Component alignment in contemporary total knee arthroplasty (TKA) is frequently achieved through personalized alignment philosophies that aim to restore prearthritic knee anatomy. The long-term clinical efficacy and safety of these approaches remain uncertain. This comprehensive review assessed the relationship between coronal component alignment and TKA implant survivorship. A scoping review was performed of published primary TKA studies that (1) reported postoperative tibial or femoral component coronal alignment on long-leg radiography, (2) reported survivorship with a minimum 12-month follow-up, and (3) were written in English. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its scoping review extension (PRISMA-ScR). The primary a priori outcome was all-cause aseptic revision. Included studies underwent qualitative synthesis. Of 3,786 screened studies, 332 underwent full-text review and 51 met inclusion criteria, encompassing 7,944 patients (9,687 TKAs) (mean [SD] age 68.1 [3.2] years; mean [SD] follow-up 4.6 [3.3] years). Most studies (76.5%, n = 39/51) investigated a single alignment philosophy (most commonly mechanical alignment [MA], n = 23, 56.1% of single-philosophy studies), while 10/51 (19.6%) compared 2 philosophies. Only 5 studies (9.8%) included >500 TKAs. Long-term follow-up (>10 years) was reported in 9 MA studies (28.1% of MA reports), 5 of which noted decreased survivorship with component varus or valgus. Survivorship ranged from 74.2% to 79.3% with increased tibial varus, 90% with increased femoral varus, and 83.3% with femoral valgus. Two kinematic alignment (KA) studies with >10-year follow-up reported no survivorship concerns. Decreased short-term to mid-term survivorship was reported in 2 KA studies (10.5%). No long-term data existed for other alignment philosophies, and the largest personalized alignment series included only 338 TKAs. Most studies demonstrated excellent short-to-midterm (5-year) survivorship regardless of coronal component alignment. However, limited evidence suggests increased early revision risk with some personalized alignment philosophies and reduced long-term (>10 years) survivorship with nonmechanical component alignment. Until higher-quality, long-term evidence with aseptic survivorship as the primary outcome is available, mechanically aligned TKA remains the most extensively validated approach. Level II. See Instructions for Authors for a complete description of levels of evidence.
To compare survivorship outcomes between patients with stage I testicular cancer (TCa) undergoing surveillance or adjuvant therapy and examine patient perceptions on counselling and management. Administrative claims data from the Optum Labs Data Warehouse (2007-2022) were reviewed to identify patients with stage I TCa managed with either surveillance or adjuvant therapy. Trends in TCa management were evaluated, and survivorship outcomes were assessed using propensity score matched survival analyses. Qualitative surveys and interviews explored patient perspectives on decision-making and identified themes in patient experiences with counseling. Of 3,613 stage I TCa patients, the mean age at diagnosis was 38.6 years (SD 13.6) with surveillance rates increasing up to 78.7% by 2022. When comparing the matched surveillance to chemotherapy groups, there were higher rates of men's health diagnoses in the chemotherapy group (35.2% vs 23.9%, p=0.027). However, time-to-event analysis showed no difference in survivorship outcomes between surveillance or adjuvant therapy. Twenty surveyed stage I TCa patients revealed satisfaction and understanding of their care but endorsed concerns regarding survivorship outcomes. Five interviewed patients communicated four key themes: 1) trust in physician recommendations, 2) proactive personal and family research, 3) gaps in communication of care, and 4) coping. This study suggests adjuvant chemotherapy may be linked to higher rates of men's health diagnoses, but over time, these risks do not differ significantly from surveillance. Patient perspectives underscore the importance of communication, shared decision-making, and addressing survivorship concerns as part of comprehensive care. Further research into survivorship outcomes is needed.
