Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study.

BACKGROUND: We explored the relationship between benefit finding (BF)/posttraumatic growth (PTG) at baseline and health-related quality of life (HRQOL) at baseline and follow-up in long-term cancer survivors (LTCS; ≥5-year post-diagnosis). MATERIALS AND METHODS: HRQOL was assessed in LTCS in 2009-2011 (5- to 16-year post-diagnosis, baseline) and re-assessed in 2018/2019 (14- to 24-year post-diagnosis, follow-up). BF and PTG were measured at baseline; mean scores were dichotomized into 'none-to-low' (<3) and 'moderate-to-high' (> =3). Linear regression models and linear mixed regression models were employed to assess the association of BF/PTG with HRQOL. RESULTS: Of the 6057 baseline participants, 4373 were alive in 2019, of whom 2704 completed the follow-up questionnaire. Cross-sectionally, LTCS with none-to-low BF reported better HRQOL at baseline and at follow-up than LTCS with higher BF. Longitudinally, no difference was found between none-to-low and moderate-to-high BF on the HRQOL change from baseline to follow-up. HRQOL differences between the PTG groups were not statistically significant cross-sectionally and longitudinally, except those participants with moderate-to-high PTG reported higher role functioning and global health status/QOL. CONCLUSIONS: Cross-sectionally, BF was significantly negatively related to subscales of HRQOL, while PTG was positively correlated to role functioning and global health status/QOL. The results add further evidence that BF and PTG are two different positive psychological concepts.

Distress mediates the relationship between cognitive appraisal of medical care and benefit finding/posttraumatic growth in long-term cancer survivors.

BACKGROUND: The objective of this study was to ascertain long-term cancer survivors' (LTCS') appraisal of medical care and how these perceptions may influence their health and well-being, including benefit finding (BF) and posttraumatic growth (PTG). METHODS: In total, 6952 LTCS from a multiregional population-based study in Germany completed the Benefit Finding Scale, the Posttraumatic Growth Inventory, the Questionnaire on Stress in Cancer, and self-designed questions on cognitive appraisal of medical care. The authors explored the mediating role of distress between medical care appraisal and BF and PTG and the possible moderation of time since diagnosis in this relationship. RESULTS: LTCS' medical care appraisals ("no unresolved/untreated symptoms," "satisfaction with cancer care," and "satisfaction with care for other diseases") were positively associated with BF. PTG was positively associated with "no unresolved/untreated symptoms" and negatively associated with "satisfaction with care for other diseases." Cancer distress partially mediated the associations between appraisals of medical care and BF, between "no unresolved/untreated symptoms" and PTG and between "satisfaction with care for other diseases" and PTG; whereas it totally mediated the association between "satisfaction with cancer care" and PTG. Time was a significant moderator in the model; the negative indirect effect of cognitive appraisal on BF and PTG through cancer distress weakened with longer time since diagnosis. CONCLUSIONS: Cancer survivors' medical care appraisal is associated with their perceptions of BF and PTG through distress. Therefore, distress screening could be part of the regular workup to identify distressed cancer survivors who are not satisfied with medical care; these survivors may benefit from interventions to reduce distress and increase BF and PTG.

Prevalence of benefit finding and posttraumatic growth in long-term cancer survivors: results from a multi-regional population-based survey in Germany.

BACKGROUND: Cancer studies reported mixed results on benefit finding (BF) and posttraumatic growth (PTG) prevalence and few were focused on long-term survivors. METHODS: BF and PTG were assessed in a multi-regional population-based study in Germany with 6952 breast, colorectal and prostate cancer survivors, using the Benefit Finding Scale and Posttraumatic Growth Inventory. We calculated the age-adjusted prevalence, stratified by demographical and clinical characteristics. RESULTS: Overall, 66.0% of cancer survivors indicated moderate-to-high BF, and 20.5% moderate-to-high PTG. Age-adjusted prevalence of BF and PTG differed according to cancer type (breast > colorectal > prostate) and sex (female > male). BF and PTG prevalence were higher in younger than in older respondents; the age-adjusted prevalence was higher in respondents who survived more years after diagnosis. The strength and direction of associations of age-adjusted prevalence with cancer stage, disease recurrence, and time since diagnosis varied according to cancer type and sex. CONCLUSIONS: A substantial proportion of long-term cancer survivors reported moderate-to-high BF and PTG. However, the prevalence was lower in older and male cancer survivors, and during the earlier years after cancer diagnosis. Further longitudinal studies on PTG and BF in cancer survivors are warranted to address heterogeneity in survivors' experience after cancer diagnosis.

Higher Incidence of Diabetes in Cancer Patients Compared to Cancer-Free Population Controls: A Systematic Review and Meta-Analysis.

