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Larsen LL, Hoffmann Merrild C. Good cancer follow-up for socially disadvantaged patients in general practice? Perspectives from patients and general practitioners. Scand J Prim Health Care 2024; 42:316-326. [PMID: 38376126 PMCID: PMC11003317 DOI: 10.1080/02813432.2024.2317843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients.
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Brink E, Pilegaard MS, Bonnesen TG, Nielsen CV, Pedersen P. Employment status in cancer patients the first five years after diagnosis-a register-based study. J Cancer Surviv 2024:10.1007/s11764-024-01576-5. [PMID: 38587762 DOI: 10.1007/s11764-024-01576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Work is important for identity formation, social status, and economic independency. Although some evidence within the field of work and cancer survivorship exists, no study has so far investigated employment status across all cancer diagnoses. Thus, the aim of the present study was to investigate the impact of all cancer diagnoses on employment status. METHODS Danish cancer patients aged 20-60 years, diagnosed between 2000 and 2015, were identified through Danish registers and matched 1:5 with cancer-free controls. Logistic and linear regression was performed separately in 11 cancer types to assess and compare work status and work participation between cancer patients and cancer-free controls one, three, and five years after diagnosis. RESULTS A total of 111,770 cancer patients and 507,003 cancer-free controls were included. All cancer types had lower chances of working one year after diagnosis (ORs between 0.05 and 0.76), with lung, colorectal, upper gastrointestinal, and blood cancer patients having the lowest chances. After three years, 10 of 11 cancer types had lower chances (ORs between 0.39 and 0.84). After five years, there were minimal differences between cancer patients and controls among most cancer types (ORs between 0.75 and 1.36). CONCLUSION Most cancer patients had lower chances of working compared with the general population until five years after diagnosis. However, patients with certain cancer types experienced lower chances of working all years, despite improvement over time. IMPLICATIONS FOR CANCER SURVIVORS The knowledge will help increase awareness on challenges regarding work-life after cancer. Furthermore, the distinguishing between diagnoses can inform to more targeted vocational rehabilitation.
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Affiliation(s)
- E Brink
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - M S Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - T G Bonnesen
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - P Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Cogollos-de-la-Peña R, Álvarez-Vargas A, Domínguez-Navarro F, Espelt A, Fuentes-Aparicio L, Puigpinós-Riera R. Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort. Breast Cancer Res Treat 2024; 204:377-387. [PMID: 38155271 PMCID: PMC10948522 DOI: 10.1007/s10549-023-07191-9] [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: 05/18/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.
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Affiliation(s)
| | - Anaís Álvarez-Vargas
- Departament d'Epidemiologia i Metodologia de Les Ciències Socials I de La Salut d'Umanresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Catalonia, Spain
| | - Fernando Domínguez-Navarro
- Faculty of Health Science, Universidad Europea de Valencia, Valencia, Spain.
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag 5. 46010, Valencia, Spain.
| | - Albert Espelt
- Departament de Psicobiologia i Metodologia de Les Ciències de La Salut, Bellaterra, Catalonia, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Fuentes-Aparicio
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag 5. 46010, Valencia, Spain
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rosa Puigpinós-Riera
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Catalonia, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
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Ahmedzai HH, Oldervoll LM, Sweetmore AMH, Hauken MA. Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study. Cancer Nurs 2024; 47:E123-E133. [PMID: 36066332 DOI: 10.1097/ncc.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway, this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. OBJECTIVE This study aimed to assess the feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. METHODS A feasibility study with a mixed methods explanatory sequential design was implemented. The intervention was a 12-week group-based rehabilitation program comprising 5 components: goal setting, physical exercise, psychoeducation, individual follow-up consultations, and peer support. Feasibility was assessed through recruitment, retention, and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive, and qualitative data were transcribed and analyzed using framework analyses. RESULTS Sixty participants started, and 55 completed the 12-week rehabilitation program. The majority were female (80%), and the mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as were adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. CONCLUSION High retention, strong adherence, and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. IMPLICATION FOR PRACTICE The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway "Home."
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Affiliation(s)
- Hilde Hjelmeland Ahmedzai
- Author Affiliations: Centre for Crisis Psychology, University of Bergen (Dr Ahmedzai, Profs Hauken and Oldervoll), Norway; and The Healthy Life Centre, Askøy District Council (Ms Sweetmore), Norway
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Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2023:1-13. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
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Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Møller JJK, la Cour K, Pilegaard MS, Dalton SO, Bidstrup P, Möller S, Jarlbaek L. The use and timing of rehabilitation and palliative care to cancer patients, and the influence of social vulnerability - a population-based study. BMJ Support Palliat Care 2023:spcare-2023-004487. [PMID: 37816594 DOI: 10.1136/spcare-2023-004487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To identify and investigate different cohorts of cancer patients' use of physical rehabilitation and specialised palliative care (SPC) services, focusing on patients with incurable cancer and the impact of social vulnerability. METHODS The sample originated from patients diagnosed during 2013-2018 and alive 1 January 2015. Use of physical rehabilitation and/or SPC units were identified from contacts registered in population-based administrative databases. Competing-risks regression models were applied to investigate disparities with regard to social vulnerability, disease duration, gender and age. RESULTS A total of 101 268 patients with cancer were included and 60 125 survived longer than 3 years after their diagnosis. Among the 41 143 patients, who died from cancer, 66%, survived less than 1 year, 23% survived from 1 to 2 years and 11% survived from 2 to 3 years. Contacts regarding physical rehabilitation services appeared in the entire cancer trajectory, whereas contacts regarding SPC showed a steep increase as time drew closer to death. The largest disparity was related to disease duration. Socially vulnerable patients had less contact with SPC, while a larger proportion of the socially vulnerable cancer survivors used rehabilitation, compared with the non-vulnerable patients. CONCLUSIONS This study provides a previously unseen detailed overview of the use of physical rehabilitation and/or SPC among patients with incurable cancer. The services appeared to overlap at a group level in the cancer trajectory, emphasising the importance of awareness with regard to coordination and combination of the services. Disparities between socially vulnerable or non-vulnerable patients were identified.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Chan VHY, Heller DR, Sanft TB. ASO Author Reflections: Ancillary Treatment After Breast Cancer Surgery: Who are We Missing? Ann Surg Oncol 2023; 30:5649-5650. [PMID: 37179270 DOI: 10.1245/s10434-023-13507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Vernice H Y Chan
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Danielle R Heller
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tara B Sanft
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
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Chan VHY, Heller DR, Berger ER, Capozza S, Greenup RA, Sanft TB. Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population. Ann Surg Oncol 2023; 30:5637-5648. [PMID: 37266804 DOI: 10.1245/s10434-023-13431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Ancillary therapies with rehabilitative, palliative, and survivorship specialists mitigate adverse effects of breast cancer surgery. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive these services. This study aimed to assess variations in ancillary provider referrals and patient visits at a high-volume urban cancer center. METHODS Electronic health records of breast cancer surgical patients at the Yale-New Haven Health System between 2010 and 2017 were reviewed. The primary end points were postoperative referral to ancillary service providers and patient use of ancillary services (defined as attending ≥ 1 consultation). Associations between end points and demographic/disease variables were identified in uni- and multivariable logistic regression analyses. RESULTS The study identified 5496 patients: 2288 patients (41.6%) referred to ancillary services and 1572 patients (28.6%) who attended one or more consultations. Referrals were highest among the patients with Hispanic (57.5%) or black (54.9%) ancestry, no health insurance (57.6%), lowest percentage of high school degrees for the zip code area (50.5%), and poorest median income bracket (50.7%). Associations remained significant in the multivariable analysis (p < 0.05). Minority race remained associated with referrals in analyses of each ancillary service individually. Visits to ancillary specialists were greatest among the patients with private insurance (70.7%), highest percentage of high school degrees (72.8%), highest median household income (72.2%), and Hispanic ethnicity (73.5%). Highest median household income (odds ratio [OR] 1.45; p = 0.02) and Hispanic ethnicity (OR, 1.50; p = 0.05) remained associated in the multivariable analysis. CONCLUSIONS In a well-resourced health system serving a demographically diverse population, traditional markers of poor health care access were associated with referral for ancillary treatment after breast cancer surgery but not with utilization of ancillary treatment. Health care access remains a critical barrier to adjunctive therapies that target postoperative morbidity and elevate quality of life.
