OBJECTIVES:To report long-term oncological outcomes for men with clinically localised prostate cancer (PCa) treated with contemporary modalities in a population-based United States cohort. PATIENTS AND METHODS:The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study prospectively enrolled men with clinically localised PCa from 2011 to 2012. Patients were stratified into two groups: favourable prognosis (clinical T stage [cT]1-T2a/bN0M0, prostate-specific antigen [PSA] level ≤ 20 ng/mL, Grade Group 1-2) and unfavourable prognosis (cT2cN0M0, PSA level 20-50 ng/mL, or Grade Group 3-5). Main outcomes were PCa-specific mortality (PCSM), composite progression to advanced disease (metastasis, PCSM event, or systemic therapy), and overall survival (OS). Cox regression models adjusted for demographic and clinical covariates. RESULTS:Of the 2604 men included, 73% were White, 15% Black, and 7% Hispanic. All hazard ratios (HRs) were adjusted for demographic and clinical covariates using multivariable Cox and Fine-Gray models. In the favourable group, compared with surgery, external beam radiotherapy (EBRT; HR 1.5, 95% confidence interval [CI] 1.1-2.1, P < 0.01), brachytherapy (HR 2.1, 95% CI 1.3-3.3, P < 0.01), and active surveillance (HR 1.5, 95% CI 1.1-2.1, P = 0.02) were associated with higher all-cause mortality; the 10-year cumulative incidence of PCSM was ≤1.5% for all five strategies, and progression did not differ. In the unfavourable group, EBRT was associated with worse OS (HR 2.8, 95% CI 1.9-4.3, P < 0.01), with no adjusted differences in PCSM (10-year cumulative incidence 3.5% after surgery vs 8.8% after EBRT) or progression across treatments. CONCLUSION:In this population-based cohort treated with contemporary modalities, the 10-year risk of PCa death was low across all treatment strategies, including active surveillance. OS differences favouring surgery likely reflect residual confounding from baseline health and treatment selection. These findings underscore the importance of patient values and comorbidities in shared decision-making for localised PCa.

Background: People diagnosed with cancer are more susceptible to COVID-19-related mortality. Other than race, age, and sex, less is known about other factors associated with a higher risk of death after COVID-19 diagnosis among cancer survivors. Objective: The goal was to examine factors associated with survival time in cancer survivors following a COVID-19 diagnosis, focusing on sociodemographic and clinical factors in a population-based cohort of New Jersey residents. Methods : Cancer cases identified using the New Jersey State Cancer Registry (NJSCR) were linked with COVID-19 cases from Communicable Disease Reporting and Surveillance System (CDRSS) diagnosed in 2020-21, creating an analytic dataset 63,330 people. Area Deprivation Index incorporated environmental and structural factors related to neighborhood disadvantage. Competing risk regression analyses were used to identify factors associated with survival. Results: People diagnosed with cancer were more likely to die from COVID-19 than die from cancer within the first five months following their COVID-19 diagnosis. Cumulative incidence rate of cancer-specific deaths surpassed that of COVID-19-specific deaths ( P <0.001), after three years. After adjusting for other covariates, females had a lower risk of dying from COVID-19 than males (HR=0.63, 95% CI= 0.58-0.65, P<0.001). Relative to whites, Blacks were 47% more likely (HR=1.47, 95% CI= 1.35-1.60, P<0.001) to die from COVID-19. Older age, API race, Hispanic ethnicity, those living in more socioeconomically disadvantaged areas of New Jersey, diagnosed with hematological cancers, or diagnosed later stage also had a significantly higher risk of dying from COVID-19 ( P <0.001). Conclusions . This study of cancer survivors illustrates that males, Black, API, or Hispanic individuals, as well as those living in more socioeconomically disadvantaged areas of New Jersey, diagnosed with a hematologic cancer or at late-stage tumor had increased risks of COVID-19-related death. Targeting more aggressive interventions to this vulnerable cancer population (e.g., access to vaccines or early treatments) may reduce morbidity and mortality.

