BACKGROUND & AIMS: :When evaluating the risks of oncogenesis and cancer mortality following exposure to the radiations of the atomic bombs (A-bombs), the medical X-ray doses received by the A-bomb survivors must also be estimated and considered. Using a human phantom, dosimetry was performed to estimate the X-ray doses received by A-bomb survivors during medical examinations at the Radiation Effects Research Foundation (RERF) as part of the long-term follow-up on the Adult Health Study (AHS). These examinations have been estimated to represent nearly 45% of the survivors' cumulative medical irradiation dose. Doses to the salivary glands, thyroid gland, lung, breast, stomach and colon were measured using thermoluminescent dosimeters. The results, which are reported here, will aid in estimating organ doses received by individual AHS participants.

背景与目标： : 在评估暴露于原子弹 (A炸弹) 辐射后的致癌风险和癌症死亡率时，还必须估计和考虑A炸弹幸存者接受的医学x射线剂量。作为成人健康研究 (AHS) 长期随访的一部分，使用人体模型进行剂量测定，以估计在辐射效应研究基金会 (RERF) 进行医学检查期间原子弹幸存者接受的x射线剂量。据估计，这些检查占幸存者累积医疗照射剂量的近45%。使用热发光剂量计测量唾液腺，甲状腺，肺，乳房，胃和结肠的剂量。此处报告的结果将有助于估计各个AHS参与者接受的器官剂量。

BACKGROUND & AIMS: PURPOSE:Physical activity (PA) is an important adjuvant component in all phases of the cancer disease and PA is important for better functioning, coping with the situation and overall quality of life (QoL). In order to achieve better scientific knowledge of the effect of PA in cancer survivors, it is of paramount importance to have validated and feasible assessment tools for PA. METHODS:This validation study, which was part of an open intervention study, used a cross-sectional and a longitudinal design. The HUNT 1 physical activity questionnaire (HUNT 1 PA-Q) was compared to the International Physical Activity Questionnaire (IPAQ) and aerobic capacity. The participants were cancer survivors with different diagnoses attending an inpatient rehabilitation program partly focusing on physical training. RESULTS:The correlations between HUNT 1 PA-Q and IPAQ were 0.41 at pre-test and 0.57 at post-test, and sensitivity to change (effect size) was 0.42 for both questionnaires. VO(2 max) demonstrated high sensitivity to change (0.68) and low correlations with HUNT 1 PA-Q (0.30 at pre-test and 0.21 at post-test). There were 13 incomplete HUNT 1 PA-Q forms and 48 incomplete IPAQ forms during the study period. CONCLUSIONS:HUNT 1 PA-Q is considered suitable for use in cancer survivors and should be preferred to IPAQ because it was easier to fill in and provided more complete data. Aerobic capacity measures other aspect of PA and should be used as a supplement to PA questionnaire when the aim is to capture health effects related to aerobic capacity.

背景与目标：

BACKGROUND & AIMS: :We hypothesized an association between renal calculi and bone mineral density (BMD) deficits, shown in adults, exists in survivors of childhood acute lymphoblastic leukemia (ALL). Thus, we analyzed the associations between quantitative computed tomography (QCT)-determined renal calcifications and clinical parameters (gender, race, age at diagnosis and age at the time of QCT), BMD, treatment exposures and Tanner stage. We investigated the associations between stone formation and nutritional intake, serum and urinary calcium and creatinine levels, and urinary calcium/creatinine ratio. Exact chi(2)-test was used to compare categorical patient characteristics, and the Wilcoxon-Mann-Whitney test to compare continuous measurements. Of 424 participants, 218 (51.4%) were males; 371 (87.5%) were nonblack. Most (n=270; 63.7%) were >or=3.5 years at ALL diagnosis. Mean (s.d.) and median (range) BMD Z-scores of the entire cohort were -0.4 (1.2) and -0.5 (-3.9 to 5.1), respectively. Nineteen participants (10 males; 10 Caucasians) had kidney stones (observed prevalence of 4.5%; 19/424) with a significant negative association between stone formation and body habitus (body mass index, P=0.003). Stone formation was associated with treatment protocol (P=0.009) and treatment group (0.007). Thus, kidney stones in childhood ALL survivors could herald the future deterioration of renal function and development of hypertension. Long-term follow-up imaging may be warranted in these patients to monitor for progressive morbidity.