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Affiliation(s)
- Vernice H Y Chan
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Danielle R Heller
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth R Berger
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Capozza
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rachel A Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tara B Sanft
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
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Karlsen RV, Høeg BL, Dalton SO, Saltbæk L, Dehlendorff C, Johansen C, Svendsen MN, Bidstrup PE. Are education and cohabitation associated with health-related quality of life and self-management during breast cancer follow-up? A longitudinal study. Acta Oncol 2023; 62:407-413. [PMID: 37083556 DOI: 10.1080/0284186x.2023.2199128] [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: 10/13/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Oncologist-led follow-up after breast cancer (BC) is increasingly replaced with less intensive follow-up based on higher self-management, which may overburden the less resourceful patients. We examined whether socioeconomic factors measured recently after the implementation of a new follow-up program for BC patients were associated with health-related quality of life (HRQoL) and self-management 12 months later. METHODOLOGY Between January and August 2017, we invited 1773 patients in Region Zealand, Denmark, to participate in baseline and 12 months follow-up questionnaires. The patients had surgery for low- and intermediate risk BC 1-10 years prior to the survey, and they had recently been allocated to the new follow-up program of either patient-initiated follow-up, or in-person or telephone follow-up with a nurse, based on patients' preferences. We examined associations between socioeconomic factors (education and cohabitation) at baseline and two outcomes: HRQoL (EORTC QLQ-C30 and QLQ-BR23) and self-management factors (health care provider, confidence in follow-up, contact at symptoms of concern, and self-efficacy) at 12 months follow-up. Sensitivity analyses were performed according to time since diagnosis (≤ 5 > 5 years). Furthermore, we investigated whether treatment and self-management factors modified the associations. RESULTS A total of 987 patients were included in the analyses. We found no statistically significant associations between socioeconomic factors and HRQoL, except in patients ≤ 5 years from diagnosis. For self-management patients with short education were more likely to report that they had not experience relevant symptoms of concern compared to those with medium/long education (OR 1.75 95% CI: 1.04; 2.95). We found no clear patterns indicating that treatment or self-management factors modified the associations between socioeconomics' and HRQoL. CONCLUSION Overall socioeconomic factors did not influence HRQoL and self-management factors except for experiencing and reporting relevant symptoms of concern. Socioeconomic factors may, however, influence HRQoL in patients within five years of diagnosis.
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Affiliation(s)
- Randi V Karlsen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
- Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lena Saltbæk
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
- Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- CASTLE, Department of Oncology, Finsen Centre, Rigshospitalet, Copenhagen, Denmark
| | - Mads Nordahl Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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Brautsch LAS, Voss I, Schmidt L, Vassard D. Social disparities in the use of ART treatment: a national register-based cross-sectional study among women in Denmark. Hum Reprod 2023; 38:503-510. [PMID: 36370443 DOI: 10.1093/humrep/deac247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark? SUMMARY ANSWER Higher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark. WHAT IS KNOWN ALREADY Infertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment. STUDY DESIGN, SIZE, DURATION Women undergoing ART treatment during 1994-2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS The women included in the analyses were aged 18-45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the age span. MAIN RESULTS AND THE ROLE OF CHANCE Adjusted results showed increased odds of receiving a first ART treatment in either the public or private sector among women with a higher educational level. Furthermore, women in employment were more likely to receive a first ART treatment in the public or private sector compared to women outside the workforce. The odds of receiving a first ART treatment increased with increasing income level. Surprisingly, income level had a greater impact on the odds of receiving a first ART treatment in the public sector than in the private sector. Women in the highest income group had 10 times higher odds of receiving a first ART treatment in the public sector (OR: 10.53 95% CI: 10.13, 10.95) compared to women in the lowest income group. Sub-analyses in different age groups showed significant associations between ART treatment and income level and labor market attachment in all age groups. LIMITATIONS, REASONS FOR CAUTION Our study does not include non-ART treatments, as the national IVF register did not register these types of fertility treatments before 2007. WIDER IMPLICATIONS OF THE FINDINGS In Denmark, there is equal access to medically assisted reproduction treatment in the publicly funded healthcare system, and since there is no social inequality in the prevalence of infertility, social inequality in the use of ART treatment would not be expected as such. However, our results show that social inequality is found for a first ART treatment attempt across publicly and privately funded ART treatment across the socioeconomic indicators, educational level, labor market attachment and income. STUDY FUNDING/COMPETING INTEREST(S) The funding for the establishment of the Danish National ART-Couple II Cohort (DANAC II Cohort) was obtained from the Rosa Ebba Hansen Foundation. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | - Ida Voss
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - Lone Schmidt
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
| | - Ditte Vassard
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark
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Mozhaeva I. Inequalities in Utilization of Institutional Care Among Older People in Estonia. Health Policy 2022; 126:704-714. [DOI: 10.1016/j.healthpol.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/07/2021] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
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12
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Nissen N, Rossau HK, Pilegaard MS, la Cour K. Cancer rehabilitation and palliative care for socially vulnerable patients in Denmark: an exploration of practices and conceptualisations. Palliat Care Soc Pract 2022; 16:26323524221097982. [PMID: 35800415 PMCID: PMC9253993 DOI: 10.1177/26323524221097982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Despite a tax-funded, needs-based organisation of the Danish health system,
social inequality in cancer rehabilitation and palliative care (PC) has been
noted repeatedly. Little is known about how best to improve access and
participation in cancer rehabilitation and PC for socio-economically
disadvantaged and socially vulnerable patients. Aim: To gather, synthesise and describe practice-orientated development studies
presented in Danish-language publications and examine the underpinning
conceptualisations of social inequality and vulnerability; explore related
views of stakeholders working in the field. Methods: The study comprised a narrative review of Danish-language literature on
practice-orientated development studies which address social inequality and
vulnerability in cancer rehabilitation and PC and an online stakeholder
consultation workshop with Danish professionals and academics working in the
field. Results: Two themes characterise the included publications (n = 8):
types of interventions; conceptualisations of social inequality and
vulnerability; three themes were identified in the workshop data: focus and
type of interventions; organisation of cancer care; and vulnerability of the
healthcare system. The publications and the workshop participants
(n = 12) favoured approaches which provide additional
individualised resources throughout the cancer trajectory for this patient
group. The terms social inequality and social vulnerability are largely used
interchangeably, and associated with low income and no or little education
yet qualified with multiple descriptors, which reflect the diverse
socio-economic situations professionals encounter in cancer patients and
their psychosocial needs. Conclusion: Addressing social inequality and vulnerability in cancer rehabilitation and
PC in Denmark entails practical and conceptual challenges. Of importance is
individualised support and the integration of rehabilitation and PC into
standardised care pathways. To conceive of social vulnerability as a
layered, dynamic, relational and contextual concept reflects current
practice in identifying the diversity of cancer patients who may benefit
from additional support in accessing and participating in rehabilitation and
PC.
