Many cancer survivors experience administrative burdens and poor financial outcomes but associations with insurance and cancer treatments are not well studied. This study aimed to fill that gap. Cancer survivors (n = 459), on average 11 years post-diagnosis and in the United States completed a cross-sectional survey. Dependent variables were five types of insurance-related administrative burdens (prior authorization, denials, surprise bills, stepped care, out-of-network care) and four dimensions of financial toxicity. Independent variables were health insurance type at diagnosis and cancer treatments. Logistic and linear regression models assessed the relationships between independent and dependent variables. Forty-six percent reported at least one insurance-related administrative burden. Participants who received immunotherapy (prior authorizations: 33
The purpose of this study is to identify activity profiles and their correlates in patients with localised renal cell carcinoma (RCC) and colorectal cancer (CRC) shortly after treatment completion. In the ReLife (n = 326 patients with RCC) and EnCoRe (n = 358 patients with CRC) studies, we measured physical activity and sedentary behaviour at 3 months and 6 weeks after treatment completion using accelerometers. We used latent profile analyses to determine activity profiles. Demographic, lifestyle-related, and clinical correlates were investigated with multinomial regression analyses. We identified three activity profiles for both populations: a most sedentary (RCC:28
Despite significant advances in melanoma treatment, many survivors continue to experience long-term effects of disease and therapy. Various survivorship care programs have been developed in recent years, but these differ in terms of their scope, content, and delivery. The aim of this scoping review was to summarize existing literature on melanoma survivorship care. The search strategy was developed using the PCC (Population, Concept, Context) framework for scoping reviews. We conducted systematic searches in MEDLINE®, the Cochrane Library, Web of Science and CINAHL for studies published between 01/2015 and 03/2026. Additionally, the reference lists of the included studies were screened. Two researchers conducted the searches independently. They screened the studies using defined criteria and extracted data on study characteristics and the reported care. The results were summarized using the content analysis by Elo and Kyngäs. Of the 2,993 references screened, 21 studies met the inclusion criteria and covered seven unique survivorship care programs. These studies were published from 2015 onward. Using the domains of the Cancer survivorship care quality framework, we characterized the studies as follows: prevention and monitoring of recurrence and new cancers; monitoring and management of physical, psychosocial, and chronic conditions; health promotion and disease prevention; and context-related domains of the healthcare system, such as clinical structure, communication and decision making, and care coordination. This scoping review summarizes the current melanoma survivorship care. Evidence gaps remain, particularly regarding health literacy and health economic perspectives. The findings will support the development of a patient-centered survivorship care program for people living with and beyond melanoma.
Despite increasing efforts to address financial toxicity among patients with cancer, approaches to best identify patients for targeted intervention remain unclear. We compared qualitative accounts of financial toxicity among patients receiving targeted oral anticancer medications (TOAMs) to their scores in two screening tools, the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) and the Economic Strain and Resilience in Cancer (ENRICh). We conducted mixed-methods analysis of adult patients at a comprehensive cancer center. Patients had confirmed cancer diagnoses and orders for TOAMs in the last 3 months. Participants completed surveys (n = 108), and a subset with COST-FACIT scores indicating financial toxicity participated in semi-structured interviews (n = 20). We applied the Framework Method to examine qualitative accounts and developed joint matrices to assess how well each measure identified financial toxicity. Qualitative accounts highlighted two elements of financial toxicity: financial strain and financial worry. For participants with extreme accounts of financial strain and financial worry (n = 6), COST-FACIT and ENRICh scores indicated medium to high levels of financial toxicity. For the rest (n = 14), qualitative accounts of financial strain and financial worry were not completely captured by COST-FACIT and/or ENRICh. Our findings suggest a single measure may not adequately identify financial toxicity and differentiate between strain and worry. A stepwise, wholistic approach may better identify and connect patients to appropriate resources. Interventions that address financial toxicity in this group may need to use more than one measure to identify and route patients to targeted intervention.
