Web-based cognitive interventions on subjective cognitive impairment in cancer survivors:A systemic review

Objective:Cancer survivors have experienced subjective cognitive impairment(SCI)when they received cancer diagnoses or treatments.Their psychosocial and emotional statuses were also impacted.With the advancement of web technologies,web-based cognitive interventions have been implemented in the management and the alleviation of the SCI,the psychosocial distress,and the emotional distress in cancer survivors.This review aimed to summarize the intervention contents of web-based cognitive interventions for SCI,and to explore the effects of the interventions on SCI,psychosocial status,and emotional health.Methods:Six databases(CINAHL Plus,Cochrane Library,Embase,APA PsycInfo,PubMed and CNKI)were searched from the establishment of databases up to December 2023.Literature references were also manually searched for related articles.Results:This review contained 21 studies that covered the contents of web-based cognitive interventions,such as computer-assisted cognitive training,online cognitive rehabilitation,cognitive behavior therapy with the Internet,telehealth physical exercise,and web-based mindfulness interventions.The effects of web-based cognitive interventions positively impacted SCI for cancer survivors.Also,these interventions showed varying degrees of effectiveness in alleviating psychosocial and emotional distresses.Conclusion:By summarizingfive types of cognitive intervention contents delivered via web technology,this review demonstrated that web-based cognitive interventions optimized SCI and overall psychosocial and emotional statuses for the cancer survivors.It is recommended that future research focus on the development of customized web-based cognitive interventions for individuals with SCI,along with their psychosocial and emotional statuses.

Management of genitourinary syndrome of menopause in breast cancer survivors:An update

There is increasing attention about managing the adverse effects of adjuvant therapy(Chemotherapy and anti-estrogen treatment)for breast cancer survivors(BCSs).Vulvovaginal atrophy(VVA),caused by decreased levels of circulating estrogen to urogenital receptors,is commonly experienced by this patients.Women receiving antiestrogen therapy,specifically aromatase inhibitors,often suffer from vaginal dryness,itching,irritation,dyspareunia,and dysuria,collectively known as genitourinary syndrome of menopause(GSM),that it can in turn lead to pain,discomfort,impairment of sexual function and negatively impact on multiple domains of quality of life(QoL).The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures,introitus,and vaginal mucosa.Systemic estrogen treatment is contraindicated in BCSs.In these patients,GSM may be prevented,reduced and managed in most cases but this requires early recognition and appropriate treatment,but it is normally undertreated by oncologists because of fear of cancer recurrence,specifically when considering treatment with vaginal estrogen therapy(VET)because of unknown levels of systemic absorption of estradiol.Lifestyle modifications and nonhormonal treatments(vaginal moisturizers,lubricants,and gels)are the first-line treatment for GSM both in healthy women as BCSs,but when these are not effective for symptom relief,other options can be considered,such as VET,ospemifene,local androgens,intravaginal dehydroepiandrosterone(prasterone),or laser therapy(erbium or CO2 Laser).The present data suggest that these therapies are effective for VVA in BCSs;however,safety remains controversial and a there is a major concern with all of these treatments.We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research.We include recommendations for an approach to the management of GSM in women at high risk for breast cancer,women with estrogen-receptor positive breast cancers,women with triplenegative breast cancers,and women with metastatic disease.

“I Felt Defeated. I Felt Helpless”: Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

A Review of the Research on Symptom Clusters in Cancer Survivors

Cancer survivors often experience multisymptom clusters, substantial discomfort and lower QOL (quality of life) than the general population. This article summarized the progress of the research on symptom clusters in cancer survivors, and reviewed the definitions, influencing factors, and identified approaches and interventions regarding symptom clusters. The findings allow recommendations to be made in clinical nursing to improve the QOL of cancer survivors. In future studies, longitudinal, large-sample and multicenter studies are recommended to obtain more in-depth information about the changes in symptom and symptom cluster experience perceived by groups of cancer survivors.