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Affiliation(s)
- Nina Nissen
- Independent Researcher, Berlin, Germany
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Henriette Knold Rossau
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Marc Sampedro Pilegaard
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- User Perspectives and Community-Based Interventions, Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Affiliation during the study: REHPA – Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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Petersen KS, Madsen LS, Nielsen CV, Labriola M, Stapelfeldt CM. "To have and then lose the safety net" - Female cancer survivors' experiences of the process of becoming ready to return to work. Work 2021; 70:1121-1130. [PMID: 34864711 DOI: 10.3233/wor-213623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Validation studies have not been able to confirm the stage-specific understanding as operationalised in the readiness for return to work (RRTW) questionnaire. OBJECTIVE To explore retrospectively how working female cancer survivors experienced the process of becoming ready to RTW during and beyond participation in an occupational rehabilitation intervention and thereby expand the understanding of the RRTW construct. METHODS A qualitative research design was employed. Thirteen female cancer survivors were included for semi-structured interviews one to two years after they had completed active treatment and returned to work. The RRTW construct guided data generation and analysis. Content analysis was performed in four analytical steps that combined a concept-driven and a data-driven analytic strategy. RESULTS Three themes were identified; "To have and then lose the safety net", "Realise a changed life situation", "Strive to balance work and everyday life". In a time span of approximately one to two years (from receiving treatment, being enrolled in an intervention and to gradually returning to work); the identified themes were interdependent of each other as one theme gradually evolved to the next theme in the process of engaging in sustained work participation. CONCLUSIONS The present study points towards continuous development of the RRTW construct and whether the addition of a preparedness dimension would improve validity.
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Affiliation(s)
- K S Petersen
- Department of Health Science and Technology, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - L S Madsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - M Labriola
- Norwegian Research Centre (NORCE), Bergen, Norway
| | - C M Stapelfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Central Region Denmark, Aarhus, Denmark
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14
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Hjorth CF, Damkier P, Ejlertsen B, Lash T, Sørensen HT, Cronin-Fenton D. Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark. BMC Med 2021; 19:235. [PMID: 34587961 PMCID: PMC8482675 DOI: 10.1186/s12916-021-02108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. METHODS We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. RESULTS Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. CONCLUSIONS Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.
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Affiliation(s)
- Cathrine Fonnesbech Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, J.B. Winsløvs vej 4, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Winsløwparken 19, University of Southern Denmark, 5000, Odense, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Timothy Lash
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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15
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Evaluation of two strategies to implement physical cancer rehabilitation guidelines for survivors of abdominopelvic cavity tumors: a controlled before-and-after study. J Cancer Surviv 2021; 16:497-513. [PMID: 34519980 PMCID: PMC9142440 DOI: 10.1007/s11764-021-01045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022]
Abstract
Purpose This study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies. Methods We tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility. Results In total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies. Conclusion Implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations. Implications for Cancer Survivors Using implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01045-3.
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16
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Clotas C, Serral G, Vidal Garcia E, Puigpinós-Riera R. Dietary changes and food habits: social and clinical determinants in a cohort of women diagnosed with breast cancer in Barcelona (DAMA cohort). Cancer Causes Control 2021; 32:1355-1364. [PMID: 34480675 DOI: 10.1007/s10552-021-01483-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the influence of social determinants on changes in dietary habits before and after diagnosis of breast cancer in women (Barcelona, 2003-2013). METHODS We performed a cohort study with 2,235 women diagnosed with breast cancer. The information was obtained from an ad hoc questionnaire based on recommendations from the Spanish Society of Community Nutrition. We conducted a descriptive bivariate analysis and fit logistic regression models. The dependent variable was the change in dietary habits (food groups) and the independent variables were a selection of social and clinical variables (age, social class, cohabitation, years since diagnosis, history of replaces, and treatment with chemotherapy). RESULTS While 5.8% of women followed a healthy diet (consumption of vegetables, fruits, farinaceous, lean meat, and seafood) before diagnosis, 9.5% did so after diagnosis. We observed statistically significant changes in consumption of all food groups (p < 0.001) after diagnosis. The greatest change in consumption patterns was observed in women aged < 50 years and those from non-manual classes (high classes) [e.g., legume consumption: OR<50 years/>65 years = 2.9 (95% CI 1.78-4.81); ORnon-manual/manual = 2.5 (95% CI 1.38-4.36)]. The occurrence of relapses and chemotherapy was associated with greater changes in dietary habits. CONCLUSION Women with breast cancer change their eating habits after diagnosis, and these changes are conditioned by social and clinical determinants.
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Affiliation(s)
- C Clotas
- Servei d'Avaluació i Mètodes d'Intervenció, Agencia de Salud Pública de Barcelona (ASPB), Pça. Lesseps, 1, 08023, Barcelona, Catalonia, Spain
| | - G Serral
- Servei d'Avaluació i Mètodes d'Intervenció, Agencia de Salud Pública de Barcelona (ASPB), Pça. Lesseps, 1, 08023, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB St. Pau), Barcelona, Catalonia, Spain
| | - E Vidal Garcia
- Facultat Ciències de la Salut Blanquerna-Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - R Puigpinós-Riera
- Servei d'Avaluació i Mètodes d'Intervenció, Agencia de Salud Pública de Barcelona (ASPB), Pça. Lesseps, 1, 08023, Barcelona, Catalonia, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
- Institut de Recerca Biomèdica Sant Pau (IIB St. Pau), Barcelona, Catalonia, Spain.
