Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer

Objective:Long-term survivors(LS)of non-small cell lung cancer(NSCLC)without driver alterations,displaying an overall survival(OS)of more than 3 years,comprise around 10%of cases in several series treated with chemotherapy.There are classical prognosis factors for these cases[stage,Eastern Cooperative Oncology Group(ECOG),etc.],but more data are required in the literature.In this multi-center study,we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization.Methods:In the first step,we conducted a clinical-pathological characterization of the patients.Afterwards,we carried out a genetic analysis by comparing LS to a sample of short-term survivors(SS)(with an OS less than 9 months).We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS,and later confirmed these with reverse transcription-polymerase chain reaction(RT-PCR)for the rest of the samples.Results:A total of 94 patients were included,who were mainly men,former smokers,having adenocarcinoma(AC)-type NSCLC with an ECOG of 0-1.We obtained an initial differential transcriptome expression,displaying 5 over-and 33 under-expressed genes involved in different pathways:namely,the secretin receptor,surfactant protein,trefoil factor 1(T FF1),serpin,Ca-channels,and Tolllike receptor(TLRs)families.Finally,RT-PCR analysis of 40(20 LS/20 SS)samples confirmed that four genes(surfactant proteins and SFTP)were significantly down-regulated in SS compared to LS by using an analysis of covariance(ANCOVA)model:SFTPA1(P=0.023),SFTPA2(P=0.027),SFTPB{P=0.02),and SFT PC(P=0.047).Conclusions:We present a sequential genetic analysis of a sample of NSCLCLS with no driver alterations,obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

Bone Marrow Transplant Long-Term Survivors’ Satisfaction with Quality of Life: Comparison with a Control Group

Purpose: To evaluate the global quality of life (QoL) of survivors with 10-year or more post-transplant, and to identify risk factors that interfere with well-being. Methods: This is a prospective analytic transversal study with 214 survivors of Bone Marrow Transplant (BMT) and 264 healthy people identified among blood donors, treated as the control group, of both sexes, 18 years or older. The protocol includes a demographic-socioeconomic questionnaire, World Health Organization Quality of Life (WHOQOL) and the Karnofsky Performance Status Scale. Results: 53.7% of the survivor group members are satisfied with their QoL. A similar result can be found in the control group (54.2%). Chronological maturity, anxiety, sexual difficulty, and being a provider are factors that interfere negatively in the QoL of male survivors. In female survivors, the risk factors are anxiety, low educational level, not having a stable partner, being a provider, and not being Caucasian. Conclusions: Survivors are as satisfied with their QoL as the control group. QoL is understood as a perceptive process composed of objective (functional and relational capacity) and subjective phenomenon (perceptive composition).

Clinical Significance of Pulmonary Function Tests in Long-Term Survivors after Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

We retrospectively assessed long-term pulmonary function in adults surviving for ≥5 years after myeloablative allogeneic hematopoietic stem cell transplantation and identified risk factors for late-onset noninfectious pulmonary complications. Among 174 patients undergoing transplantation for hematologic malignancies between May 1994 and December 2004, 81 long-term survivors were evaluated. Pulmonary function tests (PFTs) were performed before conditioning, 3 months and 1 year after transplantation, and then annually. Eight patients (10%) had abnormal pulmonary function before transplantation, but this was not associated with late changes in PFTs. Patients with chronic graft-versus-host disease (GVHD) showed a significant decline of lung function after 3 years when compared with patients without chronic GVHD. Abnormal pretransplantation lung function was associated with pulmonary chronic GVHD according to National Institutes of Health criteria (score 0, n = 58;score 1, n = 14;score 2, n = 6;score 3, n = 3). Five patients with late-onset noninfectious pulmonary complications showed a decline of lung function at 1 year after transplantation. Only chronic GVHD was significantly related to late-onset noninfectious pulmonary complications. In conclusion, abnormal lung function before transplantation may be associated with a decline in pulmonary function within 1 year after transplantation, but late-onset noninfectious pulmonary complications could not be predicted from pretransplantation lung function.

Measurement Error in Proportional Hazards Models for Survival Data with Long-term Survivors

This work studies a proportional hazards model for survival data with ＂long-term survivors＂, in which covariates are subject to linear measurement error. It is well known that the naive estimators from both partial and full likelihood methods are inconsistent under this measurement error model. For measurement error models, methods of unbiased estimating function and corrected likelihood have been proposed in the literature. In this paper, we apply the corrected partial and full likelihood approaches to estimate the model and obtain statistical inference from survival data with long-term survivors. The asymptotic properties of the estimators are established. Simulation results illustrate that the proposed approaches provide useful tools for the models considered.

Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors

Background: Pancreaticoduodenectomy(PD) is the standard curative treatment for periampullary tumors. The aim of this study is to report the incidence and predictors of long-term survival( ≥ 5 years) after PD. Methods: This study included patients who underwent PD for pathologically proven periampullary adenocarcinomas. Patients were divided into 2 groups: group(I) patients who survived less than 5 years and group(II) patients who survived ≥ 5 years. Results: There were 47(20.6%) long-term survivors( ≥ 5 years) among 228 patients underwent PD for periampullary adenocarcinoma. Patients with ampullary adenocarcinoma represented 31(66.0%) of the long-term survivors. Primary analysis showed that favourable factors for long-term survival include age < 60 years old, serum CEA < 5 ng/mL, serum CA 19-9 < 37 U/mL, non-cirrhotic liver, tumor size < 2 cm, site of primary tumor, postoperative pancreatic fistula, R0 resection, postoperative chemotherapy, and no recurrence. Multivariate analysis demonstrated that CA 19-9 < 37 U/mL [OR(95% CI) = 1.712(1.24 8–2.34 8), P = 0.001], smaller tumor size [OR(95% CI) = 1.335(1.032–1.726), P = 0.028] and R0 resection [OR(95% CI) = 3.098(2.095–4.582), P < 0.001] were independent factors for survival ≥ 5 years. The prognosis was best for ampullary adenocarcinoma, for which the median survival was 54 months and 5-year survival rate was 39.0%, and the poorest was pancreatic head adenocarcinoma, for which the median survival was 27 months and 5-year survival rate was 7%. Conclusions: The majority of long-term survivors after PD for periampullary adenocarcinoma are patients with ampullary tumor. CA 19-9 < 37 U/mL, smaller tumor size, and R0 resection were found to be independent factors for long-term survival ≥ 5 years.

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.

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.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Marital Status in Moroccan Long-term Childhood Cancer Survivors

In developed countries, currently, more than 80% of children with cancer survive and they are considered as cured. However, the survivors are at high risk of medical and social late effects. In Morocco, childhood cancer accounts for 3% of all cancers. The purpose of this study was to look for factors related to marital status in Moroccan childhood cancer survivors. This was a cross-sectional study conducted among childhood cancer survivors treated between 1978 and 2004 at the Pediatric Oncology Unit of Children＇s Hospital of Rabat. Medical and demographic data were collected through questionnaires completed by phone or internet, by the survivor, his parent or his physician. Among 995 patients considered cured; only 195 were found. The decline from the initial diagnosis varies from 10 years to 36 years, with a mean of 16.2 years and a standard deviation of 6.3 years. In our study, we found that 31 survivoi＇s （22.3%） of adult participants were married. They were aged between 23 and 43 （the mean was 31.8 and the SD was 5.9）. Men, aged more than 35 years old and unemployed are less likely to be married. To our knowledge, there is no previous study about the fate of Moroccan childhood cancer survivors before our study. Hence, it was a cross-sectional study to have a quick picture on the situation in Morocco. It would be necessary to establish a follow-up strategy in Morocco.

Technology-based psychosocial support for adolescent survivors of leukemia:An example intervention for nurse specialists

Technology-based interventions are thought to be one of the innovative alternatives for improving the psychosocial health of adolescent survivors.This article outlines an example of technology-based psychosocial intervention for adolescent survivors of leukemia.This technology-based psychosocial support intervention consists of five separate modules related to personal development,coping skills,and a healthy lifestyle.intervention can be applied to adolescents(aged 12-18 years)who have completed leukemia treatment at least 2 years ago and are disease free.Psychosocial interventions are crucial to improving adolescent survivors’psychosocial well-being in long-term follow-up.It is thought that psychosocial interventions can be effective on survivors’self-efficacy,coping skills,and quality of life,and survivors will be satisfied with the program.Regarding the model of childhood cancer survivorship care,this intervention can be integrated into the follow-up program and guide pediatric oncology nurses in preparing support programs for adolescent survivors.

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.

The relationship between psychological distress with salivary <i>α</i>-amylase and stress related symptoms among breast cancer survivors