Evaluation of the Long-Term Changes in Fatigue of Cancer Survivors Who Received Outpatient Chemotherapy in the Area Affected by the Great East Japan Earthquake

Objective: The aim of the study is to evaluate the long-term changes in fatigue of cancer patients receiving outpatient chemotherapy after a disaster such as the Great Earthquake. Methods: From 2012 to 2014, we measured subjective fatigue, autonomic function, and physical activity with reference to the criteria for chronic fatigue syndrome. Results: The participants were 13, 9 males (69.2%) and 4 females (30.8%). The most common cancer among the participants was lung cancer 4 patients (30.8%). In 2012, eight patients (61.6%) received anti-cancer drugs and three (23.0%) received the drug by intravenous drip and oral administration. Physical fatigue (p = 0.004), mental fatigue (p = 0.002), comprehensive fatigue (p = 0.012), and comprehensive evaluations (p = 0.032) were significantly different. Significant differences in the autonomic nervous function were observed during the three years from 2012 to 2014 (log LF [p = 0.017], log HF [p = 0.023] and log LF/HF [p = 0.039]). Similar to Subjective fatigue, Significant differences in physical activity were observed during the three years from 2012 to 2014 (DA [p = 0.042], TST [p = 0.037], SE [p = 0.018], AW [p = 0.023] and Naps [p = 0.014]). Conclusions: The participants fatigue worsened at one time, but showed improvement over time. In the event of an emergency such as a disaster, it is necessary to evaluate the physical and mental condition based on objective indicators of cancer patients receiving anti-cancer drug treatment and provide nursing support.

Cardiovascular risk management in cancer survivors:Are we doing it right?

Although under-recognized,cancer survivors continue to be at an increased risk of death from cardiovascular complications post-remission or cure.This increased burden of cardiovascular disease results from the interplay of various factors.Adequate cardiovascular risk assessment and timely intervention through a multi-disciplinary approach in these patients plays a pivotal role in the prevention of cardiovascular morbidity and mortality.We discuss the shortcomings of using current risk prediction scores in cancer survivors and provide some insights into cardiovascular risk management relevant for primary care physicians,oncologists,and cardiologists alike.

What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

AIM： To identify a cost-effective strategy of second primary colorectal cancer （CRC） screening for cancer survivors in Korea using a decision-analytic model. METHODS： A Markov model estimated the clinical and economic consequences of a simulated 50-year- old male cancer survivors＇ cohort, and we compared the results of eight screening strategies： no screening, fecal occult blood test （FOBT） annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years （COL10）, every 5 years （COL5）, and every 3 years （COL3）. We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost- effectiveness ratio （ICER）. RESULTS： In the base-case analysis, the non-dominat- ed strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life- year saved （LYS）, and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in can- cer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was tess than $7400/LYS regardless of screening compliance. CONCLUSION： Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Comparable outcomes but higher risks of prolonged viral RNA shedding duration and secondary infection in cancer survivors with COVID-19: A multi-center, matched retrospective cohort study

Results Sixty-one cancer survivors and 183 matched non-cancer patients were screened from 2,828 COVID-19 infected patients admitted to 4 hospitals in Wuhan,China.The median ages of the cancer survivor cohort and non-cancer patient cohort were 64.0(55.0–73.0)and 64.0(54.0–73.5),respectively(P=0.909).Cancer survivors reported a higher incidence of symptom onset than non-cancer patients.Fever(80.3%vs.65.0%;P=0.026)was the most prevalent symptom,followed by cough(65.6%vs.37.7%;P<0.001),myalgia,and fatigue(45.9%vs.13.6%;P<0.001).The risks of the development of severe events(adjusted hazard ratio[AHR]=1.25;95%confidence interval[CI]:0.76–2.06;P=0.378)and mortality(relative risk[RR]=0.90,95%CI:0.79–1.04;P=0.416)in the cancer survivor cohort were comparable to those of the matched non-cancer patient cohort.However,the cancer survivor cohort showed a higher incidence of secondary infection(52.5%vs.30.1%;RR=1.47,95%CI:1.11–1.95;P=0.002)and a prolonged viral RNA shedding duration(32 days[IQR 26.0–46.0]vs.24.0 days[IQR 18.0–33.0];AHR=0.54;95%CI:0.38–0.80;P<0.05).Conclusion Compared to non-cancer patients,cancer survivors with COVID-19 exhibited a higher incidence of secondary infection,a prolonged period of viral shedding,but comparable risks of the development of severe events and mortality.It is helpful for clinicians to take tailored measures to treat cancer survivors with COVID-19.

