Survival rates for childhood cancer have improved substantially worldwide. Although survivorship begins at cancer diagnosis, the concept of survivorship care often begins 2-5 years from cancer diagnosis. Despite the availability of evidence-based survivorship guidelines, their implementation remains inconsistent, particularly in low- and middle-income countries. This study aimed to characterize clinicians' survivorship care practices, goals, perceived barriers, and tools/needs across variably resourced global settings to inform strategies for sustainable, equitable survivorship care. We conducted semistructured interviews with physicians, psychologists, and nurses responsible for childhood cancer survivorship care across diverse health care settings. Participants were recruited across all six WHO regions and represented a range of clinical disciplines and survivorship program maturity levels. Interviews explored care delivery models, survivorship goals, institutional support, and barriers to implementation. Rapid qualitative analysis was performed using a structured matrix approach. Findings were stratified by country income classifications to contextualize resource-related differences. Thirty-one clinicians from 26 countries participated, representing low- (70.9%), middle- (6.5%), and high-income (22.6%) settings. Survivorship care models varied, ranging from structured, multidisciplinary programs to informal follow-up. Regardless of setting, clinicians shared a common goal of monitoring survivors to optimize long-term health and quality of life. Key barriers included limited funding, workforce shortages, inadequate institutional support, challenges with patient access and follow-up, and difficulties implementing complex survivorship guidelines. Clinicians from lower-resourced settings emphasized the need for adaptable care models and simplified, context-appropriate guidelines, whereas those from higher-income settings reported competing priorities and workforce constraints. Global childhood cancer survivorship care is highly variable but united by shared goals. Overcoming barriers requires context-adapted guidelines, strengthened institutional support, workforce development, and patient-centered tools. Prioritizing survivorship care everywhere is essential to achieving equitable long-term outcomes for childhood cancer survivors worldwide.
Since finding that long-term persistence of ebolavirus RNA exists in a subset of human survivors for up to 5 years post infection in several organs, viral reactivation has been implicated in recurrence of acute disease among ebolavirus disease survivors and linked to small disease outbreaks. Thus, identifying correlates of ebolavirus persistence are critical to the long-term care of survivors and outbreak management. We analyzed the humoral immune response using a comprehensive systems serology approach in 86 the 87 survivors (98.8%) of the 2022-2023 Sudan ebolavirus (SUDV) outbreak in Uganda. Across the survivors, 55% of eligible survivors (20 of 36 survivors) were found to have persistence of viral RNA in either semen or breastmilk for up to 6 months following initial infection, whereas the remaining 45% tested negative (16 of 36 survivors). We found an elevated, unique, and sustained humoral immune signature associated with persistence of viral RNA in SUDV survivors and specifically have identified 4 humoral immune features that together predicted persistence: glycoprotein-specific antibody dependent cellular phagocytosis [ADCP], nucleoprotein-specific IgG2, nucleoprotein-specific IgA1, and VP40-specific IgM. Moreover, analysis of the 4 features in the remaining 50 SUDV survivors who were ineligible for semen or breastmilk sampling, predicted an additional 17 survivors with humoral immune responses consistent with viral RNA persistence survivors. We also find that antibodies against the VP40 (matrix protein), were associated with faster clearance of persistent viral RNA. Thus, a subset of humoral immune responses could be important for monitoring and clearing viral persistence in ebolavirus disease survivors.
Direct work with victims-survivors of technology-assisted child sexual abuse who experienced online grooming reveals a constellation of mental health and support impacts, flowing from the abusive experience. This practitioner report highlights the areas of mental load affecting victims-survivors as a direct result of grooming. Juggling these psychological burdens produces lingering mental health impacts for victims-survivors. The report further outlines priorities for support services to target when working with victims-survivors, to assist in dismantling the detrimental psychological harms inflicted due to grooming. The cognitive pressure which TACSA victims-survivors experience includes feelings of culpability due to their self-reported inability to say no to their abuser or remove themselves from the online environment. This provokes an onward sense of responsibility for their own abuse, which is compounded by guilt due to how their bodies responded to what happened. The existence of images of their abuse forces silence upon victims-survivors, due to shame and embarrassment. Silence is also an attempt by victims-survivors to pre-emptively alleviate any potential societal victim-blaming. Victims-survivors express concern that abuse images potentially serve as evidence of their involvement and compliance with the grooming and abuse, inviting blame apportionment. Practitioners routinely need to unpack and gently challenge the mental distortions that victims-survivors express. Specifically, these include empowerment messages around lack of victim fault for their abuse, placing responsibility solely with the offender, normalizing physiological and psychological responses to abuse to counteract feelings that their minds and bodies welcomed the abuse. Practitioners can offer a unique view of victim-survivor experiences of mental health struggles following grooming, alongside the necessary supportive approaches to aid recovery.