背景与目标： : 我们假设儿童急性淋巴细胞白血病 (ALL) 的幸存者中存在成人肾结石与骨矿物质密度 (BMD) 缺陷之间的关联。因此，我们分析了定量计算机断层扫描 (QCT) 确定的肾脏钙化与临床参数 (性别，种族，诊断时的年龄和QCT时的年龄)，BMD，治疗暴露和Tanner分期之间的关联。我们调查了结石形成与营养摄入，血清和尿钙和肌酐水平以及尿钙/肌酐比之间的关系。使用精确的chi(2) 检验比较分类患者特征，使用Wilcoxon-Mann-Whitney检验比较连续测量结果。在424名参与者中，218 (51.4%) 为男性; 371 (87.5%) 为非黑人。大多数 (n = 270; 63.7%) 在所有诊断中> 或 = 3.5年。整个队列的平均 (s.d.) 和中位 (范围) BMD Z得分分别为-0.4 (1.2) 和-0.5 (-3.9至5.1)。19名参与者 (10名男性; 10名白种人) 患有肾结石 (观察到的患病率为4.5%; 19/424)，结石形成与身体习性之间存在显着的负相关性 (体重指数，P = 0.003)。结石形成与治疗方案 (P = 0.009) 和治疗组 (0.007) 相关。因此，所有幸存者在儿童时期的肾结石可能预示着肾功能的恶化和高血压的发展。这些患者可能需要长期随访影像学检查以监测进展性疾病。

BACKGROUND & AIMS: :Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired t-test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps (t = -3.5341; P = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week (p value <0.0001) and decreased DT scores by 0.77 per week (p value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 (p value <0.0001) and decrease in weekly DT by 0.73 (p value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Trial Registration: NCT03190720, NCT03072966.

背景与目标： : 增强体力活动 (PA) 和减少精神困扰是癌症幸存者护理中的重要问题。移动技术作为一种改变健康行为的新兴方法，正受到许多研究人员的关注。这项研究旨在调查基于移动应用程序的社区对增强PA和减少乳腺癌幸存者痛苦的影响。我们进行了一项非随机，前瞻性，干预性研究，其中包括移动社区-后期arm和移动社区-第一arm。使用安卓智能手机应用程序 (WalkON®)，使用基于应用程序的遇险温度计 (DT) 问卷从参与者那里收集了约12周的每日步行步骤和每周遇险评分。为了检查社区活动之前和期间每周步数的差异，我们使用了配对t检验方法。为了进行比较分析，我们参考了以前的前瞻性观察性研究，而没有移动社区干预，其设置与本研究相同。在倾向得分匹配 (PSM) 之后，进行具有差异差异 (DID) 的多变量回归建模，以估计基于移动应用程序的社区对PA和精神困扰的影响。从1月到2018年8月，共有64名参与者参加了这项研究。在单变量分析中，参与移动社区后，参与者显示每周总步数显着增加 (t = -3.5341; P = 0.00208)。差异的平均值为10,408.72步。在PSM之后的多变量分析中，在混合效应模型中，移动社区每周显着增加8,683.4步 (p值 <0.0001)，每周减少0.77 (p值 = 0.009)。在双向固定效应模型中，移动社区显示每周步长显着增加8,723.4 (p值 <0.0001)，每周DT显着减少0.73 (p值 = 0.013)。基于移动应用程序的社区是一种有效且资源消耗较少的工具，可提高PA并减少乳腺癌幸存者的痛苦。试注册: NCT03190720，nct03072966。

BACKGROUND & AIMS: OBJECTIVE:The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. METHODS:In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. RESULTS:20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). CONCLUSIONS:The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences.

