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Klaver KM, Duijts SFA, Geusgens CAV, Aarts MJB, Ponds RWHM, van der Beek AJ, Schagen SB. Internet-Based Cognitive Rehabilitation for Working Cancer Survivors: A Process Evaluation. J Occup Environ Med 2025; 67:268-277. [PMID: 39793002 DOI: 10.1097/jom.0000000000003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
OBJECTIVE The aim of the study was to evaluate the process of an online cognitive rehabilitation program aimed at supporting cancer survivors experiencing cognitive problems at work. METHODS Cancer survivors ( N = 279) were randomized to one of the intervention groups (ie, basic and extensive online cognitive rehabilitation) or waitlist control group. Recruitment, reach, dosage, implementation, perceived usefulness, and experiences with the program were evaluated using questionnaires and logbooks. RESULTS Implementation (ie, reach multiplied by dosage) was acceptable for both versions of the program (range 63%-76%). Cancer survivors and cognitive therapists perceived the overall program as moderately to highly useful and generally reported positive experiences. CONCLUSIONS Both a basic and extensive versions of the online cognitive rehabilitation program were successfully implemented in the context of a randomized controlled trial, suggesting their feasibility as intervention to support cancer survivors with cognitive problems at work.
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Affiliation(s)
- Kete M Klaver
- From the Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands (K.M.K., S.B.S.); Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands (K.M.K., S.F.A.D. A.J.V.D.B.); Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands (S.F.A.D.), Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands (S.F.A.D., R.W.H.M.P.); Department of Medical Psychology, Zuyderland MC, Sittard, The Netherlands (C.A.V.G.); Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands (M.J.B.A.); and Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands (S.B.S)
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Albers EAC, de Ligt KM, van der Ploeg IMC, Wouters MJWM, Schagen SB, van de Poll-Franse LV. Screening for cognitive impairment in routine clinical oncology practice: a pilot study using patient-reported outcome measures and online cognitive testing in melanoma and breast cancer patients. Support Care Cancer 2025; 33:273. [PMID: 40074888 DOI: 10.1007/s00520-025-09325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 03/02/2025] [Indexed: 03/14/2025]
Abstract
PURPOSE This pilot study aimed to identify patients with cognitive impairment by a stepped-care use of patient-reported outcome measures (PROMs) and complementary online cognitive tests implemented in routine clinical practice. METHODS Self-reported cognitive functioning was measured in breast cancer or melanoma patients, 6 months after start of treatment, with two items of the EORTC QLQ-C30. Scores below a predefined threshold of 75 indicated clinically relevant cognitive impairment. Subsequent objective cognitive functioning was assessed with an online test battery, consisting of seven tests. Impaired cognitive functioning was defined as a z score of ≤ - 1.5 on 2 or more tests, a z score of ≤ - 2 on one single test, or both. Descriptive statistics were used to analyze the prevalence of impairment. RESULTS In total, 261 patients completed PROMs 6 months after start treatment; 38/154 (25%) melanoma and 43/107 (40%) breast cancer patients reported clinically relevant self-reported cognitive impairment. Of them, 12/38 (32%) melanoma and 15/43 (35%) breast cancer patients opted for complementary online cognitive testing. Of those completing formal tests, objectively measured cognitive impairment was identified in 4/12 (33%) melanoma and 10/15 (67%) breast cancer patients. CONCLUSION A significant number of patients report cognitive problems 6 months after starting treatment. Only onethird was able and/or expressed the need for further diagnostics. Among those who were formally tested, 33-67% had cognitive impairment, which is 3-9% of the total group that completed PROMs in routine care. IMPLICATIONS FOR CANCER SURVIVORS This pilot study suggests that a stepped care pathway for cognitive problems is relevant and also mangable in terms of clinical care.