Melanoma, which accounts for only 1% of skin cancers, causes the majority of skin cancer-related deaths and morbidity. Health-related quality of life (HRQOL) outcomes in melanoma survivors have not been well-described. Given increasing melanoma survivorship in recent years, there is a need to describe and quantify HRQOL outcomes in a U.S. population-based sample of melanoma cancer survivors. This study aims to characterize HRQOL in melanoma survivors based on stage of diagnosis, demographic factors, and clinical characteristics. This cross-sectional cohort study used data from the Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (SEER-MHOS) to identify 2955 Medicare beneficiaries diagnosed with melanoma between 1998 and 2019. HRQOL was assessed using physical (PCS) and mental (MCS) component summary scores from the Veterans Rand (VR-12), along with CDC Healthy Days. We created matched non-cancer comparison groups using 1:1 propensity score matching based on covariates including sex, age, race, education, marital status, BMI, region, and medical comorbidities. Less than 10% of the study population had advanced melanoma (N = 253). Advanced melanoma survivors were more likely to be non-White (5.9 vs. 3.4%; p < 0.04) and to lack a high school diploma (11.7 vs. 7.7%; p < 0.05) compared to those with localized melanoma. They also reported lower mean PCS (38.3 vs. 41.6; p < 0.05) and MCS (51.9 vs. 54.0; p < 0.05) scores compared to localized melanoma survivors, and lower mean PCS scores compared to the matched non-cancer group (38.3 vs. 42.0; p < 0.05). Furthermore, advanced melanoma survivors reported more physically unhealthy (8.3 vs. 4.8; p < 0.05) and activity limitation days (12.5 vs. 8.4; p < 0.05) compared to the matched non-cancer group. Individuals with advanced melanoma experience poorer physical and mental health than those with localized melanoma. The difference in physical health remains significant and is clinically meaningful when comparing advanced melanoma survivors to matched non-cancer individuals. These findings underscore the value of early melanoma detection and targeted psychosocial interventions for cancer survivors.
Owing to improved prognosis, cancer survivors are a growing population; however, little is known about their prevalence in Asian countries. This study estimated the prevalence and characteristics of cancer survivors in Japan, including long-term survivors. Using data from the Osaka Cancer Registry, which covers 8.8 million residents in Osaka Prefecture, Japan, we identified individuals diagnosed with cancer between 1975 and 2019 who were alive in 2019. Cancer prevalence was calculated as the number of patients alive in 2019, stratified by sex, age in 2019, time since diagnosis, and 22 cancer types. National estimates were obtained by applying sex- and age-specific prevalence proportions in Osaka to the Japanese population. In 2019, 461,489 cancer survivors were living in Osaka Prefecture (5.4% of the prefectural population; 5221 per 100,000). Most were older adults, with 83% of males (n = 188,881) and 70% of females (n = 163,331) aged ≥ 65 years in 2019. Long-term survivors (≥ 10 years after diagnosis) comprised 34% of all survivors. These patterns varied across cancer types. Nationally, an estimated 6.9 million individuals (5.5% of the national population) lived after a cancer diagnosis. Based on 44 years of follow-up data, our findings highlighted a substantial subgroup of cancer survivors requiring long-term treatment, follow-up care, and age-specific support. These findings may provide useful insights for healthcare planning and cancer survivor policies in aging societies.