背景与目标：

BACKGROUND & AIMS: Purpose:This study evaluated differences and shifting patterns in the health-related quality of life (HRQoL) of 5-year gastric cancer survivors after either a distal subtotal gastrectomy (DSG) or total gastrectomy (TG). Materials and Methods:We analyzed the prospectively collected HRQoL data of 528 patients who survived 5 years without recurrence using the European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Quality of Life Questionnaire-Stomach module according to the type of surgery. The purpose was to identify the proportion of patients with deteriorating HRQoL and to assess the clinical significance of these changes. Results:Deteriorating HRQoL was prevalent in both groups, including a large proportion of the DSG group. Decreased overall health status and scores on several function scales were less in the DSG group, while increases on the symptom scales were higher in the TG group. For most of the scales, gaps in HRQoL during the early postoperative period did not merge within the 5 years. Scores on the diarrhea and body image scales revealed "moderate changes" in both groups. Conclusions:During the 5-year period after surgery, the TG group suffered from inferior HRQoL compared to the DSG group. However, a large proportion of the DSG group also suffered HRQoL deterioration. In general, the TG group experienced more HRQoL decline, with diarrhea and body image being the major concerns for both groups. To improve HRQoL after gastrectomy, patients must be better informed about post-gastrectomy symptoms. These symptoms must be vigorously investigated, and medical interventions should be available parallel to nutritional support. Favorable evidence of function-preserving gastrectomy should be established and disseminated to improve the HRQoL of early gastric cancer patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE:This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS:Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS:In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS:This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION:PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With increased cure, childhood cancer survivors are reaching adulthood and seeking employment. Host, disease and treatment risk factors may contribute to inability to attain or maintain employment. PROCEDURE:The prevalence and risk factors for unemployment were evaluated using self-reported employment history in 10,399 childhood cancer survivors and 3,083 siblings >/= age 18 in the Childhood Cancer Survivor Study (CCSS). RESULTS:Among survivors, 5.6% reported unemployment, compared with 1.2% of siblings (odds ratio [OR] 3.7; 95% confidence interval [CI] 2.6, 5.1). Increased risks were observed within all cancer diagnoses. In multivariate analysis, diagnosis of central nervous system (CNS) tumor (OR 1.5; 95% CI 1.1, 2.1), bone cancer (OR 1.5; 95% CI 1.0, 2.1), treatment with >/=30 Gy cranial radiotherapy (OR 4.0; 95% CI 2.9, 5.5), female gender (OR 1.4; 95% CI 1.2, 1.7) and age < 4 years at diagnosis (OR 1.4; 95% CI 1.1, 1.8) increased risk. Diagnosis of CNS or bone tumor or cranial radiotherapy >/=30 Gy remained significant after adjusting for treatment, medical late effects, age and gender. Risk of unemployment decreased with attained age (OR((year)) 0.89; 95% CI 0.87, 0.91). CONCLUSIONS:Compared to siblings, adult childhood cancer survivors are at increased risk for unemployment with highest risk defined by diagnosis, treatment and demographic factors.