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Affiliation(s)
- E A C Albers
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - K M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - I M C van der Ploeg
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - M J W M Wouters
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - S B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - L V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Deparment of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (Corps), Tilburg University, Tilburg, The Netherlands
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3
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Huberts AS, Albers EAC, de Ligt KM, Koppert LB, Schagen SB, van de Poll-Franse LV. Self-perceived cognitive impairment in the first year after breast cancer and the identification of at-risk patients. Eur J Oncol Nurs 2024; 72:102685. [PMID: 39288677 DOI: 10.1016/j.ejon.2024.102685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 08/04/2024] [Accepted: 08/17/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE This study investigated self-reported clinically relevant cognitive impairment of breast cancer patients in routine clinical care and assessed factors associated with new-onset clinically relevant cognitive impairment. METHODS Cognitive functioning was assessed before start of any treatment (T0) and at 6 (T6) and 12 (T12) months after diagnosis. Cognitive functioning (CF) was measured on a scale of 0-100 with the EORTC QLQ-C30 questionnaire, and the EORTC pre-defined threshold for clinical importance. Multivariable logistic regression analyses was used to identify factors associated with new-onset clinically relevant cognitive impairment at T6 ((CF > 75 at T0 and CF < 75 at T6 and T12) or (CF > 75 at T0 and T6 and <75 at T12)). RESULTS Pre-treatment, 21% of patients reported clinically relevant cognitive impairment. At T12, percentage was 32%; 20% of patients reported new-onset clinically relevant cognitive impairment at T6 and/or T12. New-onset clinically relevant cognitive impairment was associated with chemo(immuno)therapy and impairment in role and emotional functioning. Younger patients and patients receiving chemo(immuno)therapy were more likely to report new-onset clinically relevant cognitive impairment post treatment. CONCLUSION One in five breast cancer patients reported clinically relevant cognitive problems before start of treatment. This percentage further increased within the first year, particularly among patients treated with chemo(immuno)therapy. One in five patients reported new-onset clinically relevant cognitive impairment. Ultimately, these patients may benefit from systematic monitoring and potential referral to interventions.
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Affiliation(s)
- A S Huberts
- Department of Quality and Patient Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E A C Albers
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - K M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - L B Koppert
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - L V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
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Agelink van Rentergem JA, Lee Meeuw Kjoe PR, Vermeulen IE, Schagen SB. Subgroups of cognitively affected and unaffected breast cancer survivors after chemotherapy: a data-driven approach. J Cancer Surviv 2024; 18:810-817. [PMID: 36639610 DOI: 10.1007/s11764-022-01310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/03/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE It is assumed that a segment of breast cancer survivors are cognitively affected after chemotherapy. Our aim is to discover whether there is a qualitatively different cognitively affected subgroup of breast cancer survivors, or whether there are only quantitative differences between survivors in cognitive functioning. METHODS Latent profile analysis was applied to age-corrected neuropsychological data -measuring verbal memory, attention, speed, and executive functioning- from an existing sample of 62 breast cancer survivors treated with chemotherapy. Other clustering methods were applied as sensitivity analyses. Subgroup distinctness was established with posterior mean assignment probability and silhouette width. Simulations were used to calculate subgroup stability, posterior predictive checks to establish absolute fit of the subgrouping model. Subgrouping results were compared to traditional normative comparisons results. RESULTS Two subgroups were discovered. One had cognitive normal scores, the other -45%- had lower scores. Subgrouping results were consistent across clustering methods. The subgroups showed some overlap; 6% of survivors could fall in either. Subgroups were stable and described the data well. Results of the subgroup clustering model matched those of a traditional normative comparison method requiring small deviations on two cognitive domains. CONCLUSIONS We discovered that almost half of breast cancer survivors after chemotherapy form a cognitively affected subgroup, using a data-driven approach. This proportion is higher than previous studies using prespecified cutoffs observed. IMPLICATIONS FOR CANCER SURVIVORS A larger group of cancer survivors may be cognitively affected than previously recognized, and a less strict threshold for cognitive problems may be needed in this population.
