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.

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.

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.

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.

Breast Cancer Survivor’s Views on Duration of Follow Up

Background: Breast cancer is one of the commonest cancers in women in the UK and western countries [1]. Follow ups after breast cancer diagnosis is usual practice, but there is no agreed consensus among breast care providers on frequency or duration of follow up after diagnosis and adjuvant treatment. The aim of this study is to find out women’s views on the period of the clinical follow up after breast cancer diagnosis. Method: This was a surveillance study in Greenock and Glasgow in the UK (Between September 2009 and December 2010). The study group comprised of 446 Women, 246 with the history of breast cancer diagnosed 1 - 10 years, (median 4.2 years) were asked to complete a questionnaire about their views of preferred duration of follow up while they were waiting for the annual review at a breast clinic, the same questionnaire was completed by 200 women with no history of breast cancer. Results: Between September 2009 and December 2010, 246 patients were included in the study. 40% of patients were within the first three years of follow up, 27% between the 4th and 6th year and 33% were in follow-up for more than 6 years. 63% of cancer survivors think that, 10 years of follow up is necessary for reassurance, detection and treatment of any new, recurrent or spread of their breast cancer. 14% and 22% of women with a history of breast cancer preferred 3 and 5 years review by trained Radiologist/GP respectively. Women without a history of breast cancer were different in their thoughts about follow up after breast cancer: 10%, 25%, and 30% chosen 10, 5 and 3 years, 35% preferred don’t know the answer. Conclusion: Follow up programs for breast cancer survivors need to be organized, evidence based, flexible and patient tailored. Patients’ views should be taken into account when considering provision of follow-up care for breast cancer patients.

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.

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.

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.

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.

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.

Effects of dual sofosbuvir/daclatasvir therapy on, chronic hepatitis C infected, survivors of childhood malignancy

BACKGROUND Childhood cancer survivors are potentially at a higher risk of infection with hepatitis C virus (HCV).The effects of all-oral direct-acting antiviral therapy (DAA) on both the HCV infection as well as the state of cancer remission have not been well investigated in this population.AIM To test the effects of dual sofosbuvir/daclatasvir (SOF/DCV) therapy in the treatment of chronic HCV in survivors of hematologic malignancy in pediatric age group.METHODS We conducted a prospective,uncontrolled,open-label multicenter study.A total of 20 eligible,chronic HCV,genotype-4,infected children who had been in continuous complete remission from hematologic cancer (leukemia/lymphoma) for at least one year were included in the study.All patients were treated with combined SOF/DCV for 12 wk.Patients were monitored throughout the study till 12 wk after end of treatment for safety and efficacy outcomes including the sustained virologic response 12 (SVR12) rate,hematological indices,liver and kidney functions.RESULTS The intent-to-treat SVR12 rate was 20 of 20 (100%;95%CI: 84%-100%).All patients showed normalized liver enzymes from week-4.All hematological indices,liver and kidney functions were kept normal throughout the study.No fatalities or treatment-emergent serious or severe adverse events were reported throughout the study.CONCLUSION SOF/DCV combined therapy could be used safely and effectively in the treatment of chronic HCV genotype-4 infection in leukemia/lymphoma treated children.No relapses were detected during treatment and throughout the follow up period for either the original malignant disease or the HCV infection.

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World.In cancer patients,cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease.An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades.Determining and handling the long-term effects of cancer treatment have become more important nowadays,parallel to the good results reached in survival rates.Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications.Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart.Approximately ten years after the completion of all therapies,the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma.The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review,in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment.Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.