背景与目标：

BACKGROUND & AIMS: PURPOSE:Online communities have been heralded as one of the most promising health resources on the Internet. The purpose of this study was to identify the characteristics and levels of use of online communities for breast cancer survivors. METHODS:Using Google, we identified websites with a string of computer-mediated communication terms and individual queries of three to five words of online community terms. This was complemented by a review of website resource lists and personal libraries. Two reviewers independently extracted information on their general characteristics and number of members and message board posts. A coding scheme guided content analysis. RESULTS:We found 111 websites. Most sites (n = 64, 65.8 %) had a broad focus (e.g., health, cancer, or general). One third (n = 38, 34.2 %) were exclusive to breast cancer and 11 catered to specific disease characteristics. The majority were American (n = 79, 75.2 %), nonprofit (55.0 %), and moderated (69.5 %). Most moderators (85.7 %) were staff or community members; eight sites were moderated by health professionals. Greater than one-third of sites (n = 40, 36 %) were initiated by breast cancer survivors or loved ones. Breast cancer-specific sites contained a total of 4,186,275 posts. One-third (n = 10) contained 93.4 % of posts, displaying over 100,000 posts each. As of April 3, 2012, eight sites were discontinued. CONCLUSIONS:There is a wide range of online communities available for breast cancer survivors with extensive archives of personal illness experiences. Future efforts should focus on identifying the factors that determine their success and effectiveness.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Long-term medication therapy for patients with post-myocardial infarction (MI) can prolong life. However, recent data on long-term adherence are limited, particularly among some subpopulations. We compared medication adherence among Medicare MI survivors by disability status, race/ethnicity, and income. METHODS:We examined 100% of Medicare fee-for-service beneficiaries discharged post-MI in 2008. The outcomes were adherence to β-blockers, statins, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, for 1-year and 6-month postdischarge. Adherence was defined as having prescriptions in possession for ≥75% of days. RESULTS:Among aged beneficiaries who survived 1-year adherence to β-blockers were 68%, 66%, 61%, 58%, and 57% for whites, Asians, Hispanics, Native Americans, and blacks, respectively; among persons with disability, 1-year adherence was worse for each group: 59%, 54%, 52%, 47%, and 43%, respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location, and health status. Patterns of adherence to statins and angiotensin-converting enzymes/angiotensin II receptor blockers were similar. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to whites: odds ratio 0.70 (95% CI 0.65-0.75) for blacks and odds ratio 0.70 (95% CI 0.55-0.90) for Native Americans. CONCLUSIONS:Although β-blockers at discharge has improved since the National Committee for Quality Assurance implemented quality measures, long-term adherence remains problematic, especially among persons with disability and minority beneficiaries. Quality measures for long-term adherence should be created to improve outcomes in patients with post-MI. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.

背景与目标：

BACKGROUND & AIMS: :Cardiac transplantation is predicted to improve survival for patients with severe symptoms of heart failure and ejection fraction of 20% or less, but the exercise capacity after cardiac transplantation is less than normal. Patients responding to vasodilators and diuretics have progressive improvement in exercise capacity despite low ejection fraction. We hypothesized that among patients currently considered appropriate for transplantation who could nonetheless subsequently be stabilized on medical therapy tailored to hemodynamic goals, survivors after 6 months of sustained medical therapy would demonstrate exercise capacity comparable to that of survivors of transplantation. Of 146 patients referred, 118 (81%) were discharged on tailored therapy without transplantation, and 88 (60%) were stable for at least 1 month. Stability after discharge was more likely in patients with lower right atrial pressures and better renal function on therapy. Of the 88 stable patients, 45 patients were listed for transplant, and 43 were ineligible or unwilling. From these patients, 42 survivors for more than 6 months follow-up after cardiac transplantation or tailoring of medical therapy underwent exercise testing. Baseline functional and hemodynamic status and left ventricular ejection fraction (15 +/- 4%) were not different between the transplant and sustained medical survivor groups at the time of initial evaluation. After 14 +/- 6 months, left ventricular ejection fraction had increased to 62 +/- 7% after transplantation (p less than 0.01) and only 22 +/- 9% after sustained medical therapy (p less than 0.05). However, there were no significant differences in the maximum workload, oxygen uptake, anaerobic threshold, or maximum oxygen pulse between survivors of cardiac transplantation and survivors on sustained medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

背景与目标： : 对于严重的心力衰竭症状和射血分数20% 或更低的患者，心脏移植有望提高生存率，但心脏移植后的运动能力低于正常水平。尽管射血分数低，但对血管扩张剂和利尿剂有反应的患者的运动能力逐渐改善。我们假设，在目前认为适合移植的患者中，尽管随后仍可以根据血液动力学目标进行药物治疗而稳定下来，持续药物治疗6个月后的幸存者将表现出与移植幸存者相当的运动能力。在146例转诊患者中，118例 (81% 例) 在没有移植的情况下接受定制治疗出院，88例 (60% 例) 稳定至少1个月。右心房压力较低且治疗后肾功能较好的患者出院后更可能保持稳定。在88名稳定患者中，有45名患者被列入移植名单，而43名患者不合格或不愿意。在这些患者中，有42名幸存者在心脏移植或药物治疗定制后进行了6个月以上的随访，并进行了运动测试。在初始评估时，移植组和持续医学幸存者组之间的基线功能和血液动力学状态以及左心室射血分数 (15/- 4%) 没有差异。14 +/- 6个月后，移植后左心室射血分数增加到62 +/- 7% (p小于0.01)，持续药物治疗后仅增加到22 +/- 9% (p小于0.05)。然而，心脏移植幸存者和持续药物治疗幸存者在最大工作量、摄氧量、无氧阈值或最大氧脉搏方面没有显著差异。(摘要截短于250字)