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Affiliation(s)
- Joost A Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Room H8.014, 1066 CX, Amsterdam, The Netherlands.
| | - Philippe R Lee Meeuw Kjoe
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Room H8.014, 1066 CX, Amsterdam, The Netherlands
| | - Ivar E Vermeulen
- Department of Communication Science, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Room H8.014, 1066 CX, Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, The Netherlands
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Guo YJ, Xue P, Gu WW, Su XQ, Li JM, Kuai BX, Xu JS, Xie HW, Han PP. Development and validation of Adaptability to Return-to-Work Scale (ARTWS) for cancer patients. Front Psychol 2024; 14:1275331. [PMID: 38741785 PMCID: PMC11090167 DOI: 10.3389/fpsyg.2023.1275331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 05/16/2024] Open
Abstract
Introduction The research on cancer patients returning to work in China is still in its infancy, and there is no research and discussion on the adaptability to return-to-work for cancer patients. It is critical to develop the Adaptability to Return-to-Work Scale (ARTWS) for cancer patients and evaluate its psychometric properties. Methods The items of the initial scale were compiled based on the theoretical model and literature review results. Through two rounds of Delphi expert consultation (N = 15) and a pilot survey (N = 40), the initial scale was further checked and revised. Conduct a large sample survey (N = 376) and the construct validity and reliability of the ARTWS were assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results The final ARTWS consisted of 24 items. "Focusing on rehabilitation," "Rebuilding Self-efficiency," and "Adjusting plans" as common factors in determining adaptability to return to work for cancer patients, and the cumulative variance contribution rate for these three factors was 66.6%. The S-CVI of the total scale was 0.979. The Cronbach's α coefficient was 0.937 and the 2-week test-retest reliability was 0.814. Discussion ARTWS has good correlation validity and can be used as a tool to measure the adaptability of cancer patients' return to work. The presentation of the manuscript in Research Square (https://doi.org/10.21203/rs.3.rs-2323264/v1).
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Affiliation(s)
- Yu-Jie Guo
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Ping Xue
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
- Office of Joint Medicine, Taizhou Second People’s Hospital, Jiangyan District, Taizhou, Jiangsu, China
| | - Wen-wen Gu
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
- Department of Neurosurgery, Rudong People’s Hospital, Nantong, Jiangsu, China
| | - Xiao-qin Su
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Jia-mei Li
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Ben-xin Kuai
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Jia-shuo Xu
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Hui-wen Xie
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
| | - Ping-ping Han
- School of Nursing and Rehabilitation, Nantong university, Nantong, Jiangsu, China
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Klaver KM, Duijts SFA, Geusgens CAV, Aarts MJB, Ponds RWHM, van der Beek AJ, Schagen SB. Neuropsychological test performance and self-reported cognitive functioning associated with work-related outcomes in occupationally active cancer survivors with cognitive complaints. J Cancer Surviv 2024; 18:412-424. [PMID: 35776235 DOI: 10.1007/s11764-022-01223-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess cognitive functioning in occupationally active non-central nervous system cancer survivors with cognitive complaints using neuropsychological tests, and to investigate the association between (1) formally assessed cognitive functioning and self-reported work-related outcomes and (2) self-reported cognitive functioning at work and self-reported work-related outcomes. METHODS Baseline data of a multicenter, randomized controlled trial (n = 279) were used. Associations between neuropsychological test performance (Amsterdam Cognition Scan) and self-reported cognitive functioning (Cognitive Symptom Checklist-work) with work ability (Work Ability Index) and work functioning (Work Role Functioning Questionnaire) were examined using multivariate linear regression. RESULTS Thirty percent of cancer survivors had lower than expected performance on neuropsychological tests. Higher overall neuropsychological test performance was associated with better work ability (Cohen's f2 = 0.014) and physical functioning at work (Cohen's f2 = 0.13). Furthermore, higher motor performance was associated with better work ability (Cohen's f2 = 0.018). In addition, self-reported work-related cognitive complaints were associated with self-reported work-related outcomes (Cohen's f2 = 0.13-0.35). CONCLUSIONS The percentage of cancer survivors with lower than expected performance on neuropsychological tests exceeded the percentage expected in a normal population. This neuropsychological test performance was weakly associated with various aspects of work ability and work functioning. Stronger associations were found between self-reported cognitive functioning at work with self-reported work-related outcomes. IMPLICATIONS FOR CANCER SURVIVORS A cognitive rehabilitation approach that specifically aims at reducing cognitive symptoms at work could be a valuable part of interventions that aim to improve work-related outcomes. Trial registration The study is registered at ClinicalTrials.gov (NCT03900806) at 03 April 2019 (current status: ongoing), https://clinicaltrials.gov/ct2/show/NCT03900806?term=NCT03900806&draw=2&rank=1.