Background: Diabetes increases the risk of certain types of cancer. However, the literature regarding the incidence of diabetes after cancer diagnosis is inconsistent. We aimed to assess whether there was a higher incidence of diabetes among cancer patients by performing a systematic review and meta-analysis of results from cohort studies. Methods: A systematic electronic literature search was carried out from cohort studies regarding the incidence of diabetes in cancer patients, using the databases PubMed (MEDLINE), Embase, Web of Science, and the Cochrane Library. Random-effects meta-analyses were conducted to pool the estimates. Results: A total of 34 articles involving 360,971 cancer patients and 1,819,451 cancer-free controls were included in the meta-analysis. An increased pooled relative risk (RR) of 1.42 (95% confidence interval (CI): 1.30−1.54, I2 = 95, τ2 = 0.0551, p < 0.01) for diabetes in cancer patients was found compared with the cancer-free population. The highest relative risk was observed in the first year after cancer diagnosis (RR = 2.06; 95% CI 1.63−2.60). Conclusions: New-onset diabetes is positively associated with cancer, but this association varies according to cancer type. More prospective studies with large sample sizes and longer follow-up times are advocated to further examine the association and the underlying mechanisms.

The relationship between posttraumatic growth and health-related quality of life in adult cancer survivors: A systematic review.

BACKGROUND: Studies have reported mixed findings on the relationship between posttraumatic growth (PTG) and health-related quality of life (HRQOL) in cancer survivors. This review aims to give an overview of these studies and to identify potential study- and sample-level factors that could contribute to the heterogeneity of those findings on the relationship between PTG and HRQOL in cancer survivors. METHODS: Multiple electronic databases were systematically searched using the concepts 'posttraumatic growth', 'cancer', and 'health-related quality of life'. Eligible studies (published until 2018) were reviewed, quality-assessed, and effect sizes were extracted and synthesized. RESULTS: Of the 37 included articles, 22 received a rating of 'weak', 11 'moderate' and 4 'strong' in study quality assessment. The overall sample comprised 7954 individuals, mean age of 55.30 years, >50% females, predominantly breast cancer, and survivors mainly within 5 years post-diagnosis. The synthesized results revealed a positive association between PTG and HRQOL (Fisher's z= 0.16) on a total scale, with significant high heterogeneity (I2=75%). Variations in HRQOL measurement and methodological inconsistency contributed to study-level differences of effect sizes. Sample-level characteristics such as geographic region, smaller sample sizes (n < 100) and so on contributed to heterogeneity. LIMITATIONS: Studies assessing the relationship between PTG and HRQOL were heterogeneous, of weak study quality generally, and results were difficult to combine. CONCLUSIONS: Most studies found a positive relationship between the factors suggesting that PTG may play a role for successful coping following cancer. However, studies of higher quality and longitudinal design are needed.

Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis.

Previous studies have shown a strong coexistence of colorectal neoplasia (CRN) and cardiovascular diseases (CVD). This study was aimed to summarize the available evidence on association of CVD risk with early CRN detection in asymptomatic populations. PubMed, Web of Science, and Embase were systematically searched for eligible studies published until Dec 20, 2019. Studies exploring the associations of recommended CVD risk assessment methods (e.g., risk scores, carotid artery plaque, and coronary artery calcium score [CACS]) with risk of CRN were included. Meta-analyses were conducted to determine the overall association of CVD risk with the CRN. A total of 12 studies were finally included. The association of carotid artery plaque with the risk of colorectal adenoma (AD) was weakest (pooled odds ratio [OR)] 1.27, 95% confidence interval [CI), 1.12, 1.45]. Participants with CACS>100 had about 2-fold increased risk of AD than those with CACS=0. The pooled ORs were 3.36 (95% CI, 2.15, 5.27) and 2.30 (95% CI, 1.69, 3.13) for the risk of advanced colorectal neoplasia (AN) and AD, respectively, in participants with Framingham risk score (FRS)>20%, when compared to participants at low risk (FRS<10%). FRS might help identify subgroups at increased risk for AN, but further studies are needed.

Nutrition Support Practices of Hematopoietic Stem Cell Transplantation Centers in Mainland China.

It has been identified that malnutrition can influence the immune system and time of engraftment, and it's also associated with increased incidence of complications, prolonged length of hospital stays, and transplant mortality and morbidity in patients undergoing hematopoietic stem cell transplantation (HSCT), so dynamic nutrition care is highly important. The aim of this study was to better understand the differences between clinical nutrition practices and international recommendations as well as possible barriers to the use of nutrition support in HSCT patients. An evidence-based nutrition support pathway was constructed through a systematic literature review to identify evidence and recommendations relating to the relevant issues. Then, a questionnaire consisting of 28 questions that focused on the 4 topics, namely, assessment and screening for malnutrition, nutrition support interventions, nutrition support in gastrointestinal graft-versus-host disease (GVHD) and neutropenic diet was developed by the study authors and used for data collection. Responses of 18 HSCT centers from 17 provinces were received. General assessment for malnutrition was performed at 72% (13/18) centers. Parenteral nutrition (PN) was given as the first option to HSCT patients in the majority of centers, despite the fact that current guidelines recommend enteral nutrition (EN) over PN. As many as 72% (13/18) of the centers considered a neutropenic diet in the management of HSCT patients, but only one center had a formal neutropenic diet protocol in place for transplant recipients. Criteria for initiating nutrition support in patients with gastrointestinal GVHD were heterogeneous among the centers, and PN was the most widely used technique. The survey results revealed significant heterogeneity with regard to nutrition support practices among the centers, as well as between the practices and the guidelines. Standard nutrition support guidelines or protocols for nutrition support practices were absent in most of the centers.