Survivorship care plans (SCPs) and treatment summaries (TS) are intended to bridge oncology and primary care, yet it is unclear how well publicly available templates capture radiation therapy (RT) details necessary for safe, coordinated follow-up. We evaluated RT content in U.S. society-sponsored, non-paywalled SCP/TS templates against elements recommended by the American Society for Radiation Oncology (ASTRO). We identified SCP/TS templates from national medical organizations via targeted web searches. Guided by the ASTRO survivorship template, we abstracted the presence of RT variables including site, technique/modality, total dose, dose per fraction, fractionation, special procedures (e.g., brachytherapy), treatment dates, toxicity, sequencing within multimodality care, concurrent chemotherapy, and radiation oncology contact information. Variables were recorded as present/absent and summarized descriptively. Eighteen templates met inclusion; 11/18 (61.1%) were by the American Society of Clinical Oncology (ASCO) and 14/18 (77.8%) targeted adult populations. RT was mentioned in 17/18 (94.4%), and a radiation oncology contact was listed in 15/18 (83.3%). Key technical details were uncommon: total dose and/or modality 6/18 (33.3%); dose per fraction 4/18 (22.2%); fractionation 5/18 (27.8%); special procedures 3/18 (16.7%); toxicity 2/18 (11.1%). No template captured RT sequencing within multimodality therapy or concurrent chemotherapy. Treatment end dates were more commonly captured than start dates. The Children's Oncology Group (COG) template was the most comprehensive across RT variables.
With the increasing adoption of both cementless fixation and robotic-assisted techniques in total knee arthroplasty (TKA), it is important to recognize that these approaches carry distinct historical concerns. Earlier generations of cementless implants were associated with higher early failure rates due to inadequate osseointegration, while early robotic systems faced criticism for increased operative times and complication risk. As a result, the current literature presents conflicting evidence regarding the impact of these technologies on early complications and revision rates. This study compares the reoperation rates across 4 TKA cohorts, cemented vs. cementless, with and without robotic assistance. A retrospective cohort study was conducted using a national administrative claims database. Primary TKA cases were identified using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes, and 4 cohorts were created: robotic-cemented (R-CEMENT), robotic-cementless (R-CEMENTLESS), conventional-cemented (C-CEMENT), and conventional-cementless (C-CEMENTLESS). Matching was performed based on age, sex, Elixhauser Comorbidity Index, obesity, tobacco use, and diabetes, resulting in 5,210 patients in each group. Outcomes assessed included 1-, 5-, and 10-year ipsilateral reoperations, 30-day emergency department utilizations, and 10-year failure-free survival. χ2 tests were used for group comparisons, with p < 0.05 indicating significance. In the matched cohort (n = 20,840, C-CEMENTLESS, C-CEMENT, R-CEMENTLESS, R-CEMENT; n = 5,210 each), 1-year reoperation rates were lowest in C-CEMENTLESS (0.44%) and R-CEMENTLESS (0.52%), followed by R-CEMENT (0.84%) and C-CEMENT (0.92%) (p = 0.005). At 5 and 10 years, reoperation rates remained lowest in C-CEMENTLESS (0.79%) and R-CEMENTLESS (1.02%), compared with higher rates in C-CEMENT (1.86%) and R-CEMENT (1.71%) (p < 0.001). Kaplan-Meier survival showed 99.7% 5-year survivorship in C-CEMENTLESS and R-CEMENTLESS, versus 99.5% in both cemented groups (p-value < 0.05). No significant differences were observed in 30-day ED utilization (p = 0.11) or readmissions (p = 0.75) across all 4 matched cohorts. Cementless fixation in TKA, whether robotic or conventional, demonstrated comparable short-term reoperation rates and equivalent long-term survivorship to cemented fixation. Robotic assistance did not significantly affect failure-free survival or healthcare utilization. All 4 cohorts showed excellent 10-year outcomes.
Sleep health, defined as a multidimensional construct encompassing regularity, duration, efficiency, satisfaction, timing, and daytime alertness, is a neglected pillar of testicular cancer survivorship. In parallel, common sleep disorders, including insomnia disorder and obstructive sleep apnea, remain underrecognized despite their relevance to cardiometabolic and endocrine health. This comment argues for the systematic integration of sleep screening and targeted interventions, such as CBT-I, into multi-disciplinary survivorship care. Recognizing sleep as a fundamental component of recovery offers a high-impact opportunity to optimize long-term clinical outcomes and quality of life for survivors.