Background:Hereditary breast and ovarian cancer syndrome (HBOCS) is an inherited condition that increases the risk of developing several types of cancer; however, the true burden of HBOCS-related cancers remains unclear at the population level. Methods:We used 2015-2019 breast and ovarian cancer data (N=55,437) from the New Jersey State Cancer Registry to estimate the age-adjusted incidence of HBOCS-related breast and ovarian cancers in New Jersey, overall and by county. Cancers meeting 5 HBOCS diagnostic characteristics selected from the 2021 National Comprehensive Cancer Network risk assessment guidelines were flagged as possibly being HBOCS-related and referred to as "possible-HBOCS (pHBOCS)." We evaluated the racial/ethnic and stage patterns of HBOCS cancers and compared them to all cancers to further characterize the HBOCS burden. Age-adjusted incidence rates (AAIR) per 100,000 population, rate ratios (RR), and 95% confidence intervals (CI) were computed using the Surveillance, Epidemiology, and End Results Program (SEER) *Stat Database. Results:We identified 12,679 pHBOCS cancers among NJ residents from 2015-2019. The female AAIR of pHBOCS breast and ovarian cancers was 50.6 per 100,000 population. The rates of pHBOCS varied by county, and pHBOCS county rates varied by race. Among Hispanic women, the incidence was significantly higher in Hunterdon County (AAIR 115, 95% CI:68.4-181.1) than statewide (AAIR 40.6, 95% CI:38.7-42.6). The pHBOCS incidence was significantly lower for Asian/Pacific Islander (RR=0.85, 95% CI:0.80-0.91), Hispanic (RR=0.74, 95% CI:0.70-0.79), and non-Hispanic Black women (RR=0.90 95% CI:0.85-0.95) than non-Hispanic White women. Compared to local-stage ovarian cancers, the incidence of distant-stage was significantly higher in the overall cancer population (RR=2.59, 95% CI:2.37-2.83) and the pHBOCS cancers (RR=3.22, 95% CI:2.93-3.55). The rate of regional-stage ovarian cancers was only significantly higher than local for the pHBOCS group (RR=1.21, 95% CI:1.08-1.36). Conclusions:This study can be used as a starting point for building a framework that better estimates the population burden of HBOCS cancers. Quantifying the HBOCS impact improves our understanding of the true burden. Due to data availability limitations, true estimates could not be calculated. Policies supporting population-level, genetic/family history data collection are needed to accurately quantify HBOCS incidence.

BACKGROUND:Cancer survivors are more susceptible to contracting COVID-19. However, beyond race, age, and sex, less is known about other neighborhood and psychosocial factors contribute to this increased risk. OBJECTIVE:The goal of this study was to examine the associations of individual and area-level social determinants of health (SDOH) measures, medical, lifestyle, and psychosocial factors and COVID-19 infection in a statewide cohort of cancer survivors in New Jersey. METHODS:Survey data from 864 cancer survivors in New Jersey were collected from 2018 to 2022, which were merged with study participant data from the state of New Jersey on COVID-19 diagnoses in 2020, 2021, and 2022. We estimated adjusted odds ratios (aOR) for associations of COVID-19 diagnosis with individual-level factors (cancer type and stage, health behaviors, and psychosocial factors) and area-level SDOH [Social Vulnerability Index, Area Deprivation Index, and Index of Concentration at the Extremes (ICE) to quantify racialized deprivation vs. privilege based on income]. RESULTS:Cancer survivors born outside the US were more than twice as likely to contract COVID-19 compared to US-born survivors (aOR 2.29, 95% CI 1.01, 4.92). Compared to Quartile 4, residence in an area in Quartile 1 of racialized income ICE (i.e., predominantly Black, low income) was associated with higher odds of COVID-19 (aOR 2.15, 95% CI 0.98, 4.87). Retired survivors had lower odds of COVID-19 (aOR 0.39, 95% CI 0.19, 0.80) compared to those who were employed. Higher social well-being was associated with higher COVID-19 (aOR 1.07, 95% CI 1.02, 1.13). Type of cancer and cancer treatments received were not associated with the risk of COVID-19. CONCLUSIONS:Immigrant status and increased racialized deprivation as measured by ICE for income were associated with COVID-19. These findings support evidence that individual and area-level SDOH measures contribute to increased risk of COVID-19 among cancer survivors.

