 years and older who survived cancer responded to the survey, of whom 5,891 (73.9%) indicated annual household income. Prostate (31.3%), colorectal (22.7%) and breast (21.8%) cancer accounted for the majority of respondents. Of those who reported household income data, over 90% wrote about the impact of physical changes following treatment, their concerns about the changes, and whether they sought help for their concerns. The most frequently identified physical challenge was fatigue (63.7%). Older survivors with low annual household incomes of less than $CA25,000 reported the highest levels of concern about multiple physical symptoms. 25% or more of the survey respondents across all income levels reported difficulty finding assistance for their concerns about the physical challenges, especially in their local communities. CONCLUSION: Older survivors of cancer can experience a range of physical changes, amenable to intervention by physical therapy, yet experience challenges obtaining relevant help. Those with low income are more severely affected, even within a universal healthcare system. Financial assessment and tailored follow-up are recommended.

Improvement of a synthetic live bacterial therapeutic for phenylketonuria with biosensor-enabled enzyme engineering.

In phenylketonuria (PKU) patients, a genetic defect in the enzyme phenylalanine hydroxylase (PAH) leads to elevated systemic phenylalanine (Phe), which can result in severe neurological impairment. As a treatment for PKU, Escherichia coli Nissle (EcN) strain SYNB1618 was developed under Synlogic's Synthetic Biotic™ platform to degrade Phe from within the gastrointestinal (GI) tract. This clinical-stage engineered strain expresses the Phe-metabolizing enzyme phenylalanine ammonia lyase (PAL), catalyzing the deamination of Phe to the non-toxic product trans-cinnamate (TCA). In the present work, we generate a more potent EcN-based PKU strain through optimization of whole cell PAL activity, using biosensor-based high-throughput screening of mutant PAL libraries. A lead enzyme candidate from this screen is used in the construction of SYNB1934, a chromosomally integrated strain containing the additional Phe-metabolizing and biosafety features found in SYNB1618. Head-to-head, SYNB1934 demonstrates an approximate two-fold increase in in vivo PAL activity compared to SYNB1618.