The relationship between coping styles and benefit finding of Chinese cancer patients: The mediating role of distress.

PURPOSE: To identify the relationship of medical coping styles and benefit finding in Chinese early-stage cancer patients by preliminary pilot study. METHOD: Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University medical college and the Nantong Tumor Hospital in this study. Measurements were Chinese Benefit Finding Scale, Medical Coping Modes Questionnaire- Chinese version and Distress Thermometer. Regression analysis and pathway analysis were employed to identify the correlation of medical coping styles and benefit finding, and the mediating role of distress. RESULTS: Hierarchical regression analyses showed that confrontation coping style explained 24% of the variance in benefit finding, controlling for demographics and medical variables. While confrontation and resignation coping styles explained 10% and 6% of variance in distress separately. Pathway analyses implied that distress was found to mediate the effect of confrontation coping style on benefit finding in our study. CONCLUSIONS: Our study suggested an indirect association between medical coping styles and benefit finding, and a negative correlation of distress to medical coping styles and benefit finding. These results indicated that medical coping styles could influence benefit finding through distress.

Objectively Assessed Exercise Behavior in Chinese Patients with Early-Stage Cancer: A Predictor of Perceived Benefits, Communication with Doctors, Medical Coping Modes, Depression and Quality of Life.

This study sought to identify factors associated with objectively assessed exercise behavior in Chinese patients with early-stage cancer. Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University Medical College and the Nantong Tumor Hospital. One-way ANOVA, Pearson Chi-square tests and regression analysis were employed to identify the correlations between physical exercise and the measured factors. The results showed that occupation type (χ2 = 14.065; p = 0.029), monthly individual monthly income level (χ2 = 24.795; p = 0.003), BMI (χ2 = 15.709; p = 0.015) and diagnosis (χ2 = 42.442; p < 0.000) were significantly correlated with the subjects self-reported exercise with different frequency per week. Differences in the frequency of exercise were associated with different degrees of reported Benefit Finding (BF) (F = 24.651; p < 0.000), communication with doctors (F = 15.285; p < 0.000), medical coping modes (F = 45.912; p < 0.000), social support (F = 2.938; p = 0.030), depression (F = 6.017; p < 0.000), and quality of life (F = 12.288; p < 0.000). Multiple regression analysis showed that 1.6%-6.4% of the variance in five variables, excluding social support and optimism could be explained by exercise. Our results indicated that benefit finding, medical coping modes, communication with doctors, social support, depression and quality of life were significantly correlated with exercise. The variance in several psychosocial factors (benefit finding, medical coping modes, the communication with doctors, depression and quality of life) could be explained by exercise. Psychosocial factors should be addressed and examined over time when evaluating the effect of physical exercise that is prescribed as a clinically relevant treatment.

Application and evaluation of Benefit Finding Scale (BFS) in early-stage cancer patients from China.

PURPOSE: To adapt the Benefit Finding Scale (BFS) from English to a Chinese version after considering cross-cultural influences, to validate the tool for assessing benefit in Chinese-speaking patients with early-stage cancer, and to analyze the relationships between BF and sociodemographic and disease-related variables. METHODS: In part I of the study, the Chinese BFS was adapted from the English version by developing guidelines after due consideration for cross-cultural influences. The translation validity index was used for assessing the quality of translation, and further refining was carried out by administering the scale on early-stage cancer patients (N1 = 200, N2 = 351) in part II and III. The Chinese version of the BFS was analyzed for reliability, dimensionality and construct validity. Relationships between BF and sociodemographic and disease-related variables were analyzed by ANOVA and regression models. RESULTS: The Chinese BFS was received favorably by patients during the preliminary testing. Cronbach's alpha and interclass correlation coefficients exceeded 0.7, and factor analysis yielded six factors. Convergent validity, discriminant validity and concurrent validity results indicated a satisfactory psychometric value. Sociodemographic and disease-related predictors of BF were observed. CONCLUSION: The Chinese BFS demonstrated good patient acceptability and exhibited strong psychometric properties among Chinese patients with early-stage cancer. There were differences between Chinese cancer patients' benefit finding and patients with cancer in foreign countries, domestic cancer patients revealed high score in social relationship and family relationship dimension. Educational level, monthly individual income, treatment and physical exercise were the predictors of Chinese cancer patients' benefit finding.