OBJECTIVE:Although childhood cancer survivors require lifelong "risk-based" follow-up care, most adult survivors do not receive such care, and many are lost during the transition from pediatric to adult follow-up care. The goal of this study was to evaluate the feasibility and acceptability of the "Managing Your Health" self-management and peer mentoring intervention to improve transition readiness and self-management skills among young adult survivors of childhood cancer. METHODS:Survivors of childhood cancer ages 18-25 years were randomized 1:1 to the Managing Your Health intervention (six video/phone calls with a peer mentor, another young adult survivor, and five online educational modules) or usual care. Feasibility was measured through enrollment rates, retention rates, and engagement and satisfaction with the intervention. Participants completed measures of transition readiness, self-efficacy, and perceived support at baseline and 2-, 6-, and 12-months post-enrollment. RESULTS:A total of 50 participants (Mage = 21.1 years; 60% male) enrolled (32% of the total pool was contacted; 76% of those were screened; 94% of those screening eligible enrolled). Twenty-two (88%) of the 25 intervention participants completed the peer mentor calls. On average, participants completed 96% of the online modules, often closely timed to peer mentor calls. Participants indicated high satisfaction and acceptability of the intervention and suggested some improvements to the online modules. CONCLUSIONS:Managing Your Health was feasible and acceptable to young adult survivors and mentors. Peer mentors appeared to serve as supportive accountability agents encouraging engagement with the online modules. Additional refinements will be made to the intervention prior to efficacy testing.

The Cancer Analytics and South Asian Health - Breast Cancer (CANSAH-BC) pilot study was launched in New Jersey (NJ) in 2022 to evaluate the drivers of aggressive breast cancer, familial aggregation, and quality of life among South Asian American (SAA) females, who are an understudied population. To compare the CANSAH-BC cohort with SAA patterns in the National Health Interview Survey (NHIS), the California Health Interview Survey (CHIS), & breast cancer survivors identified in the Surveillance, Epidemiology, and End Results (SEER) NJ program, and assess familial aggregation. Eligible CANSAH-BC participants were SAA females aged 21+, diagnosed with primary invasive breast cancer in NJ (2017-2023), who provided consent. Sociodemographic, lifestyle factors, family, and medical history were collected via interviews, with tumor data from the NJ State Cancer Registry. We compared CANSAH-BC participants with SAA females from NHIS, CHIS, and SAA breast cancer survivors in SEER using descriptive statistics. Familial incidence rate was calculated by dividing breast cancers in relatives by total person-years. Using the Institute of Health Metrics and Evaluation (IHME) population rates for South Asia, we calculated the standardized incidence ratio (SIR) and its 95% confidence interval (CI). Assuming a lognormal distribution for breast cancer risk and leveraging the known relationship between SIR and coefficient of variation of the risk distribution, we estimated the proportion of breast cancers in SAA women at highest and lowest 25% risk. Among 101 CANSAH-BC participants, most were first-generation immigrants (94%), married (86%), insured (99%), and non-smokers (99%). Compared to NHIS and CHIS, more participants held a college degree (71%, 82%, 87%, respectively), were employed (62%, 68%, 73%, respectively), and had hypertension (17%, 11%, 33%, respectively) or diabetes (9%, 8%, 22%, respectively). Stage (60% localized) and triple-negative subtype (10%) distributions were similar to SEER NJ SAA survivors (62% localized, 9% triple-negative) but CANSAH-BC participants were younger (Mean (SD) = 52 (12) years vs. 56 (13) years in SEER NJ; p = 0.0017). The SIR was 3.86 (95% CI: 3.11 - 4.74), indicating significant familial aggregation. Under a lognormal distribution of risk, 68.7% of breast cancers will occur in SAA women at the top 25% risk group, while only 3.3% in the lowest 25%. CANSAH-BC participants closely mirror NHIS and CHIS respondents, but are significantly younger than SEER NJ survivors. The significant familial aggregation and likely concentration of breast cancers in the top 25% risk group underscore the predictive influence of shared genetic and environmental factors among relatives of SAA women with breast cancer. Our future direction will investigate these shared factors using germline and genomic markers. Tina Dharamdasani, 1Anusha Addanki, 1Anushyaa Vasudevan, 1Prachi Trivedi, 2Caroline Morales, 3Lisa Paddock, 3Nur Zeinomar, 2Bo Qin, 2Shridar Ganesan, 2Anita Y. Kinney, 2Elisa V. Bandera, 2Jaya M. Satagopan1. Unveiling cohort profile and familial aggregation in South Asian American women with breast cancer: Insights from the CANSAH-BC study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 970.

Purpose Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. Methods We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. Results At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. Conclusion TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients’ access to CGRA. Trial Registration This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.