Cardiovascular disease (CVD) remains a leading cause of poor outcomes among breast cancer survivors. Treatment contributes to both acute and long-term CVD risk, but social determinants of health (SDoH), like economic deprivation, also compound vulnerability. This study examined the associations between poverty-to-income ratio (PIR) and self-reported CVD in a national sample of breast cancer survivors. Using National Health Interview Survey (NHIS) data from 2019 to 2022, we examined sociodemographic characteristics, health behaviors, and comorbidities in a sample of 2745 female breast cancer survivors. We tested IPTW-adjusted logistic models for associations between PIR and CVD prevalence and interactions by race, age, years of survivorship, and delayed medical care. Higher income did not protect survivors equally. The protection of higher PIR was significantly modified by race/ethnicity (p < 0.0001). Higher PIR reduced the odds of CVD 92
Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and often persistent adverse effect that contributes to substantial symptom burden and psychological distress among cancer survivors. However, the self-regulatory mechanisms linking patients’ illness perceptions to these outcomes remain poorly understood. Guided by the Common-Sense Model of self-regulation, this study examined whether positive coping mediates the associations between illness perceptions and CIPN-related symptom burden and psychological distress, and whether mindfulness moderates these pathways. A two-center cross-sectional survey enrolled 563 adults receiving platinum-based chemotherapy who reported CIPN symptoms. Validated questionnaires assessed CIPN symptom severity, psychological distress, illness perceptions, positive coping, mindfulness, and physical activity. Structural equation modeling with bootstrapping tested mediation and moderated mediation, adjusting for covariates. More threatening illness perceptions were significantly associated with greater CIPN symptom burden and higher psychological distress. Positive coping partially mediated these associations, accounting for 51
Increasing rates of cancer survivorship suggest more individuals will face the challenges associated with living in a changed body post-treatment. Therapeutic tattooing is an intervention to address these challenges. However, no previous systematic review has synthesised the existing evidence on the psycho-social outcomes and experiences of cancer survivors who have received therapeutic tattoos. This review addresses this important gap within the literature. Seven databases were searched in this systematic review: PsycINFO, Medline, CINAHL, Embase, PubMed, Scopus, and Web of Science to identify qualitative, quantitative and mixed-methods studies that examined the psycho-social outcomes and experiences of therapeutic tattoos for cancer survivors. A convergent integrated thematic synthesis was conducted to synthesise qualitative and quantitative data. Sixteen studies were included (6 qualitative, 10 quantitative), representing data from over 747 tattooed cancer survivors across diverse cancer types. Six themes related to the psycho-social outcomes and experiences of therapeutically tattooed cancer survivors were identified: (1) fulfilment, (2) wellbeing, (3) feelings about one’s body, (4) perceived design quality, (5) processing feelings about cancer, and (6) reconceptualised identities. The findings of this review highlight that therapeutic tattoos can impact cancer survivors in several ways, positively and negatively. However, there is a limit to both the breadth and depth of the current understanding of these tattoos as a whole despite growing popularity. Advancing our understanding of therapeutic tattooing will empower cancer survivors to make more informed decisions about the practice and their bodies following treatment. Our review has identified several positive and negative psychosocial outcomes/experiences which may come from receiving a therapeutic tattoo. However, further research is needed to guide policy and training in this practice to better support and protect interested cancer survivors.
Neuro-oncology care lacks an exercise referral pathway and tailored exercise programming. The Alberta Cancer Exercise-Neuro-Oncology (i.e., ACE-Neuro) study was implemented and evaluated for feasibility and effectiveness to address this lack of resources. The purpose of the present study was to understand healthcare provider, exercise specialist, and cancer care administrator perspectives on the role of exercise in neuro-oncology. A qualitative study design using interpretive description was conducted. Clinical team members involved in the referral to and delivery of ACE-Neuro were invited for a semi-structured interview. Interviews were scheduled either in-person or remotely. Analysis was conducted by a transdisciplinary team including collaboration with a neuro-oncology clinical partner. A total of n = 10 clinical team members participated. Mean interview length was 35:44 ± 17.49 min. Three themes were created during analyses: (1) The Gateway: Optimizing Exercise Referral in Neuro-Oncology, (2) The Building Blocks: Championing a Tailored Neuro-Oncology Exercise Model, and (3) Beyond the Short-Term: Neuro-Oncology Needs a Stronger Voice in Funding and Policy. These themes highlight that the clinical team perceived an electronic medical record referral pathway as feasible, tailored exercise is non-negotiable for neuro-oncology patients, and funding and policy were identified as major barriers to sustainable exercise programming. This study offers new insights into how exercise is implemented within neuro-oncology care from the clinical perspective. A systematic focus on optimizing referral pathways, championing the delivery of personalized programming, and bridging policy and system-level strategies for long-term program sustainability are key to advancing the field of neuro-oncology. From the perspective of clinicians, integrating exercise into routine neuro-oncology care requires methodical referral pathways and tailored exercise program delivery. Clinicians also believe that long-term sustainability will require administrative and policy support to ensure access to supportive care resources for those living with brain cancer. These implementation strategies have the potential to improve patient access to evidence-based and individualized neuro-oncology exercise resources. NCT04831190 ( https://clinicaltrials.gov/study/NCT04831190 ).