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Affiliation(s)
- Kete M Klaver
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Chantal A V Geusgens
- Department of Clinical and Medical Psychology, Zuyderland Medical Center, Sittard, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University, MC, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands.
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Klaver KM, Duijts SFA, Geusgens CAV, Kieffer JM, Agelink van Rentergem J, Hendriks MP, Nuver J, Marsman HA, Poppema BJ, Oostergo T, Doeksen A, Aarts MJB, Ponds RWHM, van der Beek AJ, Schagen SB. Internet-based cognitive rehabilitation for working cancer survivors: results of a multicenter randomized controlled trial. JNCI Cancer Spectr 2024; 8:pkad110. [PMID: 38273712 PMCID: PMC10868395 DOI: 10.1093/jncics/pkad110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cognitive problems contribute to decline in work performance. We evaluated (1) the effectiveness of basic self-management and extensive therapist-guided online cognitive rehabilitation on attainment of individually predetermined work-related goals among occupationally active cancer survivors, and (2) whether effectiveness of the programs differed for survivors with and without formal cognitive impairment. METHODS In a 3-arm randomized controlled trial (NCT03900806), 279 non-central nervous system cancer survivors with cognitive complaints were assigned to the basic program (n = 93), the extensive program (n = 93), or a waiting-list control group (n = 93). Participants completed measurements pre-randomization (T0), 12 weeks post-randomization upon program completion (T1), and 26 weeks post-randomization (T2). Mixed-effects modeling was used to compare intervention groups with the control group on goal attainment, and on self-perceived cognitive problems, work ability, and health-related quality of life. RESULTS Participants in the extensive program achieved their predetermined goals better than those in the control group, at short- and long-term follow-up (effect size [ES] = .49; P < .001; ES = .34; P = .014). They also had fewer recovery needs after work (ES = -.21; P = .011), more vitality (ES = .20; P = .018), and better physical role functioning (ES = .0.43 P = .015) than controls. At long-term follow-up, this finding persisted for physical role functioning (ES = .42; P = .034). The basic program elicited a small positive nonsignificant short-term (not long-term) effect on goal attainment for those with adequate adherence (ES = .28, P = .053). Effectiveness of the programs did not differ for patients with or without cognitive impairment. CONCLUSIONS Internet-based therapist-guided extensive cognitive rehabilitation improves work-related goal attainment. Considering the prevalence of cognitive problems in survivors, it is desirable to implement this program.
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Affiliation(s)
- Kete M Klaver
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, Amsterdam, the Netherlands
| | - Chantal A V Geusgens
- Department of Medical Psychology, Zuyderland Medical Center, Sittard, the Netherlands
| | - Jacobien M Kieffer
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Joost Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Boelo J Poppema
- Department of Medical Oncology, Ommelander Hospital Group, Groningen, the Netherlands
| | - Tanja Oostergo
- Department of Medical Oncology, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Utrecht, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Ehrenstein JK, Duijts SFA, van Zon SKR, Amick BC, Schagen SB, Bültmann U. Establishing General Working Population Norms for the Cognitive Symptom Checklist-Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:766-775. [PMID: 36935459 PMCID: PMC10684708 DOI: 10.1007/s10926-023-10104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE The Cognitive Symptom Checklist-Work (CSC-W) is a self-report measure to assess cognitive symptoms (i.e., memory and executive function) in working adults with cancer. To date, general working population norm data are lacking worldwide. We established CSC-W norm values in the general working population, and assessed associations of CSC-W scores with work and health-related factors. METHODS This cross-sectional study consisted of 1,000 Dutch working adults, of whom data was collected through an online respondent panel. The sample was stratified for sex and age, and data were weighted. Summary scores of the CSC-W total scale, and memory and executive function symptoms subscales, were determined (e.g., means, percentiles). Z- and T-scores were calculated, and analysis of (co)variance has been applied. RESULTS Cognitive symptom scores were relatively stable across age groups, but 18-39-year-old respondents reported lower memory and executive function than respondents in other age groups. Symptom scores of memory function (mean 29.1; SD = 16.7) were higher for all age groups and in both sexes compared to executive function (mean 22.1; SD = 16.8). No sex differences in memory and executive function were observed. Higher symptom scores were associated with performing non-manual work only, manual work only, self-reported long-term illness, and higher levels of depressive symptoms and fatigue. CONCLUSION The CSC-W norms may enhance the interpretation and facilitate the analysis of self-reported cognitive symptoms in patients with cancer at work. Our findings may support health care professionals in identifying working adults with cancer with cognitive symptoms and in developing personalized treatment.