Objective: To characterize the distribution of FCR severity across survivorship time intervals in bladder cancer survivors. Methods: A cross-sectional study of 79 patients utilized the validated 9-item FCR Inventory-Short Form (FCRI-SF) to assess overall FCR severity. Primary analysis employed Spearman's correlation coefficient to evaluate the relationship between time elapsed since the first procedure and total FCR scores. Patients were stratified into four temporal groups (<1, 1-2, 2-5, and >5 years). Inter-group variability in FCR scores was assessed using Levene's test for equality of variances. Subgroup analyses compared FCR scores across clinical subgroups, including tumor grade and smoking history, using the Mann-Whitney U test. Multivariate logistic regression identified independent predictors of clinically significant FCR (total score ≥13). Results: Median patient age was 72.0 years (IQR 66.0-78.0), with a median of 24.0 months post-diagnosis. Clinically significant FCR (score ≥13) was prevalent in 55.7% of the cohort. Spearman correlation analysis revealed no significant relationship between months elapsed and FCR severity (rho = 0.068, p = 0.552). Patients in the 12-24 month window exhibited the highest variability (Levene's test, p = 0.058), representing a period of clinical divergence. High-Grade disease and smoking cessation motivated by diagnosis were associated with higher FCR scores. In the multivariate logistic regression model, history of tumor recurrence was the sole independent predictor of clinically significant FCR (aOR 3.28, 95% CI 1.11-9.68, p = 0.031), whereas age and gender were not significantly associated. Conclusions: FCR severity did not demonstrate a significant association with time elapsed since diagnosis in this cross-sectional sample. The 1-2 year interval demonstrated greater inter-individual variability in FCR scores. Findings highlight the need for long-term, structured survivorship support, particularly targeting the 12-24 month post-diagnosis window.
Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis in many patients. In younger patients with predominantly medial compartment disease, high tibial osteotomy (HTO) is performed as a joint-preserving treatment. However, concerns remain regarding potentially compromised outcomes of TKA after previous HTO given the axial deviation, osteotomy site, secondary surgery, previous hardware, and instrumentation. Therefore, this study compared long-term implant survival, revision, and infection rates, and patient-reported outcomes between patients undergoing TKA after HTO and matched TKA-only controls. Postoperative complications and revision surgeries were prospectively recorded in patients who underwent TKA from 2000 to 2023 at a single academic center. Patients with previous ipsilateral HTO formed the study group and were propensity matched 1:2 to TKA-only patients without a previous osteotomy based on age, sex, and body mass index. Knee Society Scores (KSS) were collected prospectively. Implant survivorship was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models. The study included 134 HTO-TKA and 268 matched TKA-only patients, with a mean follow-up of 10.5 ± 6.4 years (range: 0-24 years) after TKA. Both groups showed significant postoperative improvements in KSS (p < 0.02) with comparable clinical outcomes (HTO-TKA: 79.0 (6.0), TKA-only: 79.0 (11.8)). Revision arthroplasty rates were 5.2% for HTO-TKA and 4.5% for TKA-only (p = 0.69); the mean time to revision was 8.1 ± 8.7 years vs. 4.4 ± 3.5 years, respectively (p = 0.30). Infection rates were 2.2% and 1.1%, respectively (p = 0.74). Revision and infection rates were comparable between HTO-TKA and matched TKA-only patients, with no statistically significant differences. Our findings demonstrate comparable patient-reported outcomes in both groups. These findings indicate that a previous HTO does not adversely affect TKA implant longevity or clinical outcomes when compared with matched primary TKA patients within the US population. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Germline genetic susceptibility to pediatric acute lymphoblastic leukemia (pALL) remains incompletely characterized across the allelic spectrum, including ultra-rare, high-penetrance cancer predisposing variants (CPVs). We analyzed germline genetic data from 3,208 pALL survivors, 7,821 non-pALL survivors, and 377 non-cancer controls from the St. Jude Lifetime Cohort Study and the Childhood Cancer Survivor Study. We evaluated enrichment of ultra-rare CPVs in 60 curated cancer predisposition genes and conducted a genome-wide association study (GWAS) meta-analysis of common and low-frequency variants. Compared with non-cancer controls, pALL survivors showed significant enrichment of ultra-rare CPVs in BRCA1, PALB2, and PTPN11, in addition to established susceptibility genes CDKN2A and TP53. GWAS meta-analysis replicated 93% of previously reported pALL risk variants, with seven loci achieving genome-wide significance (P < 5 × 10⁻⁸). Two novel variants were identified: rs112425636 within SECTM1 (OR = 1.60, 95% CI = 1.39-1.84, P = 2.77 × 10⁻¹¹) and rs1821340 at 8q24.21 (OR = 1.33, 95% CI = 1.22-1.44, P = 1.63 × 10⁻¹¹). The rs112425636 risk allele was associated with reduced SECTM1 expression in B-cell pALL tumors. Median PRS was significantly higher in pALL survivors than in non-pALL survivors and non-cancer controls (P = 6.64 × 10⁻¹⁴⁷). SNP-based heritability was 0.19 (SE = 0.054). This study comprehensively characterizes the genetic etiology of pALL by integrating ultra-rare and common germline variation, expanding the spectrum of inherited risk factors. These findings advance understanding of pALL genetic architecture and inform future risk stratification.
