Amber S. Kleckner

Circadian rest-activity rhythms, or a person's consistency in their daily activity and rest patterns, can be quantified using various parametric and non-parametric methods. However, these methods are seldom applied to understand symptoms in cancer survivorship. This study examined associations between various rest-activity rhythm parameters and cancer-related fatigue and quality of life. Adult cancer survivors (n = 31) were enrolled in a 12-week randomized clinical trial of individualized nutrition counseling with or without time-restricted eating. Participants wore actigraphy watches continuously for 3-7 days at baseline, 6 weeks, and 12 weeks. Rest-activity parameters were derived using cosinor models, traditional non-parametric methods, and probabilistic hidden Markov models (HMMs). Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire, including physical, social, emotional, and functional well-being subscales; fatigue; and a quality-of-life total score. Mixed models revealed that stronger rest-activity rhythms were generally associated with lower fatigue and greater well-being in several dimensions. Specifically, intradaily variability and the HMM-derived rhythm index were positively associated with emotional well-being (p = 0.040 and p = 0.037, respectively, medium effect sizes). Earlier daily activity peaks, identified through both parametric and non-parametric methods, were linked to greater emotional well-being (e.g. cosinor peak time and emotional well-being, p = 0.006, large effect size; start hour of the most active 10 hours, p = 0.004, large effect size). There was no effect of group (time-restricted eating vs. control) on any of the rest-activity parameters. Findings suggest that rest-activity rhythm parameters, including those derived from novel HMMs, may serve as useful biomarkers of fatigue and various dimensions of well-being, supporting further research in larger samples and potential clinical application.

Advances in early detection and treatment have led to an increase in the number of cancer survivors, a trend expected to continue as the medical field advances. In the United States alone, the numb...

Although cancer prevention, care, and survivorship in the United States have dramatically improved over the last decade, inequities in morbidity and mortality among under-resourced populations have grown, mostly attributed to structural, societal, and institutional factors. To address inequities in cancer-related outcomes, community-engaged research (CEnR) and practice remains essential. Community-engaged research is generally supported by Community Outreach and Engagement (COE) units in National Cancer Institute-designated cancer centers. For more than a decade, COE remains a requirement for comprehensive designation and is a significant factor in the overall cancer center scoring. Community engagement occurs on a continuum from community-engaged to community-based participatory research. Engaging communities experiencing inequities in cancer incidence, morbidity, and mortality to ameliorate factors contributing to poorer cancer-related outcomes remains a goal, albeit a challenging one. This commentary details both novel and successful approaches that researchers throughout the country have used to engage communities to address cancer-related inequities in their catchment areas by leveraging COE infrastructure to facilitate CEnR across research programs. We also highlight and forward recommendations from a recent scientific pre-conference workshop. Cancer center-led CEnR is critical to engaging with key communities, and yet there are tremendous opportunities to better articulate and implement approaches to effective engagement. Internal inequities and barriers in COE infrastructures and how researchers, directors, and stakeholders can collaborate to optimize cancer health outcome/CEnR are discussed, in addition to potential solutions involving collaboration with upstream policy stakeholders. In this commentary, we emphasize why this work remains an ongoing but critical priority.

Cancer survivorship is a distinct phase in the cancer care continuum and represents one of the fastest-growing patient populations, with about 18.1 million cancer survivors in the United States as of January 1, 2022, a number projected to increase to 21.6 million by 2030 and about 26 million by 2040, based on National Cancer Institute Surveillance, Epidemiology, and End Results Program and U.S. population projections (Tonorezos et al., 2024).

Cancer survivors face cancer and treatment-related health challenges and are at increased risk of developing other chronic diseases, often leading to multimorbidity. Lifestyle medicine can reduce the risk and severity of up to 80% of these chronic diseases and are an important component of survivorship care. Healthy lifestyle habits — such as a plant-forward diet, regular exercise, and maintaining healthy weight — improve life expectancy in a general population with compelling evidence supporting the same benefits among cancer survivors. A new resource from the American College of Lifestyle Medicine (ACLM), the Lifestyle Medicine Cancer Risk Reduction and Survivorship Toolkit (LMCT), aims to overcome barriers by providing accessible, evidence-based lifestyle medicine resources for use at the point of care. To support oncology healthcare professionals and cancer survivors, MASCC has endorsed the ACLM Cancer Risk Reduction and Survivorship Toolkit. This editorial describes the LMCT and how it can be a resource for cancer supportive care.