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Affiliation(s)
- Johanna K Ehrenstein
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, Groningen, 9700 RB, 9713 AV, The Netherlands.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam University Medical Centers (location Vrije Universiteit), De Boelelaan 1117, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, Utrecht, 3511 DT, The Netherlands
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, Groningen, 9700 RB, 9713 AV, The Netherlands
| | - Benjamin C Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
- University of Arkansas for Medical Sciences, Winthrop P Rockefellor Cancer Institute, 449 Jack Stephens Dr, Little Rock, AR, 72205, USA
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WT, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, Groningen, 9700 RB, 9713 AV, The Netherlands
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Terra L, Lee Meeuw Kjoe PR, Agelink van Rentergem JA, Beekman MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mourits MJE, van Dorst EBL, Mom CH, Slangen BFM, Gaarenstroom KN, van der Kolk LE, Collée JM, Wevers MR, Ausems MGEM, van Engelen K, van de Beek I, Berger LPV, van Asperen CJ, Gomez Garcia EB, Maas AHEM, Hooning MJ, van der Wall E, van Leeuwen FE, Schagen SB. Long-term effects of premenopausal risk-reducing salpingo-oophorectomy on cognition in women with high familial risk of ovarian cancer: A cross-sectional study. BJOG 2023; 130:968-977. [PMID: 36715559 DOI: 10.1111/1471-0528.17415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/18/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the effect of a premenopausal risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer on objective and subjective cognition at least 10 years after RRSO. DESIGN A cross-sectional study with prospective follow-up, nested in a nationwide cohort. SETTING Multicentre in the Netherlands. POPULATION OR SAMPLE 641 women (66% BRCA1/2 pathogenic variant carriers) who underwent either a premenopausal RRSO ≤ age 45 (n = 436) or a postmenopausal RRSO ≥ age 54 (n = 205). All participants were older than 55 years at recruitment. METHODS Participants completed an online cognitive test battery and a questionnaire on subjective cognition. We used multivariable regression analyses, adjusting for age, education, breast cancer, hormone replacement therapy, cardiovascular risk factors and depression. MAIN OUTCOME MEASURES The influence of RRSO on objective and subjective cognition of women with a premenopausal RRSO compared with women with a postmenopausal RRSO. RESULTS After adjustment, women with a premenopausal RRSO (mean time since RRSO 18.2 years) performed similarly on objective cognitive tests compared with women with a postmenopausal RRSO (mean time since RRSO 11.9 years). However, they more frequently reported problems with reasoning (odds ratio [OR] 1.8, 95% confidence interval [95% CI] 1.1-3.1) and multitasking (OR 1.9, 95% CI 1.1-3.4) than women with a postmenopausal RRSO. This difference between groups disappeared in an analysis restricted to women of comparable ages (60-70 years). CONCLUSIONS Reassuringly, approximately 18 years after RRSO, we found no association between premenopausal RRSO and objective cognition.