Legg-Calvé-Perthes (LCPD) disease is an uncommon, but challenging indication for total hip arthroplasty (THA). We aim to report one of the largest single-center contemporary series of THA associated with this condition. We reviewed 201 THAs for LCPD performed at a single institution between 2000 and 2020. The mean age at surgery was 47 years, the mean body mass index was 32 and 74% were men. Bearing surfaces included ceramic-on-highly-cross-linked polyethylene(C-HXLPE) in 95 hips (47%), metal-on-HXLPE in 83 hips (41%), ceramic-on-ceramic(CoC) in 17 hips (9%), and metal-on-metal(MoM) in six hips (3%). All acetabular components were cementless. Cementless and cemented femoral stems were used in 188 (93%) and 14 hips (7%), respectively. The mean follow-up was nine years (range, two to 22). At 15 years, survivorships free of aseptic revision, any revision, and any reoperation were 99, 98, and 95% respectively. Indications for revision were infection (n=2), postoperative fracture (n=1), and metallosis (n=1). There were no significant differences in survivorship between hips with prior surgical treatment of LCPD (n=8) and those without (n=153). Complications occurred in 30 hips, most commonly sciatic neuropraxia (n=10) and intraoperative fracture (n=9). Preoperatively, patients had a mean leg-length discrepancy of 18mm shorter on the operative limb. Postoperatively, the operative limb was lengthened by a mean of 15mm. There was no difference in mean lengthening between patients who had sciatic neuropraxia and those who did not (12 versus 15mm; P=0.365). There were seven neuropraxias resolved, while three patients had persistent deficits at the latest follow-up. The mean Harris hip score (HHS) improved preoperatively from 55 to 92 at 10-year follow-up (P<0.0001). At 15 years, patients who had LCPD undergoing contemporary THA showed excellent survivorship free of revision and reoperation. Surgeons should be aware that complications were not uncommon, especially sciatic neuropraxia and intraoperative fractures.
To evaluate whether men with prostate cancer (PCa) experience better mental health outcomes than those with other major cancers, using nationally representative data. We conducted a repeated cross-sectional study using Medical Expenditure Panel Survey Household Component data (2017-2022). Respondents were categorized as having no history of cancer, PCa, or non-prostate cancer (non-PCa). The primary outcome was fair/poor self-rated mental health. Secondary outcomes included major depressive symptoms (PHQ-2 ≥ 3) and serious psychological distress (K6 ≥ 13). Multivariable logistic regression was employed to estimate adjusted odds ratios (aORs) with 95% confidence intervals, controlling for sociodemographic and health-related covariates. Among 31,706 respondent-year observations, 41.0% reported fair or poor mental health (40.4% among those with no cancer history, 42.1% with PCa, and 47.2% with non-PCa cancers; p < 0.001). In adjusted analyses, non-PCa was associated with higher odds of fair/poor mental health compared to PCa (aOR = 1.24, 95% CI: 1.05-1.46). Depression and distress rates were low across all groups (e.g., 7.3% and 3.0% in PCa, respectively), and did not differ significantly by cancer history. Exploratory analyses revealed significant variations by specific cancer type, including higher odds of fair/poor mental health (aOR = 1.37; p=0.03) but lower odds of serious psychological distress (aOR = 0.12; p=0.035) among colon cancer survivors compared to PCa survivors. Self-rated mental health among men with PCa was comparable to individuals with no history of cancer and more favorable than among those with non-PCa malignancies. However, nearly 40% of PCa patients still reported mental health below "good," supporting the need for continued psychosocial support across cancer survivorship populations. While men with PCa demonstrate more favorable mental health profiles than those with other cancers, nearly 40% report mental health status below good. These findings suggest that concerns regarding psychological distress remains highly relevant in survivorship care, including for cancers with highly favorable prognoses.