Psychiatric comorbidities in cancer survivors across tumor subtypes:A systematic review

BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depression and posttraumatic stress disorder(PTSD).AIM To identify studies that examined the prevalence of clinically relevant levels of depression,anxiety,comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.METHODS Four databases(PubMed,PsycInfo,PubPsych and the Cochrane Database)were searched and resulted in a total of 2387 articles to be screened.To be included,a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities.All articles were screened by two authors with a third author reviewing debated articles.RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review.The studies showed heterogeneity regarding the study characteristics,number of participants,time since diagnosis,and assessment tools.Generally,all four comorbidities show higher prevalences in cancer survivors than the general population.Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety.Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities.Regarding comorbidities,a wide range in prevalence existed across the tumor types.Within one cancer site,the prevalence also varied considerably among the studies.CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population,as reflected by the prevalence of depression,anxiety,comorbid anxiety-depression and PTSD across all tumor subtypes.Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.

Occupational Therapy in Cancer Survivorship—A Toolkit for Stimulating Rapid-Research on the Neglected Domain of “Participation” during COVID-19

COVID-19 has disrupted people’s occupational daily activities with detrimental impact on their daily living performances and quality of life. Occupational therapy contributes toward restoring health by remediating limitation in participation in meaningful occupation with lifestyle redesign interventions. However, the research gap on the area of “participation-limitation” for the field of Occupational Therapy in cancer survivorship during the COVID-19 is largely untapped and unknown. This commentary-review paper discussed the PEO-OT (person-environment-occupation) grid as a conceptual toolkit for stimulating research in the domain of occupational participation—an essential aspect in the field of occupational therapy, for cancer survivors. It applies the expertise finding from a large Delphi study on research priority in the fields and integrating these into evidenced methodology, to provide a structure to guide the novice researchers towards rapid reviews, by selecting evidence-based methods to ensure contextually-relevant enquiry to identify the “occupational-participation issues”—i.e., an emerging social determinant of health, affecting the daily self-management of cancer survivors with or without comorbidities.

Health Management of Breast Cancer Survivors

Breast cancer is defined as a chronic disease.Increasing amounts of attention have been paid to the healthmanagement of breast cancer survivors. An important issue ishow to find the most appropriate method of follow-up in orderto detect long-term complications of treatment, local recurrenceand distant metastasis and to administer appropriate treatmentto the survivors with recurrence in a timely fashion. Differentoncology organizations have published guidelines for followingup breast cancer survivors. However, there are few articles onthis issue in China. Using the published follow-up guidelines,we analyzed their main limitations and discussed the content,follow-up interval and economic benefits of following up breastcancer survivors in an effort to provide suggestions to physicians.Based on a large number of clinical trials, we discussed the roleof physical examination, mammography, liver echograph, chestradiography, bone scan and so on. We evaluated the effects ofthe above factors on detection of distant disease, survival time,improvement in quality of life and time to diagnosis of recurrence.The results of follow-up carried out by oncologists and primaryhealth care physicians were compared. We also analyzed thecorrelation factors for the cost of such follow-up. It appears thatfollow-up for breast cancer survivors can be carried out effectivelyby trained primary health care physicians. If anything unusualarises, the patients should be transferred to specialists.