To map the current literature regarding the unmet supportive care needs, structural barriers, and healthcare transition challenges faced by immigrant adolescent and young adult (AYA) cancer survivors. Following JBI methodology and PRISMA-ScR guidelines, a systematic search was conducted across major databases (including PubMed and Embase) to identify peer-reviewed studies focusing on foreign-born or immigrant AYA cancer survivors (aged 15–39) and their long-term survivorship experiences. Six studies met the inclusion criteria. Immigrant AYAs face a compounding matrix of linguistic, financial, and legal barriers that limit healthcare access. The transition from pediatric to adult oncology highlights a profound disconnect between individualistic Western healthcare models and collectivist, family-centered decision-making norms. Furthermore, post-migration acculturation processes sometimes erode baseline healthy behaviors, worsening financial toxicity and long-term psychosocial outcomes. Current survivorship frameworks fail to adequately account for the migratory process, often conflating immigration status with broad racial categories. Systemic changes are required in oncology research to capture granular data on nativity and length of residency to expose and address these hidden disparities. Culturally responsive survivorship programs, dedicated language services, and family-inclusive patient navigation models are essential to prevent care attrition, reduce post-treatment social stigma, and ultimately optimize the long-term quality of life for immigrant AYA survivors.
Chemotherapy-induced neuropathy (CIN) is a persistent condition that impairs function and quality of life. Auricular point acupressure (APA) has shown short-term benefit for CIN, but the durability of these effects after treatment completion is unknown. This study evaluated the sustainability of symptom improvements for 3 months following a 4-week APA intervention. This prespecified secondary analysis of a randomized wait-list controlled trial compared mobile-supported APA (mAPA) and virtual APA (vAPA) in adults with moderate or greater CIN who received APA during the initial treatment phase (mAPA, n = 80; vAPA, n = 75). Outcomes at 1, 2, and 3 months post-intervention were analyzed using generalized estimating equations with multiple imputation. The primary outcome was CIN severity, measured with an individualized composite outcome (ICO); the secondary outcome was CIN interference. Reductions in CIN severity and interference were maintained throughout follow-up in both groups (all p < .001). ICO scores decreased by 3.10, 3.36, and 3.61 points in mAPA and by 2.88, 2.90, and 3.21 points in vAPA at 1, 2, and 3 months, respectively. Benefits were maintained post-treatment, with higher retention in the mAPA group. Improvements in CIN severity and interference after APA were sustained for up to 3 months post-treatment, suggesting a durable benefit as a self-management strategy. Larger studies with longer follow-up and untreated comparison groups are needed. APA may offer survivors a durable, self-administered, nonpharmacologic option for managing CIN well beyond active treatment, without requiring ongoing clinical visits. ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.
Sexual health concerns are highly prevalent among breast cancer survivors. Sexual dysfunction can occur from various causes, including the cancer itself, treatment side effects, and psychological distress. Therefore, this study aimed to identify distinct patterns of sexual dysfunction among women in remission from breast cancer 5 years after diagnosis using latent class analysis (LCA) and to examine factors associated with higher sexual dysfunction classes. We conducted a cross-sectional secondary analysis of data from 356 women participating in the French nationwide VICAN5 survey 5 years after breast cancer diagnosis. Sexual dysfunction was assessed using five selected items from the Relationship and Sexuality Scale (RSS), and LCA was applied to these indicators to identify distinct dysfunction patterns. Ordinal logistic regression was used to examine factors associated with higher sexual dysfunction classes. A three-class model best fit the data, identifying no/low (n = 124, 34.8
Prehabilitation, delivered between cancer diagnosis and surgery, may enhance functional reserve and improve tolerance to surgical stress, but evidence remains conflicting across cancer types and outcomes. We aimed to evaluate the effects of prehabilitative exercise on physiological, functional, and patient-reported outcomes in patients undergoing oncologic surgery. A systematic review and meta-analysis was conducted (PROSPERO: CRD420251072796). Randomized controlled trials comparing structured exercise interventions with usual care in adults undergoing oncologic surgery were included. Searches were performed across seven databases until June 2025. Outcomes included cardiorespiratory fitness, muscle strength, physical function, fatigue, psychological distress, and quality of life. A three-level mixed-effects meta-analysis evaluated intervention effects and moderators. Twenty-seven studies (n = 2005) were included. Prehabilitation significantly improved cardiorespiratory fitness (SMD 0.31, p = 0.010), physical function (SMD 0.36, p < 0.001), and quality of life (SMD 0.19, p = 0.030), with sustained postoperative benefits in physical function. Fatigue was reduced preoperatively (SMD –0.21, p = 0.017), while muscle strength and psychological distress were preserved relative to baseline. Certainty of evidence ranged from very low to moderate. Prehabilitative exercise improves preoperative fitness, function, fatigue, and quality of life, and attenuates perioperative decline in patients undergoing cancer surgery. These findings support integrating structured exercise into perioperative oncology pathways to optimise recovery and long-term outcomes. Prehabilitative exercise may mitigate perioperative deconditioning and facilitates a return to baseline function. By potentially preserving functional reserve against surgical stress, these interventions could contribute to improved long-term survivorship trajectories and should be considered within structured, individualised perioperative care pathways.