Revision total hip arthroplasty (rTHA) in the setting of substantial proximal femoral bone loss is technically challenging. Modular tapered fluted stems provide predictable diaphyseal fixation while allowing independent adjustment of version, offset, and limb length. Among these, two commonly used systems-modular tapered fluted stem Type A (Revitan™) and Type B (LIMA Modulus™)-have limited direct comparative evidence. This study aimed to prospectively compare radiographic stem subsidence (primary outcome), as well as functional outcomes, complications, survivorship, and secondary outcomes, between Type A and Type B modular long stems in femoral rTHA. In this single-center randomized prospective study, 110 patients undergoing femoral revision rTHA were randomly assigned to receive either Type A (n = 55) or Type B (n = 55) stems. All procedures were performed by experienced revision surgeons under standardized perioperative and rehabilitation protocols. Radiographs were analyzed for stem subsidence, osseointegration, and limb-length restoration. Functional outcomes were assessed using the Harris Hip Score (HHS), Oxford Hip Score (OHS), and European Quality of Life Visual Analogue Scale (EQ-VAS) at baseline and final follow-up (mean 61.4 months). Complications and stem survivorship were recorded prospectively. Statistical analysis included paired and unpaired comparisons, correlation, regression, and Kaplan-Meier survival estimates. Baseline demographics and femoral defect severity were comparable. Both groups achieved high radiological stability, with mean distal subsidence of 1.3 ± 0.7 mm (Type A) and 1.5 ± 0.9 mm (Type B; p = 0.24), and osseointegration in > 92% of cases. Limb-length and offset restoration were similar. HHS improved significantly in both groups (Type A: 44.7 → 88.1; Type B: 45.1 → 87.3; p < 0.001), with > 80% achieving good-to-excellent outcomes. Complication rates were low and comparable. Five-year stem survivorship was 98.2% (Type A) and 97.6% (Type B). Early full weight-bearing and lower Paprosky defect grades independently predicted superior functional outcomes, whereas stem type did not. Both Type A and Type B modular tapered fluted stems demonstrated durable fixation, minimal subsidence, low complication rates, and excellent mid-term functional recovery. Radiographic stem subsidence did not differ between groups, indicating that design variations do not significantly affect clinical outcomes. These findings support the use of modular tapered fluted stems as reliable solutions in complex femoral rTHA.
Purpose Breast cancer is the second most prevalent cancer among women in the United States. Rural breast cancer survivors (RBCS) face unique challenges because geographical isolation limits access to facilities, support groups, and mental health services. Expressive writing (EW), a therapeutic intervention navigates individuals through traumatic experiences, has demonstrated benefits for RBCS. However, first-person accounts of how RBCS experience EW remain limited. This study addresses this gap. Methods Virtual semi-structured in-depth interviews were conducted with participants (N = 14) who previously completed a virtual EW randomized controlled trial. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results Interviewees' mean age was 54.71 years. Six themes emerged: rural-specific challenges (e.g., travel burden, infrastructure limit, gossip in small towns); emotion regulation and adaptive coping; personal strength through meaning-making; improved relationships; renewed purpose; and appreciation for life. These themes reflect participants' narratives of how EW fit into their cancer journeys. Conclusions Participants reported varied but positive experiences with EW. The intervention appeared to address key psychosocial needs of RBCS, helping to mitigate rural-specific disparities in supportive care and fostering elements of posttraumatic growth. Centering survivors' own narratives adds a nuanced understanding of what it feels like to engage in EW and how the process supports adaptation in survivorship. EW may address unmet cognitive and emotional needs among RBCS, and may serve as an economical, accessible, and scalable survivorship support strategy. Future studies may triangulate the writings, self-accounts of experiences and intervention outcomes from EW interventions to contextualize the findings.
Retrospective cohort study. To compare 10-year survivorship, secondary cervical procedure rates, and surgical complications between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF). ACDF is the traditional gold-standard treatment for cervical spine degeneration but alters adjacent segment motion, potentially accelerating degeneration. CDA has emerged as a motion-preserving alternative that may reduce adjacent segment disease. While short- and mid-term studies suggest comparable outcomes, limited data exist on long-term complications and survivorship beyond 10 years. Patients undergoing primary single-level CDA and ACDF between 2010 and 2022 were identified from a national claims database. CDA patients were propensity-score matched 1:1 to ACDF patients by age, sex, and Charlson Comorbidity Index. Kaplan-Meier survival analysis was used to determine the 10-year cumulative incidence of secondary cervical procedures, including ACDF, CDA, cervical decompression, and posterior fusion. Complications such as all-cause revision, hardware removal, spinal complications, nerve root compression, dural tear, dysphonia, dysphagia, drainage and evacuation, and mechanical failure were analyzed. Cox proportional hazards models estimated hazard ratios (HR) with 95% CIs. A total of 18,192 CDA patients were matched to 18,192 ACDF patients. At 10 years, the cumulative incidence of secondary procedures was lower for CDA (8.7%) compared with ACDF (11.4%), with ACDF patients more likely to undergo reoperation (HR: 1.12, P=0.005). ACDF patients also demonstrated higher risks of spinal complications (4.73), nerve root compression (HR: 2.61), drainage and evacuation (HR: 2.01), and mechanical failure (HR: 1.36), all statistically significant (P<0.05). CDA demonstrated superior long-term outcomes compared with ACDF by reducing secondary procedures and complication rates over 10 years. These findings suggest motion preservation with CDA translates into sustained clinical benefit. Surgeons should incorporate this evidence when counseling patients regarding surgical options for single-level cervical degeneration.