BACKGROUND & AIMS: :Survivors' information-seeking behavior has traditionally been documented through analysis of inquiries to hotlines and cancer information services. Data from these self-selected inquiries tend to be restricted to a time around diagnosis, and to those populations possessing the wherewithal and motivation to seek information actively. The current study used data from a general population survey to assess 1) the prevalence of information-seeking behavior among survivors in the general population, 2) characteristics of seekers versus nonseekers, 3) ratings of information-seeking experience, and 4) actual versus preferred sources of information. Data were analyzed from the 2005 administration of the Health Information National Trends Survey (HINTS). HINTS is a cross-sectional, random digit dial telephone survey, weighted to provide estimates for the general population. Nearly half of all Americans (48.7%) indicated that they have looked for cancer information from 1 source or another. Percentages were highest for those who have been touched by cancer (63.1% of cancer survivors and 54.6% of those with family histories) and lowest for those with no cancer history (27.6% of those with no history). Quality concerns topped the list of information-seeking experiences for those recalling the last time they looked. Patterns of information-seeking revealed a discrepancy between preferred and actual source when tracked over years since diagnosis. Information-seeking is prevalent among cancer survivors and does not diminish over time. Prescriptions are given for reengineering the information environment to improve long-term outcomes for survivors.

背景与目标： : 幸存者的信息寻求行为传统上是通过分析热线和癌症信息服务的查询来记录的。来自这些自我选择的查询的数据往往仅限于诊断前后的时间，以及那些拥有主动寻求信息的资金和动力的人群。当前的研究使用了来自一般人群调查的数据来评估1) 一般人群中幸存者中信息寻求行为的普遍性，2) 寻求者与非寻求者的特征，3) 信息寻求经验的等级，以及4) 实际与首选信息来源。数据分析来自2005健康信息管理局国家趋势调查 (HINTS)。HINTS是一项横断面的随机数字拨号电话调查，经过加权后可提供一般人群的估计。近一半的美国人 (48.7%) 表示，他们从1个或另一个来源寻找癌症信息。受癌症影响的人 (癌症幸存者的63.1% 和有家族史的人的54.6%) 的百分比最高，没有癌症病史的人 (没有病史的人的27.6%) 的百分比最低。对于那些回忆上次看的人来说，质量问题在寻求信息的经历中名列前茅。自诊断以来的多年追踪，信息寻求模式显示出首选来源与实际来源之间的差异。信息寻求在癌症幸存者中很普遍，并且不会随着时间的推移而减少。给出了重新设计信息环境以改善幸存者的长期结果的处方。