Background and Aims: This study examined the stress levels, the stressors and biomarker such as Alpha (α)-Amylase enzyme which is secreted under distress conditions. The aim was to determine the relationship between these three variables. Methods: The study respondents were made up of cancer outpatients from 3 hospitals namely the Hospital Kuala Lumpur, Seberang Jaya and Johor Baru, Pantai Ipoh and Putrajaya. The Personal Stress Inventory (PSI) questionnaire was used to identify stressors, while the Hospital Anxiety and Depression Scale (HADS) were used to determine the psychological distress levels. The Salimentary Oral Swab (SOS) Technique was used to collect the saliva and then the Salivary α-Amylase Assay Kit was used to analyse for α amylase. Results: The majority of respondents were stressed due to their sensitive emotion and nervousness in their daily lives (68.7%), they had poor memory and short attention spans of carrying out job tasks (67.3%) as well as they were emotionally depressed (65.3%). Their poor memory and short attention span (p = 0.037), heavy work load and poor task delivery (p = 0.008) were predictors for distress using HADS. The salivary α-amylase concentration was significantly related to the stress levels (p = 0.002). Conclusion: Breast cancer respondents with musculoskeletal system related symptoms, with heavy work load and poor task delivery, as well as had poor memory and short attention span were at higher risk of experiencing psychological distress. The salivary α-amylase which had significant relationships with psychological distress was therefore, a potential biological indicator for distress, while the musculoskeletal system related symptoms from the PSI questionnaire were predictors for distress.

Supportive care needs and health-related quality of life among Chinese lung cancer survivors

Purpose: The purpose of this study was to explore the supportive care needs and health-related quality of life (HRQoL) of lung cancer survivors, and to identify the association between patient characteristics, HRQoL and supportive care needs. Method: This was a sub-study of a larger scale survey of cancer survivors’ supportive care needs. A total of 48 lung cancer survivors were recruited from a regional teaching hospital, and a three-part structured questionnaire was used to collect 1) socio-demographic and clinical characteristics, 2) supportive care needs and 3) health-related quality of life data. Results: The three most commonly reported unmet needs were all in the health-system information domain: 1) being informed about your results as soon as possible (58%), 2) being informed about cancer which is under control or diminishing (50%), and 3) being informed about things you can do to help yourself get well (46%). The second most common unmet need domain was access to healthcare and ancillary support services. The survivors generally reported satisfactory HRQoL. However, household income and unmet physical and psychological needs were independently associated with HRQoL among these survivors. Conclusion: The high unmet needs in the health-system information area call for a review of the content and amount of information provided to lung cancer survivors. In addition, more attention should be given to lung cancer survivors with low incomes but high physical and psychological unmet needs, who require appropriate follow-up and long-term care of a physical, social and psychological kind.

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.

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.

“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.

Pay attention to the rehabilitation of cancer patients—Excerpts of the 2013 NCCN Guidelines for Survivorship

For some survivors, the consequences of cancer are minimal; these patients can return to a normal life after the completion of treatment. In fact, a majority of cancer survivors report being in good general health and experience good to excellent quality of life. A recent review suggests that at least 50% of survivors suffer from some late effects of cancer treatment. The most common problems in cancer survivors are depression, pain, and fatigue. The guidelines suggest the following standards for survivorship care:(1) prevention of new and recurrent cancers and other late effects;(2) surveillance for cancer spread, recurrence, or second cancers;(3) assessment of late psychosocial and medical effects;(4) intervention for consequences of cancer and treatment(eg, medical problems, symptoms, psychologic distress, financial and social concerns); and(5) coordination of care between primary care providers and specialists to ensure that all of the survivor's health needs are met. The NCCN Survivorship Panel hopes that these guidelines can help both oncologic and primary health care professionals lessen the burden left on survivors by their cancer experience so they can transition back to a rewarding life.

Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28)

We investigated the relationship between health-related quality of life (HRQOL) and psychological distress in intensive care unit (ICU) survivors 12 months after ICU discharge. The purpose of this study, conducted and completed before the onset of the COVID-19 pandemic, was to find correlations among psychiatric symptoms detected by a screening tool as the General Health Questionnaire-28 (GHQ-28) and the different domains of HRQOL measured with the SF-36 health survey (SF-36), in order to identify ICU survivors with Post-Intensive Care Syndrome (PICS) who need a specific psychiatric intervention to improve their HRQOL. Among 298 ICU survivors who stayed in the ICU for at least 72 hours, 48 patients were enrolled one year after discharge undergoing a clinical interview to assess their functional impairment (Barthel index), mental health (GHQ-28), and health-related quality of life (SF-36). 19% of those subjects had a GHQ-28 ≥ 5 and were identified as “psychiatric cases”, and they were older and experienced a greater impairment in HRQOL. Anxiety, insomnia, and depressive symptoms seemed to be particularly involved in the impairment of HRQOL. A negative correlation between GHQ-28 total scores and subscales and SF-36 subscales was found. Our findings highlighted that psychological distress in ICU survivors may negatively impact physical health recovery and quality of life;conversely, physical impairment and functional disability may trigger the onset of psychiatric symptoms after discharge. The present study is firstly to investigate the correlations between HRQOL and psychological distress in ICU survivors through the GHQ-28, and then affirms the need to carry out follow-up checks for psychiatric symptoms in ICU survivors.

3-to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge:Results from a Prospective,Multicenter Study

Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.

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.