Short, collared, metaphyseal-filling femoral stems preserve proximal bone and achieve stable fixation while reducing stress shielding compared to diaphyseal-engaging stems. Early six-month data for one such stem demonstrated improved patient-reported outcomes with no implant-related complications. This study extends follow-up of the same cohort to a minimum of two years to evaluate (a) functional outcomes, (b) implant-related complications, and (c) survivorship. The prospective cohort of 120 patients underwent robotic-arm assisted total hip arthroplasty (THA) through a direct anterior approach (DAA) using a short, collared, metaphyseal-filling stem. Patients had a mean age of 69.2 years (range 37-90) and a body mass index of 28.2 (range 18.1-49.1), and they were 71% women and were followed for a mean of 2.6 years (range 2.0-3.4). The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) was compared with baseline using Student's t-tests. Complications included all-cause revision, periprosthetic joint infection, periprosthetic fracture, and dislocation at final follow-up. At mean follow-up, HOOS-JR scores improved from a mean of 54.5 ± 13.9 preoperatively to 94.4 ± 10.3 (P < 0.001). The overall survivorship was 98.1% following two septic revisions. This short, collared, metaphyseal-filling stem demonstrated sustained functional improvements and low implant-related complication rates of the prior six-month follow-up through a minimum of two years. These results support the continued clinical efficacy and stability of the implant in robotic-arm assisted DAA THA.
This study aimed to examine the associations between counseling and supportive care delivered through a nurse-led mobile health application, theoretically informed by Mezirow's Transformative Learning Theory, and changes in grief-related emotional responses and posttraumatic growth among women diagnosed with breast cancer. This single-center, parallel-group randomized controlled trial included 56 women who had completed mastectomy and were at the beginning of the survivorship period. A mobile application titled Breast Cancer Support (BCS) was developed, and women in the intervention group used the application for eight weeks. Grief-related responses were measured using the Psychological Responses to Grief Before Loss of Health Scale, and posttraumatic growth was assessed using the Posttraumatic Growth Inventory (PTGI). The intervention group demonstrated significantly greater improvements in Positive Attitude Toward Illness scores at post-test and follow-up compared with the control group (P < .05; 95% CI: -1.195 to -0.120), with significant group × time interaction effects (P < .001). Although unadjusted PTGI scores did not significantly differ between groups (P > .05), ANCOVA analyses adjusting for baseline scores indicated significant between-group differences at post-test and follow-up (P < .001; partial η² = .707; 95% CI: 65.191-69.269). The findings provide preliminary evidence of associations between a nurse-led, theory-informed mobile health intervention and changes in grief-related emotional responses and posttraumatic growth during breast cancer survivorship. Transformative Learning Theory served as a guiding framework for intervention design rather than as an empirically measured outcome, and the results should not be interpreted as evidence that transformative learning occurred. Theory-informed mobile health applications may represent a feasible and accessible approach to delivering supportive care during the post-treatment period. Nurses may facilitate patient engagement with such tools by supporting access to informational and reflective resources; however, further rigorous trials are required before conclusions regarding effectiveness or routine implementation can be drawn.
