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Background: The aim of this study was to synthesize available data on long-term survivorship for commonly performed cervical spine procedures using cutting-edge meta-analytic techniques. Methods: A systematic review of the Ovid Medline, Embase and CENTRAL databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Title, abstract and fulltext screening was done in duplicate with kappa scores used to measure agreement. Only articles with cohorts of greater than 20 patients followed for a minimum of 36 months and with available survival data were included. Procedures included were anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), laminoplasty and posterior laminectomy and fusion. Reconstructed individual patient data were pooled across studies using a Bayesian random-effects metaregression. Results: Our search identified a total of 1456 citations after exclusion of duplicates. After a full-text review of 156 titles, we included 20 studies including 8 randomized controlled trials. The total sample included 43 487 patients undergoing ACDF, 6800 patients undergoing laminoplasty, 2075 patients undergoing CDA and 32 871 patients undergoing posterior laminectomy and fusion. Our meta-regression of synthesized follow-up data with summary curves to 150 months for each of the aforementioned procedures. Posterior laminectomy and fusion was found to have significantly higher rates of secondary reoperation. At 60 months, implant survival was 94% (95% confidence interval 80%-95%) for laminoplasty, 87% (65%-96%) for laminectomy and fusion, 93% (83 %-97%) for CDA and 92% (80%-96 %) for ACDF. At 150 months, implant survival was 90% (68% -93 %) for laminoplasty, 82% (55%-92%) for laminectomy and fusion, 90% (70%-95%) for CDA and 89% (68%-93%) for ACDF. Conclusion: This is the first study to use rigorous statistical techniques to generate statistical models for time to failure of cervical spine procedures analyzing a total of over 85 000 patients. On the basis of long-term survival data from highquality publications, posterior laminectomy and fusion appears to have a significantly higher risk of secondary surgery when compared with ventral approaches or posterior laminoplasty. The granular survival curves produced by this study can be used to inform key decision-makers, counsel patients and aid in future trial design.

By the time you read this editorial, a new self-learning resource on cancer survivorship for oncology nurses will have been launched. It is scheduled for release by the Canadian Oncology Nursing Association (CANO/ACIO) in time for Oncology Nursing Day this year.

Purpose Our study provides data on depression and anxiety in long-term cancer survivors, in men, women and various age groups, as well as identifies associated factors and coping-related resources. Methods We present data obtained from 1002 cancer survivors across a large variety of tumour entities 5 years (cohort 1) and 10 years (cohort 2) after diagnosis, in a cross-sectional study. We analysed depression (PHQ-9) and anxiety (GAD-7) symptomatology in comparison with two large age- and sex-matched samples randomly selected from the general population. Results Moderate to severe depression and anxiety were reported in 17% and 9% of cancer survivors, respectively. There were no significant differences between the 5 years and 10 years after diagnosis cohorts ( p  = 0.232). In both cohorts, we found higher depression and anxiety in women than in men ( p  < 0.001), and lower depression and anxiety in elderly patients ( p  < 0.001). Cancer survivors younger than 60 years of age were more depressed and anxious than the general population ( p  < 0.001). The variables, financial problems (Beta = 0.16, p  < 0.001), global quality of life (Beta = − 0.21, p  < 0.001) and cognitive function (Beta = − 0.30, p  < 0.001), had the strongest association with depression and anxiety. Conclusions For the prevention of depression and anxiety in long-term cancer survivors, individual treatment of physical and psychological symptoms is as important as social support and professional counselling. Post-treatment, cognitive limitations should be carefully assessed in long-term cancer survivorship to distinguish them from symptoms of a mental disorder, especially since younger cancer survivors of working age and female survivors seem to be more affected by depression and anxiety.

Echoes of trauma are traced in the relational narratives that the sons and daughters of Holocaust survivors tell about their experiences growing up in survivor families. An innovative combination of the Core Conflictual Relationship Theme (CCRT) method with narrative-qualitative analysis revealed common themes and emotional patterns that are played out in the survivors' children's meaningful relationships, especially in those with their parents. The relational world of the second generation is understood in the context of an intergenerational communication style called 'knowing-not knowing', in which there is a dialectical tension between knowing and not knowing the parental trauma. In the survivors' children's current parent-adolescent relationships with their own children, they aspire to correct the child-parent dynamics that they had experienced by trying to openly negotiate conflicts and to maintain close bonds. Clinicians treating descendents of other massive trauma would benefit from the insights offered into these complex intergenerational psychological processes.