Symptoms after cancer and its treatment challenge the well-being of cancer survivors. Little is known about symptom co-occurrence and the burden experienced by cancer survivors. This study aims to estimate a symptom burden measure based on symptom clusters using self-reported symptoms in cancer survivors. The study utilized data on 40,766 cancer survivors (i.e., breast, prostate, colon, rectum, lung, melanoma, lymphoma, head/neck) diagnosed 2010-2019 from the Danish nationwide SEQUEL cohort. Twenty-two symptoms were assessed 2-12-years after diagnosis using validated self-reported instruments. Symptom severity was dichotomized into none/low versus moderate/severe. Exploratory factor analysis derived a structural equation model (SEM) describing the co-occurrence of symptoms in terms of latent variables (symptom clusters) from a subset of data (training data, n=28,076). Symptom scores for each cluster were estimated from the SEM and used as measures of symptom burden across cancer types in the remaining data (test data=9,366). The SEM included six symptom clusters: a pain-fatigue cluster, peripheral neuropathy and oedema cluster, gastrointestinal and urological symptoms cluster, psychological symptoms cluster, head and neck region symptoms cluster, and respiratory symptoms and infections cluster. Survivors of lymphoma, lung, and head/neck cancer had a higher symptom burden across all six clusters. Our study is the first to propose the use of SEM to quantify symptom burden in cancer survivors and demonstrate robust summaries of symptom burden across six symptom clusters. This approach may facilitate more nuanced comparisons of symptom burden across clinical and demographic groups and support targeted symptom management.
Physical functional impairments are common among cancer survivors and have a substantial impact on quality of life (QoL). However, evidence remains limited regarding which specific impairments are independently associated with QoL, particularly in non-Western populations. To determine the prevalence of physical functional impairments and to identify impairments independently associated with QoL among Chinese cancer survivors, in order to inform nursing-sensitive assessment and rehabilitation care. A nationwide online cross-sectional survey was conducted in China between 17 and 24 November 2025, with 365 adult cancer survivors included in the final analysis. Physical functional impairments and QoL were assessed using validated patient-reported instruments. Participants were stratified according to the impairment severity. Between-group comparisons were performed using univariate analyses. Associations between impairments and QoL were explored using Spearman correlation, and hierarchical regression analyses were used to identify impairments independently associated with QoL. Over 72.13% of participants reported at least one physical functional impairment, and 22.47% met criteria for clinically significant physical dysfunction. The most prevalent impairments were weakness (48.22%), less able to perform daily activities (43.84%), persistent fatigue (38.90%), and pain/aching (33.97%). There were 230 (63.01%) participants who anticipated difficulties attending therapy sessions in hospital. The most commonly perceived barriers to therapy attendance included lack of accompaniment, financial burden, poor physical condition for travel, and transportation difficulties. In regression analyses, advanced disease stage was consistently associated with poorer QoL, whereas completed treatment was associated with better QoL in Model 1. After adjustment for physical functional impairment variables in Model 2, and in Model 3 adjusted only for disease stage and recurrence status, pain/aching, weakness, difficulty in opening the mouth, swallowing or chewing, and easily breathless were consistently independently associated with poorer QoL (all p < 0.05). Physical functional impairments are highly prevalent among Chinese cancer survivors and are strongly associated with reduced QoL. Identifying specific impairments independently associated with QoL offers clinically relevant insights for nursing-sensitive assessment and prioritisation of functional needs, with implications for QoL outcomes in cancer survivorship.