Cancer survivorship care emphasizes biomedical interventions, but psychological and social difficulties remain underaddressed. This study aimed to (i) quantify the association between unmet needs and quality of life (QOL), and (ii) evaluate whether these associations are consistent across two health-related QOL (HRQoL) instruments among cancer survivors. Cross-sectional survey of adults (≥ 19) in Ulsan, Korea (2021, 2022). HRQoL (EQ-5D-5 L; EORTC QLQ-C30) was related to unmet-need domains using multivariable linear regression adjusted for prespecified sociodemographic and clinical covariates (gender, age, cancer type/stage, education level, household size, household monthly income, smoking status, alcohol consumption). Statistical analyses included Student's t-tests, one-way ANOVA, and multivariable linear regression. After excluding cases with insufficient information, 372 survivors were analyzed. EQ-5D-5 L utility was negatively associated with age ≥ 60 years (B=-0.04, 95%CI[-0.07, -0.01]), advanced cancer stage (Stage IV: B=-0.11, 95%CI[-0.14, -0.07]), unmet psychological needs (B=-0.09, 95%CI[-0.13, -0.06]), and unmet financial needs (B=-0.04, 95%CI[-0.09, -0.001]). On the EORTC QLQ-C30, advanced cancer stage showed negative associations with the functional scale (Stage IV: B=-14.87, 95%CI[-18.65, -11.10]) and positive associations with the symptom scale (Stage IV: B = 9.01, 95%CI[6.44, 11.57]). Higher household income (B = 4.99, 95%CI[1.71, 8.26]) was positively associated with the functional scale, while unmet psychological needs were negatively associated with the functional scale (B=-5.96, 95%CI[-10.04, -1.89]) and positively associated with the symptom scale (B = 8.80, 95%CI[6.04, 11.57]). Unmet psychological needs showed the most consistent associations with poorer HRQoL across both generic and cancer-specific instruments. Unmet financial needs showed weaker but directionally consistent associations, and the concurrent use of both instruments provided complementary perspectives on survivorship-related quality of life.
Immune checkpoint inhibitors (ICIs) have transformed cancer care, extending survival across multiple malignancies. Yet quality-of-life (QoL) outcomes remain underreported and inconsistently integrated into research and practice. Standard frameworks and instruments do not fully capture immune-related adverse events (irAEs) and may overlook the experiences of racially, socioeconomically, linguistically, and digitally marginalized groups. This review examines how methodological limitations, and systemic inequities constrain the assessment of QoL in immune checkpoint inhibitor (ICI) therapy. It evaluates existing QoL instruments and frameworks guiding patient-reported outcomes (PROs) and identifies opportunities for advancing equity-centered, patient-informed approaches. This narrative review synthesized evidence identified through literature searches and reference screening across oncology, regulatory science, digital health, equity, and community-engaged research. QoL assessment domains analyzed included methodological rigor, trial design, digital integration, intersectionality, literacy, and social determinants of health. Quality-of-life reporting in ICI trials remains limited, with only about 14% of trials publishing PRO results and fewer than 12% including them in the primary publication. Existing tools inadequately capture irAEs, while trial designs neglect long-term survivorship and diverse populations. Frameworks such as SPIRIT-PRO and CONSORT-PRO improve methodological rigor, but provide limited guidance on equity, cultural adaptation, or caregiver perspectives. Barriers, including digital exclusion, linguistic gaps, and underrepresentation of racial and age groups, further bias QoL evidence. Quality of life should be recognized as a core clinical endpoint and an indicator of equity in ICI therapy evaluation. Future research must integrate culturally validated instruments, inclusive digital strategies, and community-engaged approaches to ensure survivorship outcomes reflect the realities of all patients. By moving beyond survival, QoL assessment can anchor cancer care in equity and patient-centered lived experience.
Our study identifies sociodemographic, clinical, and behavioral factors associated with serious psychological distress (SPD) among US adult cancer survivors, highlighting actionable targets for mental health interventions in survivorship care. We analyzed 2024 National Health Interview Survey data from adults aged ≥ 18 years with a self-reported history of cancer and complete Kessler-6 and covariate data (unweighted n = 3,680; weighted ~ 22.2 million). SPD was defined as a Kessler-6 score ≥ 13. Weighted prevalence and multivariable logistic regression identified independent correlates. The weighted prevalence of SPD was 3.7% (95% CI, 3.0%-4.5%). SPD was higher among adults aged 18-44 years (10.2% [5.5%-14.9%]) versus ≥ 65 years (2.4% [1.7%-3.1%]), women (4.8% [3.5%-6.0%]) versus men (2.6% [1.7%-3.6%]), and those with Medicaid (14.4% [7.5%-21.2%]) or no insurance (14.1% [3.6%-24.5%]). SPD was also elevated among survivors with frequent loneliness (11.7% [8.9%-14.4%]), low social support (10.7% [7.8%-13.7%]), life dissatisfaction (24.0% [16.5%-31.5%]), and functional limitations (5.5% [4.3%-6.7%]). In multivariable analyses, frequent loneliness (aOR 5.46 [2.39-12.47]), low social support (2.92 [1.40-6.08]), and life dissatisfaction (3.92 [1.64-9.46]) were independently associated with SPD; odds were lower among non-Hispanic Black adults (0.28 [0.08-1.00]). Sensitivity analyses excluding psychosocial variables strengthened associations for younger age and Non-Hispanic Black race/ethnicity. Serious psychological distress affected a clinically important minority of US cancer survivors and was strongly associated with psychosocial factors, including loneliness, social support, and life satisfaction. Integrating psychosocial assessment and targeted support into survivorship care may reduce distress and improve overall well-being.