BACKGROUND & AIMS: BACKGROUND:The magnitude of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin's lymphoma is not known. Using medically ascertained data, we applied the cumulative burden metric to compare chronic cardiovascular health conditions in survivors of Hodgkin's lymphoma and general population controls. METHODS:For this study, participant data were obtained from two ongoing cohort studies at St Jude Children's Research Hospital: the St Jude Lifetime Cohort Study (SJLIFE) and the St Jude Long-term Follow-up Study (SJLTFU). SJLIFE is a cohort study initiated on April 27, 2007, to enable longitudinal clinical evaluation of health outcomes of survivors of childhood cancer treated or followed at St Jude Children's Research Hospital, and SJLTFU is an administrative system-based study initiated in 2000 to collect outcome and late toxicity data for all patients treated at the hospital for childhood cancer. The patient cohort for our study was defined as patients treated at St Jude Children's Research Hospital who reached 18 years of age and were at least 10 years post-diagnosis of pathologically confirmed primary Hodgkin's lymphoma. Outcomes in the Hodgkin's lymphoma survivors were compared with a sample of SJLIFE community control participants, aged 18 years or older at the time of assessment, frequency-matched based on strata defined by 5-year age blocks within each sex, who were selected irrespective of previous medical history. All SJLIFE participants underwent assessment for 22 chronic cardiovascular health conditions. Direct assessments, combined with retrospective clinical reviews, were used to assign severity to conditions using a modified Common Terminology Criteria of Adverse Events (CTCAE) version 4.03 grading schema. Occurrences and CTCAE grades of the conditions for eligible non-SJLIFE participants were accounted for by multiple imputation. The mean cumulative count (treating death as a competing risk) was used to estimate cumulative burden. FINDINGS:Of 670 survivors treated at St Jude Children's Research Hospital, who survived 10 years or longer and reached age 18 years, 348 were clinically assessed in the St Jude Lifetime Cohort Study (SJLIFE); 322 eligible participants did not participate in SJLIFE. Age and sex frequency-matched SJLIFE community controls (n=272) were used for comparison. At age 50 years, the cumulative incidence of survivors experiencing at least one grade 3-5 cardiovascular condition was 45·5% (95% CI 36·6-54·3), compared with 15·7% (7·0-24·4) in community controls. The survivor cohort at age 50 experienced a cumulative burden of 430·6 (95% CI 380·7-480·6) grade 1-5 and 100·8 (77·3-124·3) grade 3-5 cardiovascular conditions per 100 survivors; these numbers were appreciably higher than those in the control cohort (227·4 [192·7-267·5] grade 1-5 conditions and 17·0 [8·4-27·5] grade 3-5 conditions per 100 individuals). Myocardial infarction and structural heart defects were the major contributors to the excess grade 3-5 cumulative burden in survivors. High cardiac radiation dose (≥35 Gy) was associated with an increased proportion of grade 3-5 cardiovascular burden, whereas increased anthracyline dose was not. INTERPRETATION:The true effect of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin's lymphoma is reflected in the cumulative burden. Survivors aged 50 years will experience more than two times the number of chronic cardiovascular health conditions and nearly five times the number of more severe (grade 3-5) cardiovascular conditions compared with community controls and, on average, have one severe, life-threatening, or fatal cardiovascular condition. The cumulative burden metric provides a more comprehensive approach for assessing overall morbidity compared with currently used cumulative incidence based analytic methodologies, and will assist clinical researchers when designing future trials and refining general practice screening guidelines. FUNDING:US National Cancer Institute, St Baldrick's Foundation, and American Lebanese Syrian Associated Charities.

背景与目标：

BACKGROUND & AIMS: :Background: To compare associations of symptom prevalence, chronic conditions, and health-related quality of life (HRQOL) between cancer survivors and non-cancer individuals using the U.S. National Health Interview Survey.Methods: Study samples comprised 604 survivors and 6,166 non-cancer individuals. Symptoms included sensation abnormality, pain, fatigue, cognitive disturbance, depression, and anxiety. Physical and mental HRQOL was measured by the Patient-Reported Outcomes Measurement Information System.Results: Compared with non-cancer individuals, survivors had higher prevalence in sensation abnormality (OR = 2.4; 95% CI = 1.9 to 3.0), pain (OR = 2.1; 95% CI = 1.7 to 2.6), fatigue (OR = 1.4; 95% CI = 1.1 to 1.8), and decremented physical HRQOL (difference = -3.7; 95% CI = -4.7 to -2.6). The prevalence of individual symptoms was significantly associated with decremented physical HRQOL [range = -5.9 (anxiety) to -8.9 (pain)] and mental HRQOL [range = -4.7 (sensation) to -8.4 (depression)]. The association between cancer experience and physical and mental HRQOL was chiefly explained by the prevalence of six symptoms and presence of chronic conditions. Pain (β = -4.0; 95% CI = -4.5 to -3.6) and ≥2 chronic conditions (β = -9.2; 95% CI = -10.2 to -8.2) significantly decremented physical HRQOL. Depression (β = -5.2; 95% CI = -5.8 to -4.6) and ≥2 chronic conditions (β = -3.3; 95% CI = -4.4 to -2.3) significantly decremented mental HRQOL.Conclusions: Cancer survivors experience more symptom burden than non-cancer individuals, which is associated with more chronic conditions and impaired HRQOL.Impacts: Interventions to manage symptom prevalence especially for older cancer survivors and survivors with more chronic conditions may improve their HRQOL outcomes. Cancer Epidemiol Biomarkers Prev; 26(7); 1124-32. ©2017 AACR.