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Affiliation(s)
- Lara Terra
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Philippe R Lee Meeuw Kjoe
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maarten J Beekman
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marc van Beurden
- Department of Gynaecological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Joanna A de Hullu
- Department for Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eleonora B L van Dorst
- Department of Gynaecologic Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Constantijne H Mom
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lizet E van der Kolk
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marijke R Wevers
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Klaartje van Engelen
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irma van de Beek
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke P V Berger
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Encarna B Gomez Garcia
- Department for Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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10
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Ehrenstein JK, van Zon SKR, Duijts SFA, Stewart RE, Almansa J, Amick BC, Schagen SB, Bültmann U. Trajectories of cognitive symptoms and associated factors in cancer survivors after return to work: an 18-month longitudinal cohort study. J Cancer Surviv 2023; 17:290-299. [PMID: 35312951 PMCID: PMC10036271 DOI: 10.1007/s11764-022-01190-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/13/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Cognitive symptoms affect cancer survivors' functioning at work. To date, cognitive symptoms trajectories in working cancer survivors and the factors associated with these trajectories have not been examined. METHODS Data from a heterogeneous group of working cancer survivors (n = 379) of the longitudinal "Work-Life-after-Cancer" study, linked with Netherlands Cancer Registry data, were used. The Cognitive Symptom Checklist-Work was administered at baseline (within the first 3 months after return to work), 6-, 12-, and 18-month follow-up to measure self-perceived memory and executive function symptoms. Data were analyzed using group-based trajectory modeling. RESULTS Four trajectories of memory and executive function symptoms were identified. All memory symptoms trajectories were stable and labeled as "stable-high" (15.3% of the sample), "stable-moderately high" (39.6%), "stable-moderately low" (32.0%), and "stable-low" (13.0%). Executive function symptoms trajectories changed over time and were labeled as "increasing-high" (10.1%), "stable-moderately high" (32.0%), "decreasing-moderately low" (35.5%), and "stable-low" (22.4%). Higher symptoms trajectories were associated with older age, longer time from diagnosis to return to work, more quantitative work demands, and higher levels of depressive symptoms at baseline. CONCLUSIONS In cancer survivors who returned to work, four cognitive symptoms trajectory subgroups were identified, representing different but relatively stable severity levels of cognitive symptoms. IMPLICATIONS FOR CANCER SURVIVORS To identify cancer survivors with higher symptoms trajectories, health care providers should assess cognitive symptoms at baseline after return to work. In case of cognitive symptoms, it is important to also screen for psychological factors to provide appropriate guidance.
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Affiliation(s)
- Johanna K Ehrenstein
- Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Sander K R van Zon
- Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Roy E Stewart
- Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Josué Almansa
- Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Benjamin C Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, The Netherlands
| | - Ute Bültmann
- Community and Occupational Medicine, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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11
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Oliveira AF, Fernandes S, Reis JD, Torres A, Santos IM, Von Ah D. Cognitive functioning and work-related outcomes of non-central nervous system cancer survivors: protocol for a systematic review with meta-analysis. BMJ Open 2022; 12:e060300. [PMID: 35820744 PMCID: PMC9277407 DOI: 10.1136/bmjopen-2021-060300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In recent years, growing attention has been given to the study of the impact of cancer-related cognitive impairment (CRCI) in working non-central nervous system (CNS) cancer survivors. Available literature has shown that working cancer survivors identify cognitive problems at work as very problematic and worrisome. Some reviews have discussed the association between CRCI and work-related outcomes; however, none to date have investigated this association through comprehensive systematic review with meta-analysis. Hence, this work will comprehensively summarise existing evidence from quantitative studies assessing the relationship between CRCI and work-related outcomes of adult non-CNS cancer survivors at working age. METHODS AND ANALYSIS The systematic review procedures and its report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Electronic searches in the databases Web of Science, Scopus, PubMed, ProQuest, PsycINFO and CINAHL, complemented by a manual search of other relevant articles, will be performed from 2000 onwards to identify relevant publications. Two independent reviewers will assess studies for inclusion and extract data from each article using a standardised form. Studies eligible for inclusion must be quantitative, contain adult non-CNS cancer survivors with CRCI, and a measure of cognitive functioning and work-related outcomes. To assess risk of bias, the Joanna Briggs Institute Critical Appraisal Tool Studies checklists will be independently used by the two researchers. Synthesis of the included articles will be conducted using a narrative method and through meta-analysis. Meta-analysis will be reported via correlation for the association between CRCI and work-related outcomes. The cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation system. ETHICS AND DISSEMINATION Ethics approval is not required since individual patient data will not be collected. The findings will be published in a peer-review indexed journal, presented at scientific meetings and included in a chapter of a Doctoral thesis. PROSPERO REGISTRATION NUMBER CRD42020165458.