Autonomy is a fundamental psychological need in old age. It is closely linked to quality of life, psychological well-being, and functional capacity. In long-term prostate cancer (PCa) survivors, autonomy may be compromised by age- and treatment-related factors. To assess perceived autonomy in long-term PCa survivors and identify sociodemographic, clinical, and psychosocial predictors. Cross-sectional analysis of data from the German multicentre project "Familial Prostate Cancer". A total of 2143 long-term PCa (mean age: 80 years) survivors after radical prostatectomy were included. Perceived autonomy was assessed using an item from the "Perceived Autonomy in Old Age Scale" and dichotomized into "rather autonomous" vs. "rather not autonomous". Sociodemographic, clinical, and psychosocial factors were analysed. Overall, 86% of participants perceived themselves as "rather autonomous". Lower perceived autonomy was significantly associated with higher age, lower education, poorer perceived economic situation, current PCa therapy, reduced quality of life, lower subjective well-being, fear of progression, and lack of daily internet use (all p < 0.001). Although perceived autonomy remains high in many older PCa survivors, it is vulnerable and related to modifiable factors. Findings highlight key targets for a patient-centered, autonomy-supportive approach in long-term uro-oncologic survivorship care. HINTERGRUND: Autonomie ist ein zentrales psychologisches Bedürfnis im höheren Lebensalter und eng mit Lebensqualität, Wohlbefinden sowie funktioneller Leistungsfähigkeit verbunden. Bei Langzeitüberlebenden eines Prostatakarzinoms (PCa) kann das Autonomieerleben durch altersassoziierte Einschränkungen und therapiebedingte Belastungen beeinträchtigt sein. Erfassung der wahrgenommenen Autonomie bei PCa-Langzeitüberlebenden und Analyse soziodemographischer, klinischer und psychosozialer Einflussfaktoren. Querschnittanalyse im Rahmen des deutschen Forschungsprojekts „Familiäres Prostatakarzinom“. Es wurden 2143 PCa-Langzeitüberlebende (mittleres Alter: 80 Jahre) nach radikaler Prostatektomie eingeschlossen. Die wahrgenommene Autonomie wurde mittels eines Items der Skala „wahrgenommene Autonomie im Alter“ (WAA) erfasst. Es erfolgte eine dichotome Auswertung in „eher autonom“ vs. „eher nicht autonom“. Die Auswertung umfasste soziodemographische, klinische und psychosoziale Parameter. Als „eher autonom“ stuften sich 86 % der Befragten ein. Eine geringere wahrgenommene Autonomie war signifikant mit höherem Alter, niedrigem Bildungsniveau, schlechterer wahrgenommener wirtschaftlicher Situation, aktueller PCa-Therapie, niedrigeren Lebensqualität, niedrigerem subjektivem Wohlbefinden, Progredienzangst und fehlender Internetnutzung assoziiert (alle p < 0,001). Die Autonomiewahrnehmung bleibt bei vielen PCa-Patienten, die die Krankheit überlebt haben, langfristig erhalten, ist jedoch durch verschiedene beeinflussbare Faktoren gefährdet. Die Ergebnisse liefern Ansatzpunkte für eine patientenzentrierte, ressourcenorientierte Langzeitversorgung.
Diaries written for patients in the intensive care unit (ICU) are widely used to promote psychological recovery. By providing a structured account, diaries may help patients reconstruct their experiences and make sense of a period marked by memory loss or confusion. Many traumatic brain injury (TBI) survivors experience impaired memory, influencing both themselves and their family caregivers (FCs). The aim of this study was to gain a deeper understanding of the impact of a nurse-written ICU diary on TBI-survivors and their FCs. Nine TBI-survivors and ten FCs were interviewed as dyads in this exploratory qualitative study. Data were analyzed inductively using the interpretive description methodology. The overarching theme "Creating a shared narrative," encompassed four themes: "Piecing the parts together," describing strategies to gather information, "Negotiating the severity of the trauma," reflecting how the diary supported mutual understanding of illness severity, "Navigating an emotional terrain," capturing the emotional complexity involved, and "Humanizing the ICU experience," highlighting how the diary acknowledged the patient as a person. For TBI-survivors, the diary helped fill memory gaps and supported understanding of illness severity. For FCs, it facilitated communication and alignment of recovery expectations. Despite emotional complexity, receiving a diary was overall a positive experience.
Adolescent and young adult (AYA) cancer survivors experience persistent physical and psychosocial effects after treatment. Despite evidence supporting exercise in adult cohorts, research specific to AYAs remains limited. This study examined physical and psychosocial outcomes associated with participation in a community-based, group exercise program. A pragmatic, single-arm, pre-post study design was used. AYAs aged 15-27 years within 2 years post-treatment completed a 12-week group exercise program in a community setting. Biweekly, individualized sessions incorporated aerobic, resistance, and flexibility training under an accredited exercise physiologist's supervision. The primary outcome was predicted VO₂peak, with secondary outcomes including one-repetition maximum (1RM) strength, physical function, body composition, and quality of life (EORTC QLQ-C30, SF-36). Pre-post changes were analyzed using mixed-effects models adjusted for diagnosis. Of 127 participants (mean age 21.4 ± 3.0 years; 51% male), 93 (73%) completed the program and final assessments. A significant improvement was observed in predicted VO₂peak (3.1 mL·kg⁻1·min⁻1, p < 0.001), all 1RM strength measures (leg press p < 0.001; chest press p < 0.001; seated row p < 0.001), physical function (push ups p < 0.001; sit ups p < 0.001; 5-rep sit-to-stand p < 0.001; grip strength p = 0.028), lean mass (p < 0.001), and quality of life across physical, role, and social domains (p < 0.001). Fat mass percentage (p = 0.002) and fatigue (p < 0.001) decreased. No adverse events occurred. Community-based, group exercise was safe and was associated with improvements in fitness, strength, and quality of life among AYA cancer survivors. Findings are consistent with a beneficial association between scalable, real-world exercise models and long-term survivorship outcomes. This trial was retrospectively registered (ACTRN12620000664943) on 10th June 2020.
