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Purpose Smoking cessation and increased physical activity (pa) have been linked to better outcomes in cancer survivors. We assessed whether socioeconomic factors influence changes in those behaviours after a cancer diagnosis. MethodsAs part of a cross-sectional study, a diverse group of cancer survivors at the Princess Margaret Cancer Centre (Toronto, ON), completed a questionnaire about past and current lifestyle behaviours and perceptions about the importance of those behaviours with respect to their health. The influence of socioeconomic indicators on smoking status and physical inactivity at 1 year before and after diagnosis were assessed using multivariable logistic regression with adjustment for clinico-demographic factors. ResultsOf 1222 participants, 1192 completed the smoking component. Of those respondents, 15% smoked before diagnosis, and 43% of those smokers continued to smoke after. The proportion of survivors who continued to smoke increased with lower education level (p = 0.03). Of the 1106 participants answering pa questions, 39% reported being physically inactive before diagnosis, of whom 82% remained inactive afterward. Survivors with a lower education level were most likely to remain inactive after diagnosis (p = 0.003). Lower education level, household income, and occupation were associated with the perception that pa had no effect or could worsen fatigue and quality of life (p ≤ 0.0001).Conclusions In cancer survivors, education level was a major modifier of smoking and pa behaviours. Lower socioeconomic status was associated with incorrect perceptions about pa. Targeting at-risk survivors by education level should be evaluated as a strategy in cancer survivorship programs.

Purpose-We examined the prognostic value of nuclear and cytoplasmic Survivin expression in men with locally advanced prostate cancer who were enrolled in Radiation Therapy Oncology Group (RTOG) protocol 8610.Methods and Materials-RTOG 8610 was a phase III randomized study comparing the effect of radiotherapy (RT) plus short-term androgen deprivation (STAD) with RT alone. Of the 456 eligible cases, 68 patients had suitably-stained tumor material for nuclear Survivin analysis and 65 patients for cytoplasmic Survivin.Results-Compared to patients with nuclear Survivin intensity scores ≤191.2, those with intensity scores >191.2 had significantly improved prostate cancer survival (hazard ratio (HR) = 0.45, 95% confidence intervals (CI) = 0.20-1.00, p = 0.0452). On multivariate analysis, nuclear Survivin intensity scores >191.2 were significantly associated with improved overall survival (HR = 0.46, 95%CI = 0.25-0.86, p = 0.0156) and prostate cancer survival (HR = 0.36, 95%CI = 0.16-0.84, p = 0.0173). On univariate analysis, compared to patients with cytoplasmic Survivin integrated optical density ≤82.7, those with integrated optical density >82.7 showed a significantly increased risk of local progression (HR = 2.49, 95%CI = 1.03-6.01, p = 0.0421).Reprints requests to: Arnab Chakravarti, M.D., Massachusetts General Hospital, Department of Radiation Oncology, 100 Blossom Street, Cox 3, Boston, MA 02114. Telephone: 617-643-3427; Fax: 617-643-3229; Email: E-mail: achakravarti@partners.org. Conflicts of Interest Notification: none.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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Objectives To determine the extent to which initial therapy for nonmetastatic prostate cancer was concordant with nationally recognized guidelines using supplemented cancer registry data and what factors were associated with receipt of nonguideline-concordant care. Methods Initial therapy for 8229 nonmetastatic prostate cancer cases diagnosed in 2004 from cancer registries in 7 states was abstracted as part of the Centers for Disease Control’s Patterns of Care Breast and Prostate Cancer study conducted during 2007 to 2009. The National Comprehensive Cancer Network clinical practice guidelines version 1.2002 was used as the standard of care based on recurrence risk group and life expectancy (LE). A multivariable model was used to determine risk factors associated with receipt of nonguideline-concordant care. Results Nearly 80% with nonmetastatic prostate cancer received guideline-concordant care for initial therapy. Receipt of nonguideline-concordant care (including receiving either less aggressive therapy or more aggressive therapy than indicated) was related to older age, African American race/ethnicity, being unmarried, rural residence, and especially to being in the high recurrence risk group where receiving less aggressive therapy than indicated occurred more often than receiving more aggressive therapy (adjusted OR = 4.2; 95% CL, 3.5–5.2 vs. low-risk group). Compared with life table estimates adjusted for comorbidity, physicians tended to underestimate LE. Conclusions Receipt of less aggressive therapy than indicated among high-risk group men with >5-year LE based on life table estimates adjusted for comorbidity was a concern. Physicians may tend to underestimate 5-year survival among this group and should be alerted to the importance of recommending aggressive therapy when warranted. However, based on more recent guidelines, among those with low-risk disease, the proportion considered to be receiving less aggressive therapy than indicated may now be lower because active surveillance is now considered appropriate.