Association between Post-Diagnosis Dietary Quality and Mortality in Prostate Cancer Survivors: Insights from NHANES 2005-2018

Background: Limited and inconsistent evidence is available on the association between dietary quality and mortality in prostate cancer (PCa) survivors. The present study aimed to elucidate the association between dietary quality, measured by the Healthy Eating Index (HEI), and mortality outcomes in PCa survivors. Methods: We analyzed data from 460 PCa survivors, representing a population of 2.25 million, derived from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The HEI-2020 total and component scores were calculated based on the 24-hour dietary recall interviews, and a qualified score indicates a higher diet quality. The Weighted Cox Proportional Hazards Models were employed to evaluate the association between HEI-2020 and mortality outcomes. Results: After adjusting for potential confounders, no significant association was observed between the total HEI-2020 score and all-cause, cancer-specific, or non-cancer mortality. As for the components, a qualified fatty acid score (indicating higher consumption of poly- and monounsaturated fatty acids), and a qualified added sugars score (indicating lower consumption) were associated with reduced risk of all-cause mortality (HR 0.64 and 0.54, 95%CI: 0.41 - 1.00 and 0.31 - 0.94, respectively) and cancer-specific mortality (HR 0.33 and 0.40, 95%CI: 0.14 - 0.79 and 0.17 - 0.92, respectively, all P Conclusions: Higher HEI-2020 scores do not uniformly translate to a reduced mortality risk among PCa survivors, and recommendations should focus on balanced dietary habits that emphasize healthier fat sources and reduced added sugars intake to enhance long-term survival and quality of life for this population. These results also highlight the need for further research with a larger sample size to develop tailored dietary assessments and recommendations for PCA survivors.

Chinese Medicine Approach in Clinical Practice for Breast Cancer Survivors

A Chinese medicine （CM） approach, designed based on the clinical experiences of the West Los Angeles Center for Traditional Chinese Medicine, is a practical path for assessing and treating breast cancer survivors. The approach consists of balancing the body with deciphering the cause of the patient＇s chief complaints by assessing and recognizing the six physiological dysfunctions that include gastrointestinal problems, sleeps problems, emotional imbalance, low body energy, menstrual change and pain. Multifaceted interventions are used for eliminating various CM pathologies based on identifying the basic CM patterns （syndromes） differentiation. Watching to assess the above two situations dynamically is used for outcome evaluation and predicting prognosis. Therefore this approach is called BMW. It can serve as a reference for CM clinical practice and integrative clinical care. It also can be used to simplify the clinical interpretation of CM and provide an easier way for CM doctors to communicate with Western medical doctors and patients. Additionally, it can be used as a guide for patients to assess their own symptoms for self-monitoring and self-care.

Assessment of Cancer-Related Fatigue Expression:Comparing the Expression of Fatigue in Patients with a History of Cancer,Patients with Other Chronic Diseases,and Healthy Individuals

Aims:We aimed to compare cancer survivors’fatigue expression with that of the general population and examine psychobiological factors associated with fatigue.Procedure:In this quantitative,transversal study,we analyzed clinical and sociodemographic indicators of 389 participants(68.38%females):148 cancer survivors on active treatment,55 disease-free survivors,75 patients with another chronic disease,and 111 healthy individuals.Results:Fatigue was expressed dissimilarly in patients with a previous history of cancer and participants without a history of cancer.Survivors on active treatment reported significantly higher levels of fatigue than the other clinical status groups.Nonetheless,some level of cancer-related fatigue persisted,in a similar pattern,after active treatment into the survivorship phase.Disease-free survivors showed significantly lower vigor levels when compared to patients with other chronic diseases.Psychological distress and daytime sleepiness emerged as transdiagnostic factors associated with fatigue.Conclusion:Cancer-related fatigue may have a unique pattern,characterized by reduced endurance and muscle weakness.In the present study,psychological distress and daytime sleepiness are associated with cancer-related fatigue.These findings suggest the pertinence of future studies examining whether interventions targeting those factors may help manage this burdensome complaint.