Mental health disorders in child and adolescent survivors of post-war landmine explosions

Background: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions.Methods: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders(DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders.Results: Seventy-eight child and adolescent survivors with a mean age of 16.11±2 years old were identified and agreed to participate in the study. The mean age of the victims at the time of injury was 8.2±3.12 years old(range 2–15). Thirty-seven(47.4%) of the adolescent survivors suffered from at least one psychiatric disorder. Twenty-nine survivors(37.1%) were newly diagnosed and needed to start medication and psychiatric treatment. The most common findings were anxiety disorders(34.6%), including posttraumatic stress disorder(PTSD) in 20(25.6%), and generalized anxiety disorder(GAD) in 7(9%) subjects. Mild-Moderate depression was found in 5(6.4%) subjects. No personality disorders were observed, and two patients suffered from mental retardation. The study results revealed a significant association between age of casualty, duration of injury and limb amputation, and types of psychological disorders.Conclusion: Child and adolescent survivors of landmine explosions had a high prevalence of psychiatric disorders.

Expectations of survivors towards disaster nurses in Indonesia:A qualitative study

Objective: This study aims to explore the expectations of survivors towards disaster nurses.Methods: The study used qualitative content analysis.Data were collected in 2017 through three focus group discussions with 21 survivors and in-depth interviews with three community leaders;the respondents had experienced one of the following events: a) an earthquake in Padang 2009,b) a volcanic eruption in Yogyakarta 2010,and c) flooding in Jakarta 2014.Results: Four themes represented survivors' expectations of what nurses can do in responding to a disaster,including: a) provision of direct nursing care,b) provision of information of health service access,c) provision of resources through cross-sector coordination,and d) disaster preparedness activities for the community.Conclusions: This study suggests the importance of disaster nurses having the competency to update information regarding healthcare access,particularly the utilization of health insurance and providing culturally competent care to the survivors.Disaster nurses are also expected to be able to train the community and families about preparedness-related activities.Besides,these disaster nurses should improve their competency in disaster risk reduction.More broadly,such nurses should have the ability to advocate and coordinate with the local government and other stakeholders regarding access to healthcare services and continuous rapid assessment,so that survivors receive immediate and appropriate treatment.

LOW-POWER SURVIVOR MEMORY ARCHITECTURE FOR DFSE IN 1000BASE-T TRANSCEIVER

A novel approach to survivor memory unit of Decision Feedback Sequence Estimator(DFSE) for 1000BASE-T transceiver based on hybrid architecture of the classical register-exchange and trace-back methods is proposed.The proposed architecture is investigated with special emphasis on low power and small decoder latency,in which a dedicated register-exchange module is designed to provide tentative survivor symbols with zero latency,and a high-speed trace back logic is presented to meet the tight latency budget specified for 1000BASE-T transceiver.Furthermore,clock-gating register banks are constructed for power saving.VLSI implementation reveals that,the proposed architecture provides about 40% savings in power consumption compared to the traditional register-exchange architecture.

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.

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.

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).

The Relationship between Workplace Stressors and Job Strain with Psychological Distress among Employed Malaysian Breast Cancer Survivors

Evidence showed occupational factors may contribute distress to breast cancer survivors, however, very few studies focused on the occupational factors and job strain among breast cancer survivors. This study examined the relationship between job strain and workplace stressors with psychological distress among employed breast cancer survivors after the completion of their medical treatment. Study subject were outpatients of 2 hospitals and members of 4 breast cancer support groups. They were requested to fill up the Job Content Questionnaires (JCQ), the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) were filled up by the selected respondents. On simple logistic regression, psychological job demand and job strain were significantly associated with anxiety, distress on HADS-T and DT at (p < 0.001). While, psychological job demand (p < 0.001), social support (p = 0.047) and job strain (p < 0.001) were significantly associated with depression. Results showed survivors with high job strain has 4.74 time the odds of having anxiety (p < 0.001). Survivors with high psychological job demand have 8.08 time the odds of getting depression (p < 0.001). On the other hand, social support served as a protective factor of depression, (p = 0.041). Survivors with high psychological job demand were 4.4 time the odds of having distress (HADS-T) (p = 0.012). As a conclusion, survivors who experienced high psychological job demand, low social support and high job strain were reported with anxiety, depression or psychological distress.