To summarize current evidence on fertility issues in breast cancer survivors, including gonadotoxic potential of cancer-directed therapies, available fertility preservation options, counseling practices, post-treatment pregnancy outcomes, and future research needs. This review aims to guide clinical practice and to highlight current gaps in oncofertility care. A critical review of recent literature was conducted, consolidating data from clinical trials, cohort studies, guidelines, and expert consensus. Key themes in oncofertility care for breast cancer survivors were mapped through the breadth of literature, including therapy-associated gonadotoxicity, fertility preservation strategies, multidisciplinary care models, and post-treatment reproductive outcomes. Breast cancer-directed therapies (chemotherapy, long-term endocrine therapy, targeted therapies) can adversely impact fertility via delaying reproductive timelines and direct gonadotoxicity. Oocyte and embryo cryopreservation are first-line methods for fertility preservation; other options include ovarian tissue cryopreservation and ovarian suppression with gonadotropin-releasing hormone (GnRH) agonist administration. Pregnancy after stage 0–3 breast cancer is considered safe, with no evidence of increased recurrence or mortality risk even among those with hormonally sensitive cancers. Fertility counseling and ovarian toxicity assessment remain inconsistently implemented in clinical trials. In addition, barriers to fertility care disproportionately affect historically excluded populations. Oncofertility is a crucial element of survivorship care for reproductive-aged patients with breast cancer. Cancer-directed therapies can significantly impair the likelihood of future fertility. Early, structured fertility counseling, multidisciplinary care team collaboration including reproductive endocrinology, and incorporation of timely fertility preservation interventions are vital to maintain fertility potential without harming oncologic outcomes. Major gaps remain in counseling practices and equitable access to fertility preservation. Enhanced access to fertility preservation, individualized reproductive planning, and multidisciplinary care teams can improve quality of life and support informed decision-making regarding future childbearing in breast cancer survivors.
The financial challenges of the author as a young adult were discussed. These costs were further made worse because of a second cancer diagnosis and treatment only a few years later. The health matters and their economic burden occurred while in college, which also presented a significant cost. This “survivor perspective” also goes on to describe a valuable resource for financial toxicity developed by the author as a way to truly pay it forward: The SAMFund (now part of Expect Miracles Foundation). The author describes the financial strain of other young adult cancer survivors who actually received funding from her organization. Samantha then discusses a “second wave” of costs that go beyond the acute costs of treatment. These are the persistent costs related to cancer survivorship. This 25-year cancer survivor provides a personal perspective on the long-term financial impact of cancer in those with a history of cancer as an adolescent or young adult.