Care of survivors of gynecologic cancers

The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.

Research status of internet-delivered cognitive behavioral therapy in cancer patients

The latest global cancer burden data released by the International Agency for Research on Cancer of the World Health Organization in 2020 shows that there were 19.29 million new cancer cases worldwide,with 4.57 million in China,ranking first.The number of cancer survivors is increasing,with a 5-year survival rate exceeding 85%,but there are emotional disorders.Cognitive behavioral therapy(CBT)can improve negative emotions and has significant effects on patients.However,there is a limited number of physicians and high costs,so internet interventions have become a solution.The feasibility of web-based interventions for breast cancer patients has been proven.Research on internet-delivered CBT is also increasing.The purpose of this study was to review the concept of web-based CBT and its application status in cancer survivors,in order to provide relevant intervention for scholars and provide reference and supplement for patients to provide psychological therapy.

Exploratory Study of Intolerance of Uncertainty and Its Cognitive Processes by the Stroop Task among Parents of a Childhood Cancer Survivor

Introduction.No study has examined the relationship between the factor of intolerance of uncertainty and its effects on the cognitive processes among parents of a childhood cancer survivor.Intolerance of uncertainty is a central factor in generalized anxiety disorder;an anxiety disorder in which impaired processing of cognitive information in the form of cognitive biases is also observed.The aim of the study was to measure,via a classical Stroop test and an emotional Stroop test,the orientation of selective attention in relation to the uncertainty intolerance factor.Methods.61 parents of a childhood cancer survivor(aged 4 to 6 years)were recruited from hospitals in the Province of Liege(Belgium).Parents completed questionnaires on intolerance of uncertainty and its associated factors(i.e.,usefulness of worry,cognitive avoidance,problem-solving attitude,and ruminations)and performed a Stroop test and an emotional Stroop task.Spearman correlations and multiple linear regressions were performed.Results.The results indicated positive and significant correlations between the emotional Stroop(negative interference index)and intolerance to uncertainty but also with repetitive thoughts(ruminations)and worries.Linear regressions showed that depressive symptoms seem to contribute to explaining longer latencies for the interference condition(color word written in another color).Conclusion.Recommendations have been published to improve the management of parents of a childhood cancer survivor,but parent-centered neuropsychological studies are still needed and should be developed to improve prevention and detection initiatives for these families.

Endothelial impairment evaluation by peripheral arterial tonometry in pediatric endocrinopathies:A narrative review

Endothelial dysfunction(ED)is characterized by an imbalance between vasodilator and vasoconstriction agents.Several pathological conditions clinically diagnosed in childhood and adolescence are characterized by ED and increased risk for early development of microangiopathic and macroangiopathic impairment,in particular type 1 diabetes mellitus(T1DM),T2DM,obesity,metabolic syndromeand pituitary dysfunction associated to various endocrinopathies.More recently insulin resistance following chemotherapy or radiotherapy for tumors,bone marrow transplantation for hematological malignancies(i.e.,cancer survivors),or immunosuppressive treatment for solid organ transplantation has been observed.Assessment of ED by means of non-invasive techniques is the gold standard for early ED detection before clinical manifestation.It is aimed to recognize patients at risk and to avoid the development and progression of more serious illnesses.Reactive hyperemia-peripheral artery tonometry is a noninvasive technique to assess peripheral endothelial function by measuring modifications in digital pulse volume during reactive hyperemia,and represents a non-invasive,reproducible and operator-independent tool able to detect precocious ED.This narrative review aimed to provide an overview of the most important papers regarding ED detection by EndoPat 2000 in children and adolescents with different endocrine diseases.A comprehensive search of English language articles was performed in the MEDLINE database without using other search filters except the publication interval between 2005 and 2020.