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17
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Sachdev R, Garg K, Shwetam S, Srivastava A. Non-specific Chief Complaints Among Oral Submucous Fibrosis Patients at Outpatient Department and Pan Shop at Rural Region in India. J Int Soc Prev Community Dent 2021; 11:382-388. [PMID: 34430498 PMCID: PMC8352048 DOI: 10.4103/jispcd.jispcd_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/29/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: The first communication with a healthcare professional is critical for determining the correct diagnosis, particularly when it comes to patients’ description of symptoms. This study aimed at exploring the primary symptoms observed in oral submucous fibrosis patients with non-specific complaints visiting outpatient department and pan shop at Kanpur, India. Materials and Methods: It was a cross-sectional study involving a two-stage sampling to select clinically diagnosed oral submucous fibrosis (OSF) patients from the outpatient department and pan shop customers (PSCs) at rural healthcare centers. A total of 321 participants were selected based on convenience sampling. Patient demographics, history of relevant habits with a period, and socioeconomic status were all documented. The extent of mouth opening was used to grade OSF cases. Data were analyzed using MedCalc Version 19.7.2 with χ2, Wilcoxon signed-rank, and t-tests used, as appropriate, to calculate P-values. Results: Out of the 184 OSF-OPD patients, only 59 (32.06%) described relevant disease symptoms of OSF: in stage III, 28.5% or stage IV, 38.7%. One hundred and twenty-five patients (67.93%) reported chief complaints (CCs) unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 72.41% and stage II: 61.53%). Out of the total 137 PSCs, 74 PSCs have had prior dental consultations, but only 44 (32.11%) people had sought medical help because of OSF-related CCs. Conclusion: A limited number of studies were conducted in this area, particularly in the rural population of central India. Our study found that considerable amount of main complaints from OSF patients was unrelated to their symptoms. There is insufficient knowledge of OSF symptoms among rural population, which further restricts early detection of the disease.
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Affiliation(s)
- Rohan Sachdev
- Department of Public Health, UWA School of Population and Global Health Australia, Perth, Western Australia, Australia
| | - Kriti Garg
- Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Samiksha Shwetam
- Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Akash Srivastava
- Department of Oral Medicine and Radiology, Rama Dental College, Kanpur, Uttar Pradesh, India
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18
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Seibaek L, Handberg C, Beedholm K. 'Well, if I don't show up and go through with the fertility treatment, I won't have a baby'; Patient involvement in clinical practice: Option or condition? J Eval Clin Pract 2021; 27:256-263. [PMID: 32652735 DOI: 10.1111/jep.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Worldwide, the concept of patient involvement has a growing impact on health care. Involvement in care represents a benefit to many patients, but while being involved is inevitable for the patient, we assume that getting involved is not in all cases obtainable. On this background, we aimed to investigate patients' perceptions and experiences concerning their treatment and care in a clinical fertility treatment setting, and discuss how these may influence their possibilities for involvement in care. METHOD Based on findings from focus-group interviews with women undergoing fertility treatment, we have dealt with two aspects that impact the patients' possibilities for getting involved in their care: Imbalanced power relations in clinical settings, and patients' experiences of their physical vulnerability. Framed by phenomenological-hermeneutic text interpretation theory key condensations were analysed and critically discussed. RESULTS We found that (a) to the individual patient it did not represent a free choice to seek and undergo treatment; (b) patients experienced substantial dependency, vulnerability, and anxiety during their clinical pathway. CONCLUSION We conclude that it is essential to integrate also the influence of the clinical setting and the bodily aspects of care in the understanding of patient involvement in clinical practice.
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Affiliation(s)
- Lene Seibaek
- Department of Gynaecology and Obstetrics, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University and National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Kirsten Beedholm
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
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19
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Validation of the Persian version of the satisfaction with life scale (SWLS) in Iranian women with breast Cancer. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01662-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Sampedro Pilegaard M, Knold Rossau H, Lejsgaard E, Kjer Møller JJ, Jarlbaek L, Dalton SO, la Cour K. Rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer: a scoping review. Acta Oncol 2021; 60:112-123. [PMID: 33021852 DOI: 10.1080/0284186x.2020.1827156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rehabilitation and palliative care may play an important role in addressing the problems and needs perceived by socioeconomically disadvantaged patients with advanced cancer. However, no study has synthesized existing research on rehabilitation and palliative care for socioeconomically disadvantaged patients with advanced cancer. The study aimed to map existing research of rehabilitation and palliative care for patients with advanced cancer who are socioeconomically disadvantaged. MATERIAL AND METHODS A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic literature search was performed in CINAHL, PubMed and EMBASE. Two reviewers independently assessed abstracts and full-text articles for eligibility and performed data extraction. Both qualitative and quantitative studies published between 2010 and 2019 were included if they addressed rehabilitation or palliative care for socioeconomically disadvantaged (adults ≥18 years) patients with advanced cancer. Socioeconomic disadvantage is defined by socioeconomic position (income, educational level and occupational status). RESULTS In total, 11 studies were included in this scoping review (138,152 patients and 45 healthcare providers) of which 10 were quantitative studies and 1 was a qualitative study. All included studies investigated the use of and preferences for palliative care, and none focused on rehabilitation. Two studies explored health professionals' perspectives on the delivery of palliative care. CONCLUSION Existing research within this research field is sparse. Future research should focus more on how best to reach and support socioeconomically disadvantaged people with advanced cancer in community-based rehabilitation and palliative care.
