Bakgrund: Cancer är en sjukdom som 61000 individer drabbas av i Sverige varje år. Antalet överlevande är större tack vare tidigare upptäckt av cancer. Att drabbas av cancer kan upplevas traumatisk varför flera efter friskförklarande upplever rädsla för canceråterfall. Syfte: Syftet med denna litteraturöversikt var att utforska upplevelser av att leva med rädsla för canceråterfall. Metod: En litteraturöversikt över nio vetenskapliga artiklar enligt Fribergs metod. Artiklarna till resultatet hämtades från Academic Search Complete, Cinahl Complete och Nursing & Allied Health Database. Resultat: Rädsla för canceråterfall kan ses som ett fenomen som orsakar lidande hos den drabbade, och påverkar fler områden i livet negativt, fysiska, psykologiska samt psykosociala. Litteraturöversikten presenteras i två teman. Det första temat är Utlösande fenomen som behandlar fenomen som ökar rädslans intensitet. Det andra temat är Hantering av rädslan för canceråterfall som behandlar hur det drabbade påverkas psykosocialt och hur de hanterar livet. Diskussion: Canceröverlevare befinner sig i en ny livssituation efter cancerbehandlingen är klar, detta kan innebära svårigheter att hantera livet efter cancersjukdom. Sjuksköterskan behöver vara uppmärksam på att dessa patienter inte enbart dyker upp i onkologisk kontext utan också i öppenvården. Litteraturöversiktens fynd har diskuterats utifrån Roys adaptionsmodell. / Background: Cancer is a disease that 61,000 individuals suffer in Sweden each year. The number of survivors is greater due to early cancer detection. Being affected by cancer can be perceived as traumatic, which is why several people whom survived cancer, experience fear of cancer recurrence. Aim: The aim of this literature review was to explore experiences of living with fear of cancer recurrence. Method: A literature review of nine scientific articles according to the Friberg method. The results articles were taken from Academic Search Complete, Cinahl Complete and Nursing & Allied Health Database. Results: Fear of cancer recurrence can be seen as a phenomenon that causes suffering in the affected person, and affects areas of life negatively, physically, psychological and psychosocially. The literature review is presented in two themes. The first theme is Triggering Phenomena which deals with phenomena that increase fear. The second theme is Managing the Fear of Cancer Recurrence, which addresses how the fear affect the affected psychosocially and how the affected deal with life. Discussion: Cancer survivors are in a new life situation after the cancer treatment is complete, this can mean difficulties in managing life after cancer. The nurse needs to be aware that these patients not only appear in the oncological context but also in outpatient care. The findings of the literature review have been discussed on the basis of Roy's adaptation model

Background: The number of cancer survivors across North America is increasing, with estimates indicating that this population will grow to nearly 19 million individuals by the end of 2020. This increase can be attributed, in part, due to improvements in cancer treatments, of which radiation therapy is most commonly used. Unfortunately, exposure to radiation also increases the risk of secondary cancer development long-term. Moreover, obesity and physical inactivity are prevalent, modifiable, risk factors among cancer survivors, with both factors being linked to decrements in quality of life, increased cancer risk, and greater mortality risk. To date, there has been promising epidemiological and clinical data highlighting the role of exercise as a way to mitigate cancer risk and improve survival; however, longitudinal studies are lacking and the effects of radiation in these studies have been largely ignored. Therefore, there is a major clinical need to directly evaluate the combinatory long-term effects of radiation, exercise, and/or obesity to reveal their implications on healthspan, cancer incidence, and survival. Recent pre-clinical work from our group has shown that after being exposed to radiation, endurance exercise prevented several negative alterations to hematopoietic stem cells and their niche caused by high-fat diet (HFD)-induced obesity. We also showed that leukemic blast viability in vitro was greater when cultured in bone marrow supernatant from mice with HFD-induced obesity compared to bone marrow supernatant from mice without HFD-induced obesity. It is unknown, however, whether these findings extend to alterations in cancer risk across the lifespan. As such, the purpose of this study was to evaluate the effects of lifelong exercise and diet-induced obesity on healthspan, cancer incidence, and survival in an established mouse model of radiation-induced cancer. Methods: Male CBA mice (n=80) were randomly divided into either a control diet (CTRL; n=40) of 45% high-fat diet (HFD; n=40) and then further divided into either a sedentary group (SED; n=20) or exercise-trained group (EX; n=20). At age 13 weeks, all mice were exposed to a cancer inducing dose of whole-body ionizing radiation (3 Gy). A healthspan index score and endpoint monitoring were conducted throughout the study by blinded investigators. Results: When normalized to CTRL/SED, the highest healthspan score was in the CTRL/EX (score = +2.5), followed by HFD/EX (score = +1) and lastly HFD/SED (score = -0.5). Cancer incidence was significantly higher in the HFD/SED group when compared to the CTRL/EX group (p<0.05) and a trend for higher cancer incidence for HFD/SED was observed when compared to the CTRL/SED group (p=0.079). There was no significant difference between the HFD/SED and HFD/EX group in cancer incidence (p>0.05). Overall survival was significantly higher in the HFD/SED group compared to CTRL/SED group (p<0.05); however, risk of cancer-related mortality was 1.6-times higher in the HFD/SED group compared to the CTRL/SED group (RR=1.60; 95% CI, 1.00-2.56; p=0.0495) and 1.68-times that of the CTRL/EX group (RR=1.68; 95% CI, 1.02-2.78; p=0.0415). Conclusion: Our findings show that lifelong exercise training resulted in higher healthspan index, lower cancer incidence, and lower risk of cancer-related mortality following radiation exposure, with these effects being largely reversed by HFD-induced obesity. This study provides the rationale for future studies to uncover cellular and molecular mechanisms that could be underlying these results. Moreover, this study presents a proof of concept for the consideration of clinical studies in cancer survivors examining exercise as an intervention to reduce the long-term effects of radiation.