Disseminated carcinomatosis of the bone marrow caused by granulocyte colony-stimulating factor:A case report and review of literature

BACKGROUND Disseminated carcinomatosis of the bone marrow(DCBM)is a widespread metastasis with a hematologic disorder that is mainly caused by gastric cancer.Although it commonly occurs as a manifestation of recurrence long after curative treatment,the precise mechanism of relapse from dormant status remains unclear.Granulocyte colony-stimulating factor(G-CSF)can promote cancer progression and invasion in various cancers.However,the potential of G-CSF to trigger recurrence from a cured malignancy has not been reported.CASE SUMMARY A 55-year-old Japanese woman was diagnosed with Ewing sarcoma localized on the fifth lumbar vertebrae 6 years after curative gastrectomy for T1 gastric cancer.After palliative surgery to release nerve compression,pathological diagnosis of the resected specimen was followed by curative radiation and chemotherapy.During treatment,G-CSF was administered 32 times for severe neutropenia prophylaxis.Eight months after completing definitive treatment,she complained of severe back pain and was diagnosed as multiple bone metastases with DCBM from gastric cancer.Despite palliative chemotherapy,she died of disseminated intravascular coagulation 13 d after the diagnosis.Immunohistochemical examination of the autopsied bone marrow confirmed a diffuse positive staining for the G-CSF receptor(G-CSFR)in the relapsed gastric cancer cell cytoplasm,whereas the primary lesion cancer cells showed negative staining for G-CSFR.In this case,G-CSF administration may have been the key trigger for the disseminated relapse of a dormant gastric cancer.CONCLUSIONWhen administering G-CSF to cancer survivors,recurrence of a preceding cancer should be monitored even after curative treatment.

Quality of life and survival outcomes of patients with inoperable esophageal squamous cell carcinoma after definitive radiation therapy:A multicenter retrospective observational study in China from 2015 to 2016

Objectives:To investigate the health-related quality of life(HRQL)of long-term survivors of inoperable esophageal squamous cell carcinoma(ESCC)treated with definitive radiation therapy,the real-world trends in the use of advanced radiation techniques,and their impact on the survival outcomes of ESCC patients.Methods:In this multicenter retrospective observational study,the medical records related to demographics and treatment of ESCC patients who were treated with definitive radiation therapy at 14 provincial hospitals in China from 1 January 2015 to 31 December 2016 were analyzed.A HRQL questionnaire was completed by survivors and collected by doctors at the final follow-up.The difference in quality of life between patients with or without recurrence was compared using the Wilcoxon-Mann-Whitney test.Overall survival(OS)was estimated using the Kaplan-Meier method and the group differences were assessed by unstratified log-rank test.The Cox proportional hazards model with Efron’s method of tie handling was used to calculate the risk factors for OS.Results:The data of a total of 3,308 patients were collected for this study,248 were excluded because of missing data,and a final of 3,060 patients were included in the analysis.Most patients(2,901;94.8%)received intensity-modulated radiotherapy(IMRT)/volumetric-modulated arc therapy(VMAT)/tomotherapy(TOMO).The 5-year OS rate was 30%.Patients who received either two-dimensional radiotherapy(2DRT;HR,2.43[95%CI,1.70-3.47];P<0.001)or three-dimensional radiotherapy(3DRT;HR,1.45[95%CI,1.14-1.84];P=0.003)had a significantly increased risk of death compared to those who received IMRT/VMAT/TOMO.Of the 716(23.4%)long-term survivors who completed the HRQL questionnaire,nearly 70%patients were still able to swallow normally or almost normally,and>80%patients did not experience weight loss.Nearly 80%patients found life very enjoyable or were fairly enjoying life.Conclusions:This large,multicenter retrospective study on ESCC patients who received definitive radiation ther-apy found that most ESCC survivors are satisfied with their quality of life.Most patients received advanced radiation technology.Patients who received either 2DRT or 3DRT had a significantly increased risk of death compared to those who received advanced radiation technology.