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Affiliation(s)
- Ana F Oliveira
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Sofia Fernandes
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Juliana D Reis
- Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Ana Torres
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- Department of Psychology and Education, Faculty of Human and Social Sciences, University of Beira Interior, Covilhã, Portugal
| | - Isabel M Santos
- William James Center for Research (WJCR), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Diane Von Ah
- The Ohio State University, College of Nursing, Columbus, Ohio, USA
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12
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Van Beek FE, Wijnhoven LMA, Holtmaat K, Custers JAE, Prins JB, Verdonck-de Leeuw IM, Jansen F. Psychological problems among cancer patients in relation to healthcare and societal costs: A systematic review. Psychooncology 2021; 30:1801-1835. [PMID: 34228838 PMCID: PMC9291760 DOI: 10.1002/pon.5753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study systematically reviewed the association of psychological problems among cancer patients with healthcare and societal resource use and costs. METHODS PubMed, PsycINFO, and Embase were searched (until 31 January 2021) for studies on psychological symptoms (anxiety, depression, distress, fear of recurrence) or psychiatric disorders (anxiety, depression, adjustment) and healthcare use (e.g., mental, inpatient healthcare), economic losses by patients and family, economic losses in other sectors (e.g., absence from work), and costs. The search, data extraction, and quality assessment were performed by two authors. RESULTS Of the 4157 identified records, 49 articles were included (psychological symptoms (n = 34), psychiatric disorders (n = 14), both (n = 1)) which focused on healthcare use (n = 36), economic losses by patients and family (n = 5), economic losses in other sectors (n = 8) and/or costs (n = 13). In total, for 12 of the 94 associations strong evidence was found. Psychological symptoms and psychiatric disorders were positively associated with increased healthcare use (mental, primary, inpatient, outpatient healthcare), losses in other sectors (absence from work), and costs (inpatient, outpatient, total healthcare costs). Moderate evidence was found for a positive association between (any) psychiatric disorder and depression disorder with inpatient healthcare and medication use, respectively. CONCLUSIONS Psychological problems in cancer patients are associated with increased healthcare use, healthcare costs and economic losses. Further research is needed on psychological problems in relation to understudied healthcare use or costs categories, productivity losses, and informal care costs.
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Affiliation(s)
- Florie E Van Beek
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lonneke M A Wijnhoven
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Karen Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc Cancer Center Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc Cancer Center Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam (CCA), VU University Medical Center, Amsterdam, The Netherlands
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13
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Trajectories of Cognitive Symptoms in Sick-Listed Cancer Survivors. Cancers (Basel) 2021; 13:cancers13102444. [PMID: 34069998 PMCID: PMC8157828 DOI: 10.3390/cancers13102444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The effects of cognitive symptoms on the ability to work are of major concern for cancer survivors. The aim of our study was to explore trajectories of cognitive functioning in sick-listed cancer survivors with work capacity. We found that cognitive functioning improved between two and four years after first day of sick leave, although cognitive symptoms remained of clinical concern in cancer survivors who are non-durable work-disabled (partly or fully). This underlines the importance to provide partly and fully, non-durable work disabled cancer survivors with evidence-based treatment options for their self-perceived cognitive symptoms. Abstract Many non-central nervous system (CNS) cancer survivors experience cognitive symptoms, which may affect their self-perceived work ability. Little is known about trajectories of self-perceived cognitive functioning in cancer survivors in the period after work disability assessment. Therefore, we evaluated: (1) trajectories of self-reported cognitive functioning, in cancer survivors with work capacity, (2) differences in trajectories of self-reported cognitive functioning between three work disability groups, and (3) explanatory factors of trajectories of self-reported cognitive functioning. Participants (n = 206) were assessed on self-reported cognitive functioning at three time points between two and four years after first day of sick leave. A statistically significant improvement in cognitive functioning was found in the total group (β = 4.62, SE = 0.91, p < 0.001). When comparing cancer survivors in different work disability groups, similar trajectories of cognitive functioning were observed. Fatigue was the only factor found to be associated with the reported trajectory (β = −0.23, SE = 0.086, p = 0.08). Self-perceived cognitive functioning scores remained considerably lower than the mean score of the general Dutch population, indicating that cognitive symptoms are a persistent problem in sick-listed cancer survivors and that evidence-based treatment options are warranted.
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