背景与目标： 背景: 使用美国国家健康访谈调查，比较癌症幸存者和非癌症个体之间的症状患病率、慢性病和健康相关生活质量 (HRQOL) 的关联。方法: 研究样本包括604名幸存者和6,166名非癌症个体。症状包括感觉异常，疼痛，乏力，认知障碍，抑郁和焦虑。通过患者报告的结果测量信息系统测量身体和精神HRQOL。结果: 与非癌症患者相比，幸存者在感觉异常 (OR = 2.4; 95% CI = 1.9至3.0)，疼痛 (OR = 2.1; 95% CI = 1.7至2.6)，乏力 (OR = 1.4; 95% CI = 1.1至1.8) 和物理HRQOL降低 (差异 = -3.7; 95% CI = -4.7至-2.6)。个体症状的患病率与身体HRQOL [范围 = -5.9 (焦虑) 至-8.9 (疼痛)] 和精神HRQOL [范围 = -4.7 (感觉) 至-8.4 (抑郁)] 显着相关。癌症经历与身体和心理HRQOL之间的关联主要由六种症状的患病率和慢性病的存在来解释。疼痛 (β = -4.0; 95% CI = -4.5至-3.6) 和 ≥ 2种慢性病 (β = -9.2; 95% CI = -10.2至-8.2) 显着降低了身体HRQOL。抑郁 (β = -5.2; 95% CI = -5.8至-4.6) 和 ≥ 2种慢性病 (β = -3.3; 95% CI = -4.4至-2.3) 显著降低了心理HRQOL。结论: 癌症幸存者比非癌症患者经历更多的症状负担，这与更多的慢性疾病和受损的HRQOL相关。影响: 管理症状患病率的干预措施，特别是对于年龄较大的癌症幸存者和患有更多慢性疾病的幸存者，可能会改善他们的HRQOL结果。癌症流行病学生物标志物; 26(7); 1124-32。©2017 AACR.

BACKGROUND & AIMS: BACKGROUND:The American Society of Clinical Oncology (ASCO) recently released a "Top Five" list of opportunities to improve the quality of cancer care. Item 4 on the list advises against using advanced imaging and biomarkers for surveillance in patients with breast cancer who are treated with curative intent. This study examined concordance with ASCO follow-up care guidelines for breast cancer survivors treated at an academic medical center. METHODS:Claims data and medical records were reviewed and abstracted for early stage breast cancer survivors starting 1 year post diagnosis. A trained abstractor classified imaging tests as diagnostic or surveillance. Proportions and frequencies were generated for receipt of services. Multilevel logistic regression was used to estimate factors associated with receiving recommended and nonrecommended services and biomarker tests. RESULTS:Records were available for 258 patients. Mean age at diagnosis was 58 years (standard deviation of 13 years), mean time since diagnosis was 6 years (standard deviation of 2 years), and 71% were stage 0/1. Only 47% of the sample received a mammogram within 1 year of diagnosis, and 55% of the sample received at least 1 nonrecommended imaging service for surveillance purposes. Seventy-seven percent of the sample received at least 1 nonrecommended biomarker test. Regression results indicate that main treating physician, advanced disease stage, younger age at diagnosis, and greater number of years since diagnosis were associated with receiving nonrecommended services for surveillance. CONCLUSIONS:Use of nonrecommended services for surveillance occurs frequently among early-stage breast cancer survivors. There are opportunities to increase use of guideline concordant posttreatment care for breast cancer survivors.

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