One of the most significant events following a diagnosis of cancer is the diagnosis of subsequent malignant neoplasm (SMN). Estimates of the number and risk of more than one malignancy in this population are needed. Utilizing data from 1975 to 2021 from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, estimates of the number, proportion, and standardized incidence ratios (SIRs) of survivors with SMN by age at diagnosis, time since diagnosis, and primary site were calculated. As of January 1, 2022, the estimated number of cancer survivors in the US with one malignancy was 14,940,581, while 2,191,482 survivors had two malignancies. A smaller number of survivors (379,897) had three malignancies; 110,859 people had four or more malignancies. Compared to people who never had cancer, cancer survivors had an increased risk of SMN (SIR, 1.19; 95
Depression disproportionately affects older cancer survivors with fewer socioeconomic resources, yet the mechanisms underlying this disparity remain under-explored. Guided by Fundamental Cause Theory, this study examined whether financial hardship mediates the relationship between socioeconomic status (SES) indicators, education, income, and wealth, and depressive symptoms among older cancer survivors in the United States. Data were drawn from the Health and Retirement Study (2012–2018). The analytic sample comprised 1,520 cancer survivors aged 50 and older. A seven-item latent financial hardship variable was developed. Structural equation modeling with weighted least squares estimation was employed under a complex survey design to test direct and indirect effects of SES indicators on subsequent depressive symptoms through financial hardship, controlling for demographic, health, and cancer-related characteristics. The measurement model demonstrated excellent fit (CFI = .997; TLI = .995; RMSEA = .031). In the structural model, income and wealth were fully mediated by financial hardship in their associations with depression, while education exhibited partial mediation with both direct and indirect pathways. Younger age at cancer diagnosis and more recent diagnoses were significantly associated with greater financial hardship. Financial hardship was a significant predictor of subsequent de-pressive symptoms (β = 0.213, p < .001), and the model explained 36.2
This systematic review synthesises data relating to the effectiveness of behavioural interventions aimed at reducing alcohol consumption among people living with cancer. Five databases were systematically searched for randomised controlled trials (RCTs) published between January 2000 and April 2025 that reported behavioural interventions addressing alcohol consumption among people living with cancer. Evidence was assessed using the Cochrane Risk-of-Bias tool. Meta-analysis was not feasible due to substantial heterogeneity and few eligible studies. Instead, a TIDieR-guided narrative synthesis with vote-counting was performed. We conducted this systematic review according to the PRISMA 2020 statement. Eight RCTs (n = 1437) were included. Two trials targeted alcohol reduction, whereas the remaining six addressed alcohol use within broader multiple health-behaviour interventions. Alcohol intake was assessed via self-report using heterogeneous measures. At 2–3 months, all five reporting studies favoured the intervention (100
Young adult survivors of childhood cancer frequently experience transition failure when transferred to adult-focused survivorship care, yet associated factors within specific care models remain poorly studied. This retrospective cohort study included higher-risk young adult survivors transitioned from Children’s Hospital Los Angeles to an affiliated adult-focused survivorship clinic from 2010 to 2018 using a protocolized pathway. Transition failure was defined as no documented adult-clinic visit within 2 years of transition launch. Late effects were defined per the Common Terminology Criteria for Adverse Events (CTCAE, v5.0). The sample (N = 289) had mean age 22.9 years (range 17–53), was 54.0
Cancer survivors are at increased risk of developing subsequent primary cancers, yet participation in recommended cancer screening remains suboptimal. Greater understanding of factors impacting screening participation is needed to inform strategies for improving uptake. Therefore, we aimed to review and quantitatively synthesize predictors of participation in breast cancer (BC) and colorectal cancer (CRC) screening among cancer survivors. MEDLINE (Ovid), EMBASE, PubMed, and CINAHL databases were searched from inception through September 2024 to identify studies examining predictors of CRC or BC screening among survivors of other adult cancers. Random effect models were used to estimate pooled associations for predictors reported in ≥ 3 studies. From 2492 initial citations, 49 studies were included, with 35 studies reporting on CRC and 29 on BC screening participation. Factors significantly associated with CRC screening included having a healthcare provider, having health insurance, receiving a provider recommendation for screening, a greater number of physician visits, older age, being a nonsmoker, being married, higher income or education, urban residence, and better mental health. Factors associated with BC screening included receiving a written follow-up care plan, a greater number of physician visits, being married, not having dual Medicaid-Medicare coverage status, receiving specialist care, and White racial identity. Healthcare access and survivorship care factors appear to play an important role in screening participation among cancer survivors. Interventions addressing barriers to care and social determinants of health may help improve screening uptake and reduce disparities in subsequent cancer screening in this high-risk population.
The current study examines longitudinal changes in sleep disturbances and the risks they pose for new-onset health conditions in survivors of childhood cancer. Five-year survivors (N = 1081; median [range] age 50.0 [45.2–55.0] years) and siblings (N = 214; age 49.2 [39.9–51.1] years) from the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI) at two time points (median interval = 17 years). Sex-specific changes of PSQI scores were assessed, adjusting for demographics, using generalized estimating equation. Within survivors, logistic regressions estimated associations between persistent clinically significant sleep disturbances with diagnosis and treatment exposures, and new-onset chronic health conditions. Female siblings reported increases in sleep disturbances (T1 35