Unmet post-stroke needs are associated with poorer rehabilitation outcomes and delayed recovery. Because post-stroke challenges vary among genders, their unmet-need trajectories and predictors may also differ. However, these gender-specific patterns remain unclear. In this study, we aimed to examine the trajectory of unmet needs and identify predictors among young men and women stroke survivors across the first 6 months post-stroke. A prospective longitudinal secondary data analysis. Data were drawn from a cohort of 122 stroke survivors aged 31 to 64 years who completed assessments at baseline and at 1, 3, and 6 months post-stroke. Unmet needs were measured using the Unmet Needs Questionnaire. Andersen's Behavioral Model guided the selection of predisposing, enabling, and need-related predictors. Gender-stratified generalized estimating equations were applied to evaluate changes in unmet needs and key predictors over time. Unmet needs declined over time for both genders. Women reported fewer unmet needs in rehabilitation-related resources and economic and post-stroke life adjustment compared with men. Among men, worsening post-stroke memory emerged as the strongest predictor across several unmet-need domains. Among women, living alone consistently predicted higher unmet needs. Young stroke survivors experienced decreasing unmet needs during the first 6 months; however, gender differences were evident in unmet needs and their predictors.
Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are prevalent complications in aging stroke survivors and are often overlooked due to the lack of early diagnostic indicators, leading to poor prognosis. Identifying reliable predictors is crucial for timely intervention. This prospective cohort study followed 78 acute stroke survivors for 6 months. A composite neuropsychological outcome-defined as the development of PSD and/or PSCI-was determined using the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) and NINDS-CSN criteria. To account for the limited sample size, multivariable Firth's penalized logistic regression was employed to identify independent predictors, generating robust odds ratios (ORs) and 95% confidence intervals (CIs). An exploratory classification and regression tree (CART) analysis was also conducted for hypothesis generation. The final cohort comprised 78 acute ischemic stroke survivors with a median age of 62 years (IQR 51-71). Among these participants, 26.0% were women, and the median admission score on the National Institutes of Health Stroke Scale (NIHSS) was 3 (IQR 1-5). Within 6 months, 56 patients (71.8%) developed the composite outcome (13 experienced PSCI alone, 24 had PSD alone, and 19 had both conditions). A multivariable analysis revealed that right hemisphere lesions (OR = 9.019, 95% CI: 1.329-61.213, p = 0.016), greater baseline emotional distress (higher 9-item Patient Health Questionnaire (PHQ-9) scores; OR = 5.157, 95% CI: 1.835-14.494, p < 0.001), and pre-existing cognitive vulnerability (lower Mini-Mental State Examination (MMSE) scores; OR = 0.714, 95% CI: 0.517-0.984, p = 0.023) were independent predictors of poor neuropsychological outcomes. Advanced age (p = 0.094) and elevated urea levels (p = 0.095) showed only marginal trends. Exploratory CART modeling highlighted the hierarchical interaction of these baseline clinical scores for risk stratification. Right hemisphere lesions, early emotional distress, and baseline cognitive vulnerability independently predicted a high risk of composite neuropsychological impairment at 6 months post-stroke. Rather than serving merely as novel biomarkers, high baseline PHQ-9 scores and low MMSE scores reflected the persistence of early distress and poor cognitive reserve, respectively. These highly accessible clinical parameters facilitate early risk stratification, emphasizing the absolute need for immediate psychological triage and integrated, long-term cognitive-emotional monitoring.
