Sexual dysfunction is a common consequence of cancer treatment, affecting at least half of men and women treated for pelvic malignancies and over a quarter of people with other types of cancer. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function. Sexual dysfunction also may be associated with depression, anxiety, relationship conflict, and loss of self-esteem. Innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction. Some new and effective cancer treatments, including aromatase inhibitors for breast cancer or chemoradiation for anal cancer also have very severe sexual morbidity. Cancer-related infertility is an issue for younger patients, who comprise a much smaller percentage of total cancer survivors. However, the long-term emotional impact of being unable to have a child after cancer can be extremely distressing. Advances in knowledge about how cancer treatments may damage fertility, as well as newer techniques to preserve fertility, offer hope to patients who have not completed their childbearing at cancer diagnosis. Unfortunately, surveys in industrialised nations confirm that many cancer patients are still not informed about potential changes to their sexual function or fertility, and all modalities of fertility preservation remain underutilised. After cancer treatment, many patients continue to have unmet needs for information about restoring sexual function or becoming a parent. Although more research is needed on optimal clinical practice, current studies suggest a multidisciplinary approach, including both medical and psychosocial treatment options.

Background Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations. Methods Two cross-sectional studies were conducted in 2009–2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data. Results Overall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not ( P <  0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders. Conclusions Among lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.

Prior studies have shown a significantly reduced second-cancer risk in Hodgkin lymphoma (HL) survivors treated with more limited-field radiation therapy (RT), although the impact of RT field size reduction on long-term overall survival (OS) has been unclear. The purpose of this study is to analyze long-term OS by field size. Materials/Methods: An institutional review board-approved retrospective study was conducted using a multi-institutional database of stage I and II HL patients treated 1967-2007 with RT with or without chemotherapy. Statistical analysis was conducted using SAS 9.3 (SAS Institute, Inc., Cary, NC) and Stata 14 (StataCorp LP, College Station, TX). Covariates included age, gender, year of treatment, histology, number of sites, B symptoms, favorable versus unfavorable prognostic group, chemotherapy regimen, RT field, and mediastinal RT dose. The Kaplan-Meier method was used for estimates of OS and the logrank test was used to test for significance of univariate differences. A Cox proportional hazards model was constructed based on an established method to evaluate for factors associated with all-cause mortality.Results: A total of 1,541 clinical stage I and II HL patients were included. The overall median follow-up time was 15.2 years, with 35% of patients having >20 years of follow-up. The 10-, 15-and 20-year OS rates were 89%, 83%, and 76%, respectively. There was an increasing percentage of patients treated with involved-field (IF) RT in more recent year-cohorts of treatment: 1967-1983 (2%), 1983-1993 (3%), and 1994-2007 (42.2%). On univariate analysis, younger age at diagnosis (P<0.01), favorable-prognosis disease (P<0.01), absence of B symptoms (P Z 0.04), classical or lymphocyte predominant histology (P<0.01) and more recent treatment era (P<0.01) were associated with longer OS. For the regression model (Table 1), follow-up time was restricted to the first 20 years of follow-up to ensure parity between treatment-era cohorts. Although correlated with RT field size, chemotherapy regimen fell out of the model due to lack of significance. After adjusting for covariates, IFRT, as compared to extended-field (EF) RT, was associated with significantly lower all-cause mortality, with a hazard ratio of 0.59 (P Z 0.038). Conclusion: Treatment with IFRT in early-stage Hodgkin lymphoma was associated with a 41% reduction in the risk of death compared to those treated with EFRT. These results support current efforts to reduce RT volume to involved sites and potential further volume reduction in selected patients.

Background Hip and pelvic fractures do commonly occur among older adults. This pilot study aimed to evaluate the effect of introduction of the WOLK hip airbag on the incidence of hip fractures. Methods A retrospective study was performed among 969 participants residing within 11 long-term care facilities for older patients, belonging to one large healthcare organization in The Netherlands. The intervention concerned application of 45 WOLK hip-airbags, distributed among selected residents of the long-term care facilities. Inclusion criteria; physically active participants with a pelvic circumference between 90-125 cm able to wear the hip airbag. Exclusion criteria; participants who continuously removed the hip airbag themselves or participants who depended on a wheelchair for mobility. Main outcome measures were the occurrence of falls and hip, pelvic and other fractures. Results The incidence of hip and pelvic fractures declined from 3.3/100 person years to 1.8/100 person years during the study for an Incidence Rate Ratio (IRR) of 0.55 (95% confidence interval (95%CI) 0.34–0.87) in the entire study population. The incidence of other fractures did not decline during the study period (IRR 0.72;95%CI 0.37–1.40). The incidence of falls declined to some extent during the study (IRR 0.88; 95%CI 0.83–0.93). Conclusions After introduction of the WOLK hip airbag a reduction of the incidence of hip and pelvic fractures by almost half was observed in older patients residing in long-term care facilities, even though only 45 hip airbags were distributed among the 969 residents. As selection bias cannot be ruled out in this study, the results of this pilot study warrant replication by a future clinical trial to determine true effectiveness of this intervention.

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