PurposeCancer patient survival rates are rapidly growing, and further data are needed on the impact of the disease beyond diagnosis and treatment phases. The aims of this study were to analyze the prevalence and sociodemographic and medical risk factors of clinical distress. Additionally, we also explore the relationship between unmet psychosocial needs and both clinical distress and subgroups of survival periods.MethodsA cross-sectional study of 450 women who at least 1 month before had completed the primary treatment for breast cancer was conducted. The Brief Symptom Inventory 18 and the Cancer Survivors Unmet Needs measure were used.ResultsOne in four women showed clinical distress related to unmet psychosocial needs. None of the sociodemographic and medical predictors was associated with clinical distress. Needs focused on the possibility of recurrence and its cognitive-emotional impact were the most frequent. Needs tended to decrease through periods of survival; however, there was a considerable level of unmet needs even among long-term survivors.ConclusionsThe findings highlight the relevance of extending psychosocial care beyond the breast cancer primary medical treatment. Early and regular screen for distress and unmet supportive needs permits to identify high-risk groups that likely benefit from targeted preventive interventions.

Background Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors. Methods One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65–85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis. Results At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p  < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO 2max (p < 0.001), muscular strength (p < 0.001), osteocalcin ( p  = 0.01), and BSAP ( p  = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group ( p  < 0.01). Conclusions A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care. Trial registration This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.

Purpose Over half of young adult cancer survivors do not meet physical activity (PA) guidelines. PA interventions can enhance health and quality of life among young adult cancer survivors. However, few exercise interventions have been designed and tested in this population. This study evaluated the feasibility and preliminary efficacy of a 12-week, Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA compared with a Facebook-based self-help comparison (SC) condition. Methods Young adult cancer survivors ( n  = 86) were randomly assigned to the FITNET or SC group. All participants were asked to complete self-administered online questionnaires at baseline and after 12 weeks. Results Seventy-seven percent of participants completed postintervention assessments, and most participants reported using intervention components as intended. Participants in both groups would recommend the program to other young adult cancer survivors (FITNET, 46.9 vs. SC, 61.8 %; p  = 0.225). Over 12 weeks, both groups increased self-reported weekly minutes of moderate-to-vigorous PA (FITNET, 67 min/week ( p =  0.009) vs. SC, 46 min/week ( p  = 0.045)), with no significant difference between groups. Increases in light PA were 135 min/week greater in the FITNET group relative to the SC group ( p =  0.032), and the FITNET group reported significant weight loss over time (−2.1 kg, p  = 0.004; p  = 0.083 between groups). Conclusion Facebook-based intervention approaches demonstrated potential for increasing PA in young adult cancer survivors. Implications for Cancer Survivors Social networking sites may be a feasible way for young adult cancer survivors to receive health information and support to promote PA and healthy behaviors.

Witnessing Witnessing focuses critical attention on those who receive the testimony of Holocaust survivors. Questioning the notion that traumatic experience is intrinsically unspeakable and that the Holocaust thus lies in a quasi-sacred realm beyond history, the book asks whether much current theory does not have the effect of silencing the voices of real historical victims. It thereby challenges widely accepted theoretical views about the representation of trauma in general and the Holocaust in particular as set forth by Giorgio Agamben, Cathy Caruth, Berel Lang, and Dori Laub. It also reconsiders, in the work of Theodor Adorno and Emmanuel Levinas, reflections on ethics and aesthetics after Auschwitz as these pertain to the reception of testimony. Referring at length to videotaped testimony and to texts by Charlotte Delbo, Primo Levi, and Jorge Semprun, the book aims to make these voices heard. In doing so, it clarifies the problems that anyone receiving testimony may encounter and emphasizes the degree to which listening to survivors depends on listening to ourselves and to one another. Witnessing Witnessing seeks to show how, in the situation of address in which Holocaust survivors call upon us, we discover our own tacit assumptions about the nature of community and the very manner in which we practice it.

Purpose This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue. Background Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors. Method A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks. Results Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group. Conclusion This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF. Trial registration number KCT0008447 (Date of registration: May 19, 2023)

Background The incidence of thyroid cancer is increasing. As such, the number of survivors is rising, and it has been shown that their quality of life (QOL) is worse than expected. Using results from the North American Thyroid Cancer Survivorship Study (NATCSS), a large-scale survivorship study, we aim to compare the QOL of thyroid cancer survivors to the QOL of survivors of other types of cancer. Methods The NATCSS assessed QOL overall and in four subcategories: physical, psychological, social, and spiritual well-being using the QOL-Cancer Survivor (QOL-CS) instrument. Studies that used the QOL-CS to evaluate survivors of other types of cancers were compared to the NATCSS findings using two-tailed t tests. Results We compared results from NATCSS to QOL survivorship studies in colon, glioma, breast, and gynecologic cancer. The mean overall QOL in NATCSS was 5.56 (on a scale of 0–10, where 10 is the best). Overall QOL of patients with thyroid cancer was similar to that of patients with colon cancer (mean 5.20, p  = 0.13), glioma (mean 5.96, p  = 0.23), and gynecologic cancer (mean 5.59, p  = 0.43). It was worse than patients surveyed with breast cancer (mean 6.51, p  < 0.01). Conclusions We found the self-reported QOL of thyroid cancer survivors in our study population is overall similar to or worse than that of survivors of other types of cancer surveyed with the same instrument. This should heighten awareness of the significance of a thyroid cancer diagnosis and highlights the need for further research in how to improve care for this enlarging group of patients.