Gynecological neoplasms, encompassing ovarian, cervical, and endometrial cancers, frequently lead to considerable physical and functional disabilities as a result of surgical intervention, radiotherapy, and pharmacological treatments such as chemotherapy. Prominent among the most prevalent sequelae are muscular weakness, lymphedema of the lower extremities, and sexual dysfunction, which together undermine quality of life and long-term survivorship. Recent scholarly evidence underscores the significance of exercise and physiotherapeutic interventions in alleviating these detrimental consequences. Resistance training and multimodal exercise regimens have demonstrated efficacy in augmenting muscular strength, thereby enhancing functional autonomy and overall physical capability in survivors of gynecological malignancies. Interventions grounded in physiotherapy, which encompass lymphatic drainage techniques and specialized rehabilitation programs, are effective in the management of lower-limb lymphedema, leading to a reduction in swelling, discomfort, and the potential for secondary complications. Moreover, rehabilitation of the pelvic floor and regimented physical activity can exert a beneficial effect on sexual function, particularly in relation to arousal, orgasmic dysfunctions, and concomitant discomfort. Preclinical investigations further substantiate the mechanistic framework underlying these interventions, revealing advancements in muscle morphology, lymphatic flow, and neuromuscular capabilities. Notwithstanding these encouraging results, the variability in intervention methodologies and outcome assessment presents a significant constraint. This review amalgamates the existing clinical and preclinical literature regarding exercise and physiotherapeutic approaches, underscoring their combined efficacy in augmenting muscular strength, managing lymphedema, and enhancing sexual health within the context of gynecologic oncology. Such revelations may pave the way for future research endeavors and facilitate the formulation of individualized, multimodal rehabilitation strategies aimed at optimizing survivorship outcomes.
Atypical spindle cell/pleomorphic lipomatous tumor and dysplastic lipoma are closely related fatty masses associated with RB1 abnormalities. While it is not yet widely agreed that they are separate entities, the distinct morphological features of dysplastic lipomata and divergent anatomic distribution suggest that this is probable. RB1 abnormalities are present in spindle cell/pleomorphic lipoma, pleomorphic liposarcoma, and pleomorphic liposarcoma with or without myxoid component. Survivors of hereditary retinoblastoma, caused by germline mutations in the RB1 gene, have a substantially increased risk of developing benign and malignant lipomatous tumors including atypical spindle cell/pleomorphic lipomatous tumor and dysplastic lipoma. This report describes the MRI findings of several such lesions in a survivor of bilateral retinoblastoma including features such as enhancement that might otherwise be concerning for higher-grade malignancy.
The sudden transition into caregiving following a stroke presents significant challenges for family members, profoundly affecting their well-being and capacity to adapt. A comprehensive understanding of the barriers and facilitators involved is essential for the development of effective support mechanisms, particularly in resource-limited contexts. This study investigates these factors among family caregivers of stroke survivors in Iran. This qualitative study employed conventional content analysis. Twelve participants were selected through purposive sampling with maximum variation. Data obtained from in-depth, semi-structured interviews were analyzed utilizing Graneheim and Lundman's framework. Twelve family caregivers (9 women, 3 men; mean age 45 years) participated in the study. Analysis generated three integrative themes. First, caregivers described a multidimensional erosion of well-being, including physical exhaustion, psychological identity disruption, financial strain, and loss of personal space. Second, adaptation was mediated through culturally grounded meaning-making, kinship support, knowledge acquisition, and episodic healthcare assistance. Third, adaptation emerged as a dynamic balancing process in which caregivers managed cumulative burdens through active coping, identity reformation, and conditional growth within structurally limited support systems. Caregiver adaptation following stroke reflects a dynamic balance between cumulative burden and contextually mediated reconstruction. Rather than signaling resolution of hardship, adaptation involves the conditional reorganization of identity, relationships, and everyday practices within structural constraints. Recognizing caregivers' simultaneous vulnerability and resourcefulness offers a culturally grounded framework to inform responsive, context-sensitive caregiver support policies and interventions.