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Affiliation(s)
- Marc Sampedro Pilegaard
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- Department of Public Health, Research Unit of General Practice, The Research Initiative of Activity Studies and Occupational Therapy, University of Southern Denmark, Odense, Denmark
| | - Henriette Knold Rossau
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Esben Lejsgaard
- Department of Sociology and Social Work, Aalborg University, Denmark, Aalborg, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship & Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department for Clinical Oncology & Palliative Care, Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Næstved, Denmark
| | - Karen la Cour
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
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21
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IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
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22
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Kjeldgaard AH, Hørslev-Petersen K, Wehberg S, Soendergaard J, Primdahl J. Does socioeconomic status make a difference? A register-based study on the extent to which cardiovascular screening in patients with inflammatory arthritis leads to recommended follow-up in general practice. RMD Open 2020; 6:rmdopen-2019-000940. [PMID: 32868450 PMCID: PMC7507734 DOI: 10.1136/rmdopen-2019-000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate to what extent patients with inflammatory arthritis (IA) follow recommendations given in a secondary care nurse-led cardiovascular (CV) risk screening consultation to consult their general practitioner (GP) to reduce their CV risk and whether their socioeconomic status (SES) affects adherence. METHODS Adults with IA who had participated in a secondary care screening consultation from July 2012 to July 2015, based on the EULAR recommendations, were identified. Patients were considered to have high CV risk if they had risk Systematic COronary Risk Evaluation (SCORE) ≥5%, according to the European SCORE model or systolic blood pressure ≥145 mmHg, total cholesterol ≥8 mmol/L, LDL cholesterol ≥5 mmol/L, HbA1c ≥42 mmol/mol or fasting glucose ≥6 mmol/L. The primary outcome was a consultation with their GP and at least one action focusing on CV risk factors within 6 weeks after the screening consultation. RESULTS The study comprised 1265 patients, aged 18-85 years. Of these, 336/447 (75%) of the high-risk patients and 580/819 (71%) of the low-risk patients had a GP consultation. 127/336 (38%) of high-risk patients and 160/580 (28%) of low-risk patients received relevant actions related to their CV risk, for example, blood pressure home measurement or prescription for statins, antihypertensives or antidiabetics. Education ≥10 years increased the odds for non-adherence (OR 0.58, 95% CI 0.0.37 to 0.92, p=0.02). CONCLUSIONS 75% of the high-risk patients consulted their GP after the secondary care CV risk screening, and 38% of these received an action relevant for their CV risk. Higher education decreased adherence.
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Affiliation(s)
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jens Soendergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa 6200, Denmark
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Jie Y, Wang Y, Chen J, Wang C, Lin Y, Hu R, Wu Y. Unmet supportive care needs and its relation to quality of life among adult acute leukaemia patients in China: a cross-sectional study. Health Qual Life Outcomes 2020; 18:199. [PMID: 32576289 PMCID: PMC7310469 DOI: 10.1186/s12955-020-01454-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Patients with acute leukaemia (AL) usually require prolonged periods of hospitalisation. The treatment and clinical symptoms may lead to patients’ supportive care needs (SCNs) not being met and impairs their quality of life (QoL). Studies on QoL and SCNs among AL patients are limited. This study aimed to identify the unmet SCNs and its relation to QoL of adult AL patients in China. Methods This multicentre cross-sectional study recruited 346 participants to complete a self-developed questionnaire, detailing demographic information and disease-related variables. A 34-item Supportive Care Needs Survey (SCNS-SF34) was used to identify unmet SCNs, and the Functional Assessment of Cancer Therapy-Leukaemia (FACT-Leu) questionnaire measured patients’ QoL. Results Unmet SCN rates for the 34 items ranged from17.6 to 81.7%. Patients’ needs were high for health systems and information, but low in the sexual domain. The results reveal nine factors associated with the unmet SCNs of adult AL patients, including marital status, original residence, age, education, occupation, other diseases, chemotherapy course, disease course, and treatment stage (p < 0.05). The total score of the FACT-Leu negatively correlated with the SCNS-SF34 in the physical/daily living (r = − 0.527, p < 0.01), psychological (r = − 0.688, p < 0.01), sexual (r = − 0.170, p < 0.01), patient care and support (r = − 0.352, p < 0.01), and health systems and information (r = − 0.220, p < 0.01) domains. Conclusions Adult AL patients exhibit a high demand for unmet SCNs, especially in the domain of health systems and information. There was a significant association between patients’ unmet SCNs and QoL. Future research should develop tailored interventions to address the unmet SCNs of adult AL patients, to further improve their QoL.
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Affiliation(s)
- Yan Jie
- School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China
| | - Ying Wang
- School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China
| | - Jingyi Chen
- School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China
| | - Chunfeng Wang
- School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China
| | - Yingchun Lin
- Department of Hematology, the First Affiliated Hospital of Fujian University, No. 20 of Chazhong Road, Taijiang District, Fuzhou City, 350004, Fujian Province, China
| | - Rong Hu
- School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, 350122, Fujian Province, China.
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou City, 350001, Fujian Province, China.
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Investigating whether shared video-based consultations with patients, oncologists, and GPs can benefit patient-centred cancer care: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101023. [PMID: 32238390 PMCID: PMC7330209 DOI: 10.3399/bjgpopen20x101023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Guidelines have proposed that GPs should have a central role as coordinators of care and support patients with cancer during all stages of treatment, follow-up, and rehabilitation. Multidisciplinary video consultation involving the patient with cancer, the oncologist, and the GP may help to define roles and tasks, and this resulting clarity may enable greater support for patients with cancer. Aim To explore the consultation structure, content, and task clarification when a GP and an oncologist are attending a video consultation with a patient with cancer. Design & setting A qualitative study took place in the Region of Southern Denmark to investigate multidisciplinary video consultations, based on thematic analysis. Method Recordings of 12 video consultations were analysed using the framework method. A combined deductive and inductive approach was undertaken. The deductive themes were selected based on a consultation guide given to the doctors before the consultations. Results The study identified 15 themes, which were grouped into the following three categories: the implications of sharing a consultation; consultation structure; and health concerns. Conclusion Multidisciplinary video-based consultations with a patient and two health professionals succeeded in having a patient-centred communication style. In clarifying tasks between the GP and oncologist to support the patient, work-related issues and professional support for psychosocial challenges were always a task for the GP. Dissemination of this first-line evidence may improve acceptability among medical specialists and help assist GPs in supporting patients with cancer. However, focus on the involvement of relatives should be emphasised.
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Kørup AK, Wehberg S, Hvidt EA, Hvidt NC, Fitchett G, Hansen DG. Age‐stratified validation of the functional assessment of chronic illness
therapy‐spiritual well‐being
based on a large cohort of Danish cancer survivors. Psychooncology 2020; 29:1217-1223. [DOI: 10.1002/pon.5412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/27/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Alex K. Kørup
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department of Mental Health Kolding‐VejleRegion of Southern Denmark Vejle Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
| | - Elisabeth A. Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department for the Study of CultureUniversity of Southern Denmark (SDU) Odense Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Academy of Geriatric Cancer Research (AgeCare)Odense University Hospital Odense Denmark
| | - George Fitchett
- Department of Religion Health and Human Values, College of Health SciencesRush University Chicago Illinois USA
| | - Dorte Gilså Hansen
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
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Stapelfeldt CM, Duijts SFA, Horsboel TA, Momsen AMH, Andersen NT, Larsen FB, Friis K, Nielsen CV. Educational attainment and work disability in cancer survivors: Do diagnosis and comorbidity affect this association? Eur J Cancer Care (Engl) 2020; 29:e13228. [PMID: 31999396 DOI: 10.1111/ecc.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study whether educational attainment had less impact on work disability in cancer survivors than in individuals without cancer. To study whether comorbidity had a higher impact on work disability in low-educated cancer survivors than in high-educated and whether this impact differed when compared with individuals without cancer. METHODS Linkage of population-based public health survey data and the Danish Cancer Registry formed two groups: cancer survivors (n = 3,514) and cancer-free individuals (n = 171,262). In logistic regression models, the risk of experiencing an 8-week sick leave spell and the granting of disability pension within a 3-year follow-up period was studied in three educational levels and whether these associations were modified by history of cancer and comorbidity. Odds ratios (OR) with 95% confidence intervals (CI) are reported. RESULTS Non-stratified adjusted risk of experiencing an 8-week sick leave spell (OR: 1.41, 95% CI (1.33-1.49)) or being granted a disability pension (OR: 1.61, 95% CI (1.31-1.97)) was significantly higher in low-educated than in high-educated respondents. Cancer or comorbidity did not significantly interact with education on the risk of work disability. CONCLUSIONS A moderate impact of low education on future work disability was found for all respondents, neither history of cancer nor comorbidity modified this association.