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist’s daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome—i.e., overall and/or recurrence-free survival—in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient’s bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

Background: New genomic tests are being developed to predict an individual’s risk of cancer recurrence by analyzing the expression of multiple genes. However, it is unclear how to report the test results so that they would be most useful to clinicians. A mail-out questionnaire has the potential to help a) describe physicians’ attitudes towards the clinical use of new genomic tests, b) determine what information physicians prefer to have included in the test reports, and c) explore how physicians think the test results would impact their treatment recommendations. Objectives: To design such a questionnaire that could be used in the eventual large-scale survey, and to ensure that the questionnaire a) is comprehensible, b) has face validity, c) appears interesting to, and d) does not place undue response burden on, the target population. Methods: The first draft, based on a specific genomic test for breast cancer recurrence (Oncotype DX) and on two case scenarios, was created. Cognitive interviews with practicing oncologists were conducted to identify problems in the questionnaire. The evaluation involved face-to-face interviews with Kingston oncologists who treat breast cancer, followed by telephone interviews with medical oncologists who treat breast cancer in other places in Ontario. Three-to-four oncologists were included in each round of interviewing after which the questionnaire was revised based on that round’s recommendations. Additional rounds of interviews were conducted until no new problems/issues were raised in one entire round. Results: A medium-length questionnaire was drafted. Four rounds of interviews were conducted with no new problems/issues being raised in the fourth round. Most of the problems identified in the questionnaire related to comprehensibility, followed by logical issues which detected fundamental problems in the questionnaire design. There was no evidence of fatigue or disinterest in participants and they deemed the response burden reasonable. Conclusion: The results suggest that the proposed questionnaire is comprehensible and has face validity. Additionally, it appears to be an interesting questionnaire to, and would not place undue burden on, the target population. Thus, the questionnaire is now ready for the field administration. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-05-05 17:23:10.551

Due to the high survival rates of many young cancer patients and a high risk of second tumors, fear of cancer recurrence (FCR) can cause serious impairment for adolescent and young adult (AYA) cancer patients. The aim of this study is to analyze the structure of the Fear of Disease Progression Questionnaire (FoP-Q-12) to better understand the construct of FCR.We performed a cross-sectional survey on a sample of AYA patients aged 15–39 years with different tumor entities. FCR was measured using the FoP-Q-12, and a network analysis was conducted to examine the relationship of FCR symptoms. The importance of individual items in the network was determined using centrality analyses. A total of 247 AYA patients (81.8% female, median age 31.0 years) participated in the study. The mean FCR score in the sample was 35.9 (SD = 9.9). The majority of patients reported having high FCR (59.5%), according to the established cut-off. The two questionnaire items with the strongest association related to fears about work, and the most central symptom was the fear of serious medical interventions. The centrality of emotional issues in the sample indicates that these symptoms should be prioritized in the development of interventions targeting FCR. Further research should address this topic with larger samples of patients in other age groups and in longitudinal studies.