Purpose There is limited evidence of tobacco smoking's effect on cancer survivors' quality of life (QOL) and function. As the natural history of localized prostate cancer (PCa) is protracted, there is a need to identify modifiable risk factors that can influence PCa survivorship, such as tobacco smoking. Material and methods We used up to 10-year survey data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a prospective, population-based, observational study of patients diagnosed with localized PCa in 2011-2012. Survivors were categorized as never, former, and current smokers during survivorship. Adjusted multivariable linear regression models were used to assess the association between smoking and 5-year and 10-year scores on the 26-Item Expanded Prostate Index Composite (EPIC-26; PCa-specific domains) and 5-year scores on the Medical Outcomes Study 36-Item Short Form Survey (SF-36; general health domains). Results We included 2426 patients of whom 142 (6%) were current smokers, 1039 (43%) were former smokers, and 1245 (51%) were never smokers. Current smokers were more likely to be Black, low-income, and less formally educated (all p < 0.01). After adjustments, there was no association between smoking history with disease-specific functional outcomes (EPIC-26) at 5 years or 10 years (all p > 0.05). However, in adjusted analyses assessing general health domains (SF-36), compared to participants who never smoked, current smokers during survivorship had worse physical function (- 10.96, 95% CI - 16.37 to - 5.55, p < 0.01) at 5 years. Conclusion PCa survivors who continue to smoke experience worse physical functioning though there is no significant independent effect on PCa-specific functional domains. Implications for Cancer SurvivorsProstate cancer survivors who continue to smoke experience worse physical functioning though there is no significant independent effect on PCa-specific functional domains. Smoking cessation may improve prostate cancer survivorship.

To examine how household income and county income inequality are linked to financial hardship among cancer survivors. Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the average marginal effect (AME) was calculated. Compared to survivors residing in households with income of 90,000 or more (higher income), those with household incomes between50,000 and 89,999 (middle income) had a significantly higher risk of ever being unable to cover their share of the cost of cancer-related medical care (AME = .104, p = .001), higher risk of foregoing care in the past 12 months because of cost, including dental care (AME = .124, p < .001), eye care (AME = .082, p = .005), and mental health care or counseling (AME = .067, p = .002). An increase in the Gini index from the 25th to 75th percentile was associated with an increased risk of unmet needs in paying for follow-up care or medications related to cancer (AME = .021, p = .014) and an increased risk of foregoing doctor visits (AME = .017, p = .02) and eye care (AME = .03, p = .002) because of cost in the past 12 months. Local area income inequality was associated with certain aspects of cancer survivors’ experience of financial hardship. It is important to consider refining and extending financial navigation programs to survivors residing in areas with high income inequality.

PURPOSE Our purpose was to describe the prevalence and predictors of symptom and function clusters related to physical, emotional, and social components of general health-related quality of life (HRQOL) in a population-based sample of prostate cancer (PCa) survivors. METHODS Participants (N = 1,162) completed a baseline survey at a median of 9 months after diagnosis to ascertain the co-occurrence of eight symptom and functional domains that are common across all cancers and not treatment-specific. We used latent profile analysis (LPA) to identify subgroup profiles of survivors with low, moderate, or high HRQOL levels. Multinomial logistic regression models were used to identify clinical and sociodemographic factors associated with survivors' membership in the low versus moderate or high HRQOL profile. RESULTS The LPA identified 16% of survivors who were categorized in the low HRQOL profile at baseline, indicative of the highest symptom burden and lowest functioning. Factors related to survivors' membership in the low versus higher HRQOL profile groups included less than age 65 years at diagnosis, identifying as non-Hispanic Black race, not working, being a former versus never smoker, systemic therapy, less companionship, more comorbidities, lower health care financial well-being, or less spirituality. Several factors remained associated with remaining in the low versus higher HRQOL profiles on the follow-up survey (n = 699), including younger age, Black race, comorbidity, and lower financial and spiritual well-being. CONCLUSION About one of six PCa survivors experienced elevated physical and psychosocial symptoms that were independent of local curative therapy, but with younger age, race, comorbidity, and lower financial and spiritual well-being as stable risk factors for poor HRQOL over time.