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Affiliation(s)
- Christina M Stapelfeldt
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM Social & Health Services and Labour Market, Aarhus C, Denmark
| | - Saskia F A Duijts
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Trine A Horsboel
- Survivorship and Inequality in Cancer, Danish Cancer Society, Copenhagen, Denmark
| | | | - Niels T Andersen
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Finn B Larsen
- DEFACTUM Social & Health Services and Labour Market, Aarhus N, Denmark
| | - Karina Friis
- DEFACTUM Social & Health Services and Labour Market, Aarhus N, Denmark
| | - Claus V Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM Social & Health Services and Labour Market, Aarhus C, Denmark.,Regional Hospital West Jutland, Herning, Denmark
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Witte H, Handberg C. An assessment of survivorship care needs of patients with colorectal cancer: The experiences and perspectives of hospital nurses. J Clin Nurs 2019; 28:4310-4320. [PMID: 31294502 DOI: 10.1111/jocn.14995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/30/2019] [Accepted: 06/30/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To describe and analyse hospital nurses' experiences and perspectives of needs assessment in relation to colorectal cancer patients' survivorship care and rehabilitation needs. METHOD The methodology and design of this study was phenomenological-hermeneutic, and the analysis was performed by Ricoeur's theory of interpretation. Twelve hospital nurses working within the care of patients with colorectal cancer participated in four focus group interviews between February-March 2018. Focus group interviews were recorded, transcribed and analysed. The study adhered to the COREQ checklist. RESULTS Our analysis showed that nurses experienced challenges and barriers in conducting needs assessment. These challenges were described in three main themes. Encountering paradigms brought to light the difficulties relating to implementation of needs assessment into daily practice in the complex context of a hospital setting. Patient involvement could be challenging because of insufficient involvement and inadequate health literacy of patients in relation to needs assessment. A negative attitude towards systematic needs assessment among nurses could present a barrier because of their role as gatekeepers. CONCLUSION The findings point to important elements that are necessary to consider when planning cancer survivorship care in the hospital setting so that all patients experience the best possible cancer trajectory. These insights can guide future clinical practice in the endeavour to ensure more systematic initiatives towards cancer rehabilitation. RELEVANCE TO CLINICAL PRACTICE Based on our findings, cancer survivorship care needs assessment in the hospital setting should encompass specific guidelines on needs assessment and systematic implementation of these guidelines by involving hospital management, nurses and patients through use of visionary information and communication. Implementation of these guidelines would be supported by securing knowledge on cancer survivorship care for all hospital health professionals. Health literacy should be considered in formulating guidelines that enhance involvement of patients by use of patient-centred communication.
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Affiliation(s)
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Gadbail AR, Dande R, Sarode SC, Gondivkar S, Belekar L, Mankar-Gadbail M, Sarode GS, Patil S, Yuwanati M. Patients with oral submucous fibrosis who visit dental hospitals have nonspecific chief complaints. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2019. [DOI: 10.1177/2057178x19858453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The first consultation with a health-care professional is crucial to make the correct diagnosis particularly with respect to narrating the symptoms encountered by the patient. Yet, currently, no information is available concerning the primary symptoms documented by patients with oral submucous fibrosis (OSF). Materials and Methods: A total of 158 OSF patients visiting outdoor patient departments (OSF-OPDs) and 104 pan shop customers (PSCs) were investigated. OSF-OPD cases and relevant PSCs cases were investigated to discover the chief complaints (CCs) leading to dental visits. Detailed demographic data, patient histories concerning relevant habits (with duration), and socioeconomic status were recorded. OSF cases were graded based on the degree of mouth opening. Results: Out of 158 OSF-OPD patients, only 43 (26.58%) reported relevant disease symptoms of OSF: in stage III, 28.57%, or stage IV, 38.09%. One hundred and sixteen patients (73.41%) reported CCs unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 47.05% and stage II: 22.5%). Out of the total 104 PSCs, 66 PSCs have had prior dental consultations, but only five (4.80%) individuals had visited a health-care professional due to OSF-related CCs. Conclusion: A significant number of CCs made by OSF patients were unrelated to their disease signs and symptoms. There is a lack of awareness of OSF symptoms by pan chewers, thus hindering early detection.
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Affiliation(s)
- Amol Ramchandra Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Ravi Dande
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, India
| | - Shailesh Gondivkar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Lalita Belekar
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Mugdha Mankar-Gadbail
- Department of Orthodontics, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Gargi S Sarode
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Monal Yuwanati
- Department of Oral Pathology & Microbiology, People’s Dental College & Hospital, Bhopal, Madhya Pradesh, India
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Handberg C, Svendsen ML, Maribo T. A Cross-Sectional Study Evaluating Potential Differences in the Need for Cancer Survivorship Care in Relation to Patients' Socioeconomic Status. J Clin Med Res 2019; 11:515-523. [PMID: 31236171 PMCID: PMC6575116 DOI: 10.14740/jocmr3871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background There seems to be inequity within cancer survivorship care in primary care settings related to gender, shorter education, and early poor health, but there is uncertainty regarding the character of the needs in hospital and in primary care settings and whether there is inequity regarding meeting these needs. This study aims to describe potential differences in needs among patients in hospital and in primary care settings, and to assess the need for survivorship care and rehabilitation in patients with cancer in relation to socioeconomic status. Methods In a cross-sectional study including patients in hospital (n = 89) and primary care settings (n = 99), information from needs assessments was linked with population-based data on socioeconomic status via unique personal identification numbers. The association between socioeconomic status and stated needs was analyzed separately for patients in hospital and primary care settings, with adjustment for age and gender. Results A total of 90% patients expressed one or more needs in the physical area, 51% in the emotional area, and 40% in the practical area. Patients in primary care expressed more needs than patients in hospital. Men expressed more needs than women in primary care (adjusted odds ratio (OR) (95% confidence interval (CI)): 2.66 (1.04 - 6.79)). The results indicate that higher socioeconomic status is associated with fewer stated needs. Conclusions This study suggests that the association between gender and stated needs may depend on healthcare setting and confirms that higher socioeconomic status in relation to civil status, educational level, income, and labor market status is associated with fewer stated needs.
