Purpose: Patient-reported outcomes (PROs), routinely collected as a part of cancer clinical trials, have been linked with survival in numerous clinical studies, but a comprehensive critical review has not been reported. This study systematically assessed the impact of PROs on patient survival after a cancer diagnosis within the context of clinical trials. Design: Cancer clinical trials that assessed baseline PROs and mortality were identified through MEDLINE (through December 2006) supplemented by the Cochrane database, American Society of Clinical Oncology/European Society for Medical Oncology abstracts and hand searches. Inclusion criteria were publication in English language and use of multivariate analyses of PROs that controlled for one or more clinical factors. Two raters reviewed each study, abstracted data, and assessed study quality; two additional raters verified abstractions. Results: In 36 of 39 studies (N = 13,874), at least one PRO was significantly associated with survival (P < .05) in multivariate analysis, with varying effect sizes. Studies of lung (n = 12) and breast cancer (n = 8) were most prevalent. The most commonly assessed PRO was quality of life, measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 in 56% of studies. Clinical variables adjusted for included performance status (PS), treatment arm, stage, weight loss, and serum markers. Results indicated that PROs provide distinct prognostic information beyond standard clinical measures in cancer clinical trials. Conclusion: PROs might be considered for stratification purposes in future trials, as they were often better predictors of survival than PS. Studies are needed to determine whether interventions that improve PROs also increase survival and to identify explanatory mechanisms through which PROs relate to survival.

Associations between shift work and chronic disease have been observed, but relatively little is known about how to mitigate these adverse health effects. This critical review aimed to (i) synthesize interventions that have been implemented among shift workers to reduce the chronic health effects of shift work and (ii) provide an overall evaluation of study quality. MeSH terms and keywords were created and used to conduct a rigorous search of MEDLINE, CINAHL, and EMBASE for studies published on or before 13 August 2012. Study quality was assessed using a checklist adapted from Downs & Black. Of the 5053 articles retrieved, 44 met the inclusion and exclusion criteria. Over 2354 male and female rotating and permanent night shift workers were included, mostly from the manufacturing, healthcare, and public safety industries. Studies were grouped into four intervention types: (i) shift schedule; (ii) controlled light exposure; (iii) behavioral; and, (iv) pharmacological. Results generally support the benefits of fast-forward rotating shifts; simultaneous use of timed bright light and light-blocking glasses; and physical activity, healthy diet, and health promotion. Mixed results were observed for hypnotics. Study quality varied and numerous deficiencies were identified. Except for hypnotics, several types of interventions reviewed had positive overall effects on chronic disease outcomes. There was substantial heterogeneity among studies with respect to study sample, interventions, and outcomes. There is a need for further high-quality, workplace-based prevention research conducted among shift workers.

Background: Although Iran is a high-risk region for esophageal squamous cell carcinoma (ESCC), dietary factors that may contribute to this high incidence have not been thoroughly studied. The aim of this study was to evaluate the effect of macronutrients, vitamins and minerals on the risk of ESCC.Methods: In this hospital-based case-control study, 47 cases with incident ESCC and 96 controls were interviewed and usual dietary intakes were collected using a validated food frequency questionnaire. Data were modeled through unconditional multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), controlling for age, sex, gastrointestinal reflux, body mass index, smoking history (status, intensity and duration), physical activity, and education.Results: ESCC cases consumed significantly more hot foods and beverages and fried and barbecued meals, compared to the controls (p < 0.05). After adjusting for potential confounders, the risk of ESCC increased significantly in the highest tertiles of saturated fat [OR:2.88,95%CI:1.15-3.08], cholesterol [OR:1.53, 95%CI: 1.41-4.13], discretionary calorie [OR:1.51, 95%CI: 1.06-3.84], sodium [OR:1.49,95%CI:1.12-2.89] and total fat intakes [OR:1.48, 95%CI:1.09-3.04]. In contrast, being in the highest tertile of carbohydrate, dietary fiber and (n-3) fatty acid intake reduced the ESCC risk by 78%, 71% and 68%, respectively. The most cancer-protective effect was observed for the combination of high folate and vitamin E intakes (OR: 0.02, 95%CI: 0.00-0.87; p < 0.001). Controls consumed 623.5 times higher selenium, 5.48 times as much β-carotene and 1.98 times as much α-tocopherol as the amount ESCC cases consumed.Conclusion: This study suggests that high intake of nutrients primarily found in plant-based foods is associated with a reduced esophageal cancer risk. Some nutrients such as folate, vitamin E and selenium might play major roles in the etiology of ESCC and their status may eventually be used as an epidemiological marker for esophageal cancer in Iran, and perhaps other high-risk regions.

Adjuvant endocrine therapy (AET) significantly decreases the risk of breast cancer recurrence and mortality. Notwithstanding the demonstrated efficacy of AET, 31–73% of breast cancer survivors do not persist with AET. The purpose of this study was to explore breast cancer survivors’ experiences and perspectives of persisting with AET and to identify the psychosocial and healthcare system factors that influence AET persistence. Informed by interpretive descriptive methodology and relational autonomy theory, individual interviews were conducted with 22 women diagnosed with early-stage breast cancer who had been prescribed AET. These participants also completed a demographic form and a survey that assessed their perceived risk of recurrence. Interviews were analysed using inductive thematic and constant comparative analysis to iteratively compare data and develop conceptualizations of the relationships among data. Descriptive statistics were used to summarize the quantitative data. The personal, social, and structural factors found to influence AET persistence included AET side effects, perception of breast cancer recurrence risk, medication and necessity beliefs, social support, the patient-provider relationship, and the continuity and frequency of follow-up care. For most women, over time, the decision-making process around AET persistence became a balancing act between quality of life and quantity of life. The interplay between the personal, social, and structural factors was complex and the weight women placed on some factors over others influenced their AET persistence or non-persistence. Expanding our understanding of the factors affecting breast cancer survivors’ AET persistence from their perspective is the first step in developing efficacious, patient-centered interventions aimed at improving AET persistence. In order to improve AET persistence, enhanced symptom management is required, as well as the development of supportive care strategies that acknowledge the values and beliefs held by breast cancer survivors while reinforcing the benefits of AET, and addressing women’s reasons for non-persistence. Improved continuity of health care and patient-healthcare provider communication across oncology and primary care settings is also required. The development and evaluation of supportive care strategies that address the challenges associated with AET experienced by breast cancer survivors hold the potential to increase both women’s quality and quantity of life.

Tamoxifen is an essential drug in treating hormone receptor-positive breast cancer and has been used successfully for the past three decades. More recently, aromatase inhibitors (AIs) have also shown great promise in reducing breast cancer recurrence. To receive the optimal benefits, patients need to take these drugs for a period of 5 years. Yet, despite the known positive patient outcomes associated with their use, adherence to both tamoxifen and AIs is substantially less than ideal. This article reviews the most recent literature reporting adherence rates for tamoxifen and AIs, as well as correlates of adherence. Factors that help to explain nonadherence are reviewed, including the side-effect profile, and approaches to intervention to enhance adherence are discussed.