Importance Adverse outcomes associated with treatments for localized prostate cancer remain unclear. Objective To compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Design, Setting, and Participants An observational cohort study using data from 5 US Surveillance, Epidemiology, and End Results Program registries. Participants were treated for localized prostate cancer between 2011 and 2012. At baseline, 1877 had favorable-prognosis prostate cancer (defined as cT1-cT2bN0M0, prostate-specific antigen level <20 ng/mL, and grade group 1-2) and 568 had unfavorable-prognosis prostate cancer (defined as cT2cN0M0, prostate-specific antigen level of 20-50 ng/mL, or grade group 3-5). Follow-up data were collected by questionnaire through February 1, 2022. Exposures Radical prostatectomy (n = 1043), external beam radiotherapy (n = 359), brachytherapy (n = 96), or active surveillance (n = 379) for favorable-prognosis disease and radical prostatectomy (n = 362) or external beam radiotherapy with androgen deprivation therapy (n = 206) for unfavorable-prognosis disease. Main Outcomes and Measures Outcomes were patient-reported sexual, urinary, bowel, and hormone function measured using the 26-item Expanded Prostate Cancer Index Composite (range, 0-100; 100 = best). Associations of specific therapies with each outcome were estimated and compared at 10 years after treatment, adjusting for corresponding baseline scores, and patient and tumor characteristics. Minimum clinically important differences were 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritation, and 4 to 6 for bowel and hormone function. Results A total of 2445 patients with localized prostate cancer (median age, 64 years; 14% Black, 8% Hispanic) were included and followed up for a median of 9.5 years. Among 1877 patients with favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -12.1 [95% CI, -16.2 to -8.0]), but not worse sexual function (adjusted mean difference, -7.2 [95% CI, -12.3 to -2.0]), compared with active surveillance. Among 568 patients with unfavorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -26.6 [95% CI, -35.0 to -18.2]), but not worse sexual function (adjusted mean difference, -1.4 [95% CI, -11.1 to 8.3), compared with external beam radiotherapy with androgen deprivation therapy. Among patients with unfavorable prognosis, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel (adjusted mean difference, -4.9 [95% CI, -9.2 to -0.7]) and hormone (adjusted mean difference, -4.9 [95% CI, -9.5 to -0.3]) function compared with radical prostatectomy. Conclusions and Relevance Among patients treated for localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function at 10-year follow-up compared with radiotherapy or surveillance among people with more favorable prognosis and compared with radiotherapy for those with unfavorable prognosis. Among men with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year follow-up compared with radical prostatectomy.

Background Although there is extensive literature on correlates of health-related quality of life (HRQoL) among cancer survivors, there has been less attention paid to the role of socioeconomic disadvantage and survivorship care transition experiences in HRQoL. There are few large cohort studies that include a comprehensive set of correlates to obtain a full picture of what is associated with survivors’ HRQ0L. This cohort study of recent cancer survivors in New Jersey aimed to explore the association between social determinants of health, health history, health behaviors, survivorship care experiences, and psychosocial factors in HRQoL. Methods Eligible survivors were residents of New Jersey diagnosed with genitourinary, female breast, gynecologic, colorectal, lung, melanoma, or thyroid cancers. Participants completed measures of social determinants, health behaviors, survivorship care experiences, psychosocial factors, and HRQoL. Separate multiple regression models predicting HRQoL were conducted for each of the five domains (social determinants, health history, health behaviors, survivorship care experiences, psychosocial factors). Variables attaining statistical significance were included in a hierarchical multiple regression arranged by the five domains. Results 864 cancer survivors completed the survey. Lower global HRQoL was associated with being unemployed, more comorbidities, a less healthy diet, lower preparedness for survivorship, more unmet support needs, and higher fear about cancer recurrence. Two psychosocial factors, unmet support needs and fear of recurrence, played the most important role in HRQoL, accounting for more than 20% of the variance. Both unmet support needs and fear of recurrence were significant correlates of physical, functional, and emotional HRQoL domains. Conclusions Interventions seeking to improve cancer survivors’ HRQoL may benefit from improving coordinated management of comorbid medical problems, fostering a healthier diet, addressing unmet support needs, and reducing survivors’ fears about cancer recurrence.

<p>Description of the studies included in the pooled analysis and methods of data collection</p>

PDF - 149K, Supplemental Table 1. Participating invasive epithelial ovarian cancer studies. Supplementary Table 2. NF-κB genes studied. Supplemental Table 3. Association between clinical variables and overall survival.

Monitoring cancer incidence data by geography is useful for planning public health activities. However, due to anticipated confidentiality and statistical reliability issues, data on cancer incidence and mortality are more often displayed at a national, state, or county level, rather than at more local levels. To address this gap in displaying cancer data at the local level, the CDC's National Environmental Public Health Tracking Program and 21 National Program of Cancer Registries worked together on a pilot project to examine the feasibility of displaying sub-county-level incidence of selected cancer types diagnosed during 2007-2016. The results from this project are important steps for building sub-county cancer displays into data visualizations and using the data in a way that provides meaningful insights. The availability of sub-county cancer data may allow researchers to better examine cancer data at a local level which may help guide public health decisions regarding community-based interventions and screening services.