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Affiliation(s)
- Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | | | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Jeppesen MM, Mogensen O, Hansen DG, Bergholdt SH, Jensen PT. How Do We Follow Up Patients With Endometrial Cancer? Curr Oncol Rep 2019; 21:57. [PMID: 31093835 DOI: 10.1007/s11912-019-0805-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW In this review, we present the existing evidence regarding follow-up care after endometrial cancer, including content of follow-up and type of provider. We furthermore discuss the future perspectives for follow-up care and research in the field. RECENT FINDINGS Recently published randomized controlled trials show that nurse-led telephone follow-up and patient-initiated follow-up are feasible alternatives to routine hospital-based follow-up. No randomized or prospective study has evaluated the effect of routine follow-up on survival. Hence, current knowledge is derived from retrospective studies with the inherent risk of bias. The most important method for recurrence detection is a review of symptoms. There is no evidence to support a survival benefit from the use of routine physical examinations, additional tests, or imaging. One in three of the women attending hospital-based follow-up experience unmet needs, and alternative models for follow-up focused on survivorship care and empowerment should be tested.
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Affiliation(s)
- Mette Moustgaard Jeppesen
- Department of Gynecology and Obstetrics, Lillebaelt Hospital, Kolding, Sygehusvej 24, 6000, Kolding, Denmark.
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorte G Hansen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws vej 9A, 5000, Odense C, Denmark
| | - Stinne H Bergholdt
- Department of Gynecology and Obstetrics, Odense University Hospital, Sdr Boulevard, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Pernille T Jensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
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Oksbjerg Dalton S, Halgren Olsen M, Moustsen IR, Wedell Andersen C, Vibe-Petersen J, Johansen C. Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: A population-based study in Copenhagen, Denmark 2010-2015. Acta Oncol 2019; 58:730-736. [PMID: 30905247 DOI: 10.1080/0284186x.2019.1582800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Implementation of new cancer services may lead to socioeconomic differences in uptake and despite reports of more unmet needs among patients with low socioeconomic position studies have found that these patients receive less rehabilitation. We aimed to investigate associations between indicators for socioeconomic position and referral as well as attendance to rehabilitation for cancer. Methods: Through the Danish Cancer Registry, we identified all persons diagnosed with cancer in Copenhagen municipality 2010-2015 and obtained information on referral to and visits at the municipal rehabilitation center from municipal records. We linked the population with information on socioeconomic information and vital status through national registries. Associations were analyzed using multivariate Cox regression models. Results: Among 13,059 persons diagnosed with cancer a total of 2523 were referred for rehabilitation within 2.5 years from diagnosis. Compared to persons with short education, men and women with long education and men with medium education had higher adjusted hazard ratios (HR) for being referred to rehabilitation (Long: HR-men, 1.30 (95% CI: 1.06-1.59) and HR-women, 1.33 (95% CI: 1.15-1.53; Medium: HR-men, 1.23 (95% CI: 1.02-1.49)). Both men and women with children living at home had higher HR of referral (HR-men, 1.23 (95% CI: 1.00-1.52) and HR-women, 1.28 (95% CI: 1.11-1.48)). Among patients referred to rehabilitation, 81% attended a visitation consultation. Long education was associated with attendance in both genders while in men, medium education and in women high income, respectively was associated with attendance. Conclusion: Clear socioeconomic differences in referral and attendance to rehabilitation services indicate that socioeconomic inequality exists in patients' transition from cancer treatment into post-treatment care. Systematic needs assessment and clarification of wish for rehabilitation should be a requisite for all cancer patients independent of their socioeconomic position.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Maja Halgren Olsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ida Rask Moustsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Christoffer Johansen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Castle late effects unit, Oncology Clinic, Rigshospitalet, Copenhagen, Denmark
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Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC. Impact of socioeconomic inequalities on quality of life in oral submucous fibrosis patients. Future Oncol 2019; 15:875-883. [PMID: 30669879 DOI: 10.2217/fon-2018-0645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM The purpose of this study was to analyze the impact of socioeconomic characteristics on oral health-related quality of life (OHRQoL) in patients with oral submucous fibrosis (OSF). METHODS A total of 300 OSF patients' quality of life (QoL) data were obtained using OHRQoL-OSF and global self ratings of oral health and overall wellbeing. The socioeconomic status (SES) of participants was analyzed by using modified Kuppuswamy scale. RESULTS OSF patients with lower SES had worse OHRQoL as compared with those with middle and upper SES (p < 0.001). The household income of the family was found to be strongly associated with poor OHRQoL. CONCLUSION Socioeconomic characteristics should be considered in the holistic management of OSF as it has been strongly associated with the OHRQoL of these patients.
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Affiliation(s)
- Shailesh M Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Rahul R Bhowate
- Department of Oral Medicine & Radiology, Sharad Pawar Dental College & Hospital, DMIMSU, Sawangi (M), Wardha, Maharashtra, India
| | - Amol R Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra, India
| | - Rima S Gondivkar
- # 301, Aarti regency, Mahalakshmi Nagar, Manewada Road, Nagpur, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr DY Patil Dental College & Hospital, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
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Evaluating a professional patient navigation intervention in a supportive care setting. Support Care Cancer 2019; 27:3281-3290. [PMID: 30612239 DOI: 10.1007/s00520-018-4622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Unmet supportive care needs are common among cancer patients. This study evaluates a patient navigation intervention (i.e., specially trained oncology nurse who monitors, advises, and (if needed) refers patients to supportive cancer care) in terms of need, satisfaction, advice uptake, and consumption of supportive cancer care. METHODS Using a cross-sectional design, the intervention was evaluated among healthcare professionals, patients who participated, and patients who did not participate in the intervention. All patients were newly diagnosed with breast cancer or melanoma. Data was collected through medical records and online surveys. RESULTS In total, 1091 patients were offered patient navigation. Most of these patients (755) were willing to consult the patient navigator (PN). Approximately 90% of patients who completed both the intervention and the questionnaire (N = 120, response rate 54%) perceived the PN as valuable, accessible, and reliable. Approximately 80% of respondents who needed advice regarding nutrition (n = 67), fatigue (n = 98), emotions (n = 106), and work (n = 79) were adequately informed by the PN. Of the 120 respondents, 59 used some form of supportive cancer care. Most of the responding healthcare professionals (N = 70, response rate 45%) perceived the intervention as a valuable addition to current cancer care (n = 51) and mentioned that the PN should be available to all patients (n = 54). CONCLUSIONS The intervention was perceived as valuable by both patients and healthcare professionals. The results may, however, been biased by the large number of patients who were omitted from participation due to logistical reasons.