Population-level descriptions of long-term childhood cancer survivors are fundamental to survivorship care and research but seldom available. Accordingly, we aimed to describe long-term childhood cancer survivors at the population-level and project future prevalence. In this register-based study we calculated the absolute number and prevalence proportions of all individuals diagnosed with a childhood cancer (aged 0-14 years, 1958-2018) in Sweden who survived ≥ 5 years post-diagnosis and were alive and residing in Sweden on December 31st, 2023. We also described the clinical and sociodemographic characteristics of this population and presented the observed prevalence over time (1990-2023) and projected prevalence under different mortality assumptions (2024-2040). On December 31st, 2023, there were 8645 long-term childhood cancer survivors in Sweden, equivalent to nearly 1 in 1000 inhabitants (921 persons per million). Leukemias (28.3%) and central nervous system tumors (27.0%) were the most common childhood cancer diagnoses, although the distribution of cancer type varied by attained age. Disease burden in the preceding five years was heterogeneous: approximately 25-30% of the survivors had no recent diagnoses or prescriptions, while a similar proportion experienced substantial morbidity. Most adult survivors were employed (72.0%) and relatively few received sickness benefits (9.7%). From 1990 to 2023, the long-term survivor population tripled in size. Projected mean annual growth was between 1.6% and 2.2%, with the population increasing to approximately 11,400 - 12,600 individuals by 2040. As this heterogeneous population continues growing, our comprehensive description can help plan survivorship care and provide a benchmark for prevalence estimates in settings with less complete data.
Background and Objectives: Medial unicompartmental knee arthroplasty (UKA) has emerged as an effective surgical option for isolated medial compartment osteoarthritis (OA), offering advantages in bone preservation, knee kinematics, and postoperative recovery compared with total knee arthroplasty (TKA). Although numerous studies have evaluated the mid- to long-term outcomes of UKA, reports focusing on cohorts with follow-up periods exceeding 10 years remain relatively limited. The purpose of this study was to analyze the long-term clinical and radiological results of medial fixed-bearing UKA using the Miller-Galante prosthesis. Methods: Sixty-eight patients who underwent UKA at a single institution with at least 10 years of follow-up were retrospectively reviewed. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM). Radiological parameters including the hip-knee-ankle axis angle (HKA) and osteoarthritis (OA) grade using the Kellgren-Lawrence (K-L) grading system were evaluated. Implant survivorship was evaluated using Kaplan-Meier survival analysis. Results: A total of 68 patients were included with a mean age of 56.8 ± 7.5 years at surgery and a mean follow-up of 170.9 ± 37.3 months. Significant improvement in the WOMAC score was observed from 48.9 ± 17.2 preoperatively to 23.8 ± 27.7 at final follow-up (p = 0.002). The cumulative survival rates were 97.1% at 10 years and 84.8% at 15 years with conversion to total knee arthroplasty as the endpoint. Significant improvement in the HKA was observed from 172.5° ± 4.4° to 174.3° ± 4.8° postoperatively (p = 0.002), though residual varus alignment persisted. Progressive OA was observed in the lateral tibiofemoral and patellofemoral compartments (both p < 0.001) but showed no correlation with the WOMAC score. The failure group showed trends toward higher body mass index (BMI) and smaller preoperative HKA angle compared to the non-failure group. Conclusions: The long-term outcomes of medial fixed-bearing UKA using the Miller-Galante prosthesis were generally favorable, with significant functional improvement and acceptable implant survivorship. Although overall varus alignment was corrected, some residual varus deformity remained, and OA progression was observed in the lateral tibiofemoral and patellofemoral compartments over time. However, given the retrospective design and limited sample size, these findings should be interpreted with caution.