Background Benign prostatic hyperplasia, lower urinary tract symptoms, and prostate cancer often co-occur. Their effect on urinary function is an important consideration regarding prostate cancer treatment choices. While prostate volume (PV) and urinary symptoms are commonly used in treatment choice decision making, their association with post-treatment urinary function is unknown. We evaluated the associations between PV and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. Methods We identified 1647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer, for analysis. Primary outcomes were treatment choice and health-related quality of life (HRQOL) assessed by the 26-item Expanded Prostate Index Composite (EPIC-26) at pre-specified intervals up to 5 years. Multivariable analysis was performed, controlling for demographic and clinicopathologic features. Results Median baseline PV was 36 mL (IQR 27–48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75–100). There was no observed clinically meaningful association between PV and treatment choice or post-treatment urinary function. Among patients with poor baseline urinary function, treatment with radiation or surgery was associated with statistically and clinically significant improvement in urinary function at 6 months which was durable through 5 years (improvement from baseline at 5 years: radiation 20.4 points, surgery 24.5 points). Conclusions PV was not found to be associated with treatment modality or post-treatment urinary irritative/obstructive function among men treated for localized prostate cancer. Men with poor baseline urinary irritative/obstructive function improve after treatment with surgery or radiation therapy.

Background Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care. Objective The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL). Methods This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES’s impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation. Results Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES. Conclusions This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention’s effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention’s uptake in and impact on an oncology care setting or nonprofit organizations. Trial Registration ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449 International Registered Report Identifier (IRRID) DERR1-10.2196/39996

Background:Women with low-grade ovarian serous carcinoma (LGSC) benefit from surgical treatment; however, the role of chemotherapy is controversial. We examined an international database through the Ovarian Cancer Association Consortium to identify factors that affect survival in LGSC. Methods:We performed a retrospective cohort analysis of patients with LGSC who had had primary surgery and had overall survival data available. We performed univariate and multivariate analyses of progression-free survival and overall survival, and generated Kaplan-Meier survival curves. Results:Of the 707 patients with LGSC, 680 (96.2%) had available overall survival data. The patients' median age overall was 54 years. Of the 659 patients with International Federation of Obstetrics and Gynecology stage data, 156 (23.7%) had stage I disease, 64 (9.7%) had stage II, 395 (59.9%) had stage III, and 44 (6.7%) had stage IV. Of the 377 patients with surgical data, 200 (53.0%) had no visible residual disease. Of the 361 patients with chemotherapy data, 330 (91.4%) received first-line platinum-based chemotherapy. The median follow-up duration was 5.0 years. The median progression-free survival and overall survival were 43.2 months and 110.4 months, respectively. Multivariate analysis indicated a statistically significant impact of stage and residual disease on progression-free survival and overall survival. Platinum-based chemotherapy was not associated with a survival advantage. Conclusion:This multicentre analysis indicates that complete surgical cytoreduction to no visible residual disease has the most impact on improved survival in LGSC. This finding could immediately inform and change practice.

BACKGROUND:A theory-guided Tailored Counseling and Navigation (TCN) intervention successfully increased cancer genetic risk assessment (CGRA) uptake among cancer survivors at increased risk of hereditary breast and ovarian cancer (HBOC). Understanding the pathways by which interventions motivate behavior change is important for identifying the intervention's active components.PURPOSE:We examined whether the TCN intervention exerted effects on CGRA uptake through hypothesized theoretical mediators.METHODS:Cancer survivors at elevated risk for HBOC were recruited from three statewide cancer registries and were randomly assigned to three arms: TCN (n = 212), Targeted Print (TP, n = 216), and Usual Care (UC, n = 213). Theoretical mediators from the Extended Parallel Process Model, Health Action Planning Approach, and Ottawa Decision Support Framework were assessed at baseline and 1-month follow-up; CGRA uptake was assessed at 6 months. Generalized structural equation modeling was used for mediation analysis.RESULTS:The TCN effects were most strongly mediated by behavioral intention alone (β = 0.49 and 0.31) and by serial mediation through self-efficacy and intention (β = 0.041 and 0.10) when compared with UC and TP, respectively. In addition, compared with UC, the TCN also increased CGRA through increased perceived susceptibility, knowledge of HBOC, and response efficacy.CONCLUSIONS:Risk communication and behavioral change interventions for hereditary cancer should stress a person's increased genetic risk and the potential benefits of genetic counseling and testing, as well as bolster efficacy beliefs by helping remove barriers to CGRA. System-level and policy interventions are needed to further expand access.