Financial toxicity (FT) refers to increased risk of treatment discontinuation and anxiety in daily life due to the cost burden of cancer treatment. However, little is known about which groups of patients are more likely to experience FT under universal health coverage. Thus, we aimed to explore demographics and psychological factors associated with FT among adult cancer patients in Japan. We analyzed responses from the Patient Experience Survey, a self-administered questionnaire conducted by the National Cancer Center in 2018. Outcome indicators were aligned with the Phase 4 Basic Plan to Promote Cancer Control Programs in Japan. We used a modified Poisson regression model to analyze the association between patient demographics and FT, estimating the Prevalence Ratio (PR) and conducting subgroup analysis by sex. Of 6766 responses received, approximately 30% of patients reported FT. FT was categorized into "FT impacted on daily life (FT_Life)," "FT impacted on treatment-receiving behavior (FT_Tx)," and "FT led to treatment change or discontinuation (FT_DisTx)." Across all FT categories, younger age (< 40 vs. 65 + ; male: PR = 2.26 [95% CI, 0.98-5.23]; female: PR = 1.79 [95% CI, 1.01-3.17]), and those with no-one to talk to (vs. with; male: PR = 2.04 [95% CI, 1.05-3.94]; female: PR = 2.07 [95% CI, 1.09-3.93]) were consistently associated with FT. These results identify groups that require financial assistance due to cancer treatment, including younger patients, individuals with unstable employment, and those with limited interpersonal support. Strengthening social support systems is critical to enable these patients to manage treatment costs and maintain daily life.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(3):25f04106. Author affiliations are listed at the end of this article.
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To determine whether serum biomarkers, BUN-to-albumin ratio (BAR) and creatinine-to-albumin ratio (CAR), have prognostic utility in dogs. A retrospective, single-center study utilizing signalment, clinicopathological, and mortality data collected from medical records of dogs presented to a referral hospital from September 2022 through June 2025. Dogs were stratified based on mortality. 327 cases were included. Nonsurvivors (n = 92) had significantly elevated BAR (median, 6.62; 95% CI, 5.69 to 7.61) and CAR (0.36; 95% CI, 0.32 to 0.42) compared with survivors at 5.01 (95% CI, 4.52 to 5.50) and 0.29 (95% CI, 0.27 to 0.31), respectively. Nonsurvivors had lower albumin (2.9 g/dL; 95% CI, 2.7 to 3.0) than survivors (3.2 g/dL; 95% CI, 3.1 to 3.2). Blood urea nitrogen was higher in nonsurvivors (18.8 mg/dL; 95% CI, 17.1 to 23.2) than survivors (16.0 mg/dL; 95% CI, 14.8 to 17.4). Survival analysis identified low albumin as the strongest predictor of mortality, with increased risk of death (hazard ratio, 2.01; CI, 1.32 to 3.07). High BAR, BUN, and CAR were associated with poor survival, whereas creatinine was not related to outcome. A random forest-classified model showed strong discrimination between survivors and nonsurvivors, with an area under the curve of 0.998 (Specificity, 100%; Sensitivity, 71.7%). Nonsurvivors had significantly higher BAR, CAR, BUN, and creatinine and lower albumin; BAR, CAR, BUN, and albumin outperformed creatinine in predicting mortality. Biochemical ratios are easily calculated, have the potential to predict mortality in dogs, and thus warrant further investigation.
Tracking patient-reported outcomes (PROs) offers critical insights into cancer survivors' symptoms and health-related quality of life (HRQOL). This study evaluated longitudinal trajectories of PROs across cancer types and identified factors associated with symptom burden and HRQOL. We conducted a retrospective longitudinal observational study of 6939 cancer survivors (breast, prostate, lung, head and neck (H&N), gastrointestinal (GI), gynecological (GYN), and hematological malignancies) in ambulatory oncology clinics. All cancer survivors completed electronic health record-integrated PRO assessments measuring anxiety, depression, pain interference, fatigue, and physical function, and HRQOL. Linear mixed-effect models evaluated difference in PRO level and change over time by cancer types, adjusting for sociodemographic and clinical covariates. Meaningful differences in overall symptom burden were observed across cancer types. Survivors with GYN cancers reported consistently higher anxiety, pain interference, fatigue, and poorer physical function, whereas prostate cancer survivors reported lowest symptom burden and highest HRQOL. Hematologic malignancy survivors improved in physical function over time compared to prostate cancer survivors. Chemotherapy and surgery were associated with greater pain interference, fatigue, reduced physical function, and lower HRQOL. Greater comorbidity burden and being unpartnered were associated with worse PRO. PRO trajectories varied by cancer types and patient characteristics, underscoring the need for tailored, cancer-specific survivorship care strategies. Routine, EHR-integrated PRO monitoring can identify survivors at risk for persistent symptom burden and support timely, individualized interventions to improve long-term HRQOL.