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Handberg C, Midtgaard J, Nielsen CV, Thorne S, Lomborg K. Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors. Rehabil Nurs 2018; 43:127-137. [PMID: 27766645 DOI: 10.1002/rnj.298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation. DESIGN Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs. METHODS Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. FINDINGS Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation. CONCLUSIONS Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct. CLINICAL RELEVANCE These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.
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Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort). Cancer Epidemiol 2018; 54:38-47. [DOI: 10.1016/j.canep.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 01/01/2023]
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37
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Affiliation(s)
- David Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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Kiasuwa Mbengi RL, Nicolaie AM, Goetghebeur E, Otter R, Mortelmans K, Missinnne S, Arbyn M, Bouland C, de Brouwer C. Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up. BMJ Open 2018; 8:e014094. [PMID: 29455161 PMCID: PMC5855469 DOI: 10.1136/bmjopen-2016-014094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes. PARTICIPANTS We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. RESULTS The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. CONCLUSION Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.
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Affiliation(s)
- Régine Levo Kiasuwa Mbengi
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | | | | | - Renee Otter
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | | | - Sarah Missinnne
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Catherine Bouland
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | - Christophe de Brouwer
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
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Kristiansen M, Adamsen L, Piil K, Halvorsen I, Nyholm N, Hendriksen C. A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark. Scand J Public Health 2017; 47:511-518. [PMID: 29212431 DOI: 10.1177/1403494817746535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Scandinavian cancer care policies emphasise community-level rehabilitation services, but little is known about changes in service provision over time. This follow-up study explores development in these services in Danish municipalities, focusing on availability, utilisation and organisation of services, including existing opportunities and challenges. Methods: A national survey among all 98 Danish municipalities was conducted in 2013 (baseline) and repeated in 2016 (follow-up). The electronic questionnaire comprised closed- and open-ended questions. Data were analysed using descriptive statistics and content analysis. Results: A total of 93 municipalities responded (95% response rate) and the services offered primarily comprised group physical activity, dietary advice, smoking cessation and individual counselling on physical activity. The number of patients enrolled was below the estimated number needing rehabilitation in Denmark. Inequality in utilisation by ethnicity, age and gender was reported. Key challenges for the delivery of services were: inadequate referral and recruitment procedures; lack of needs assessment tools; obstacles to ensuring collaboration and referral of patients between hospitals and municipalities; and inadequate evidence on the rehabilitation's effect. Key recommendations include ensuring collaboration between municipalities; provision of diagnosis-specific group-based activities; services focusing on physical activity; and gender-specific activities directed particularly at men. Conclusions: This study, which highlights improvements in the provision of community-level cancer rehabilitation, recommends that more effort be made to ensure equality in utilisation across patient groups, improved integration of municipal-level services into cancer care trajectories, more uniform documentation of service delivery and the enforcement of patient outcomes to gradually build a more robust evidence base for community-level cancer rehabilitation.
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Affiliation(s)
| | - Lis Adamsen
- 1 Department of Public Health, University of Copenhagen, Denmark.,2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karin Piil
- 2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ida Halvorsen
- 1 Department of Public Health, University of Copenhagen, Denmark
| | - Nanna Nyholm
- 1 Department of Public Health, University of Copenhagen, Denmark
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Regnier Denois V, Querre M, Chen L, Barrault M, Chauvin F. Inequalities and Barriers to the Use of Supportive Care Among Young Breast Cancer Survivors: a Qualitative Understanding. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:790-798. [PMID: 27476073 DOI: 10.1007/s13187-016-1087-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The development of supportive care for cancer patients has been shown to have a positive impact on both mortality rates and many aspects of life after cancer, particularly in young women. Meanwhile, there are still numerous inequalities in terms of cancer mortalities and quality of life among cancer survivors in France. The processes leading to unequal access to supportive care services, and the impact this has on the post-treatment period, have been poorly documented, however. The goal of this study was to understand the barriers to using supportive care services among young women breast cancer survivors under the age of 50 and to find out how this can contribute to inequalities. Thirty-six young breast cancer survivors, one third of which deemed socially deprived, were interviewed using a qualitative, inductive approach at two comprehensive care centres in France. Our findings primarily show that there are still a number of barriers to accessing supportive care for a large number of patients. The way information about supportive services is delivered is a major cause of inequalities in the use of these services. The guidance provided does not take into account either the patients' needs or their capacity to integrate the information and anticipate problems. Certain specific post-treatment issues have yet to be addressed. Some systemic barriers could be lifted by changing the way information on supportive care services is currently organised and thereby prevent the survivorship plans now being implemented in cancer care settings from reinforcing health inequalities.
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Affiliation(s)
| | - Madina Querre
- REVeSS (Recherches et Etudes sur les Vulnérabilités Sociales et la Santé), Bordeaux, France
| | - Linjie Chen
- Decision & Information Sciences for Production Systems laboratory, INSA, Lyon, France
| | - Marion Barrault
- Institut Bergonié, 229 cours de l'Argonne, F-33000, Bordeaux, France
| | - Franck Chauvin
- HYGEE-ICLN, Université de Lyon, EA HESPER 7425, F-69003, Lyon, France
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Handberg C, Jensen CM, Maribo T. Lack of Needs Assessment in Cancer Survivorship Care and Rehabilitation in Hospitals and Primary Care Settings. J Clin Med Res 2017; 9:864-871. [PMID: 28912923 PMCID: PMC5593434 DOI: 10.14740/jocmr3160w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/25/2017] [Indexed: 11/21/2022] Open
Abstract
Background Formalized and systematic assessment of survivorship care and rehabilitation needs is prerequisite for ensuring cancer patients sufficient help and support through their cancer trajectory. Patients are often uncertain as to how to express and address their survivorship care and rehabilitation needs, and little is known about specific, unmet needs and the plans necessary to meet them. There is a call for both ensuring survivorship care and rehabilitation for cancer patients in need and further for documenting the specific needs related to the cancer disease and its treatment. Thus the aim of this study was to describe specific survivorship care and rehabilitation needs and plans as stated by patients with cancer at hospitals when diagnosed and when primary care survivorship care and rehabilitation begins. Methods Needs assessment forms from cancer patients at two hospitals and two primary care settings were analyzed. The forms included stated needs and survivorship care and rehabilitation plans. All data were categorized using the International Classification of Functioning, Disability and Health (ICF). Results Eighty-nine patients at hospitals and 99 in primary care, stated their needs. Around 50% of the patients completed a survivorship care and rehabilitation plan. In total, 666 (mean 7.5) needs were stated by hospital patients and 836 (mean 8.0) by those in primary care. The needs stated were primarily within the ICF component “body functions and structure”, and the most frequent needs were (hospitals/primary care) fatigue (57%/67%), reduced muscle strength (55%/67%) and being worried (37%/36%). Conclusions The results underpin an urgent need for a systematic procedure to assess needs in clinical practice where cancer patients are being left without survivorship care and rehabilitation needs assessment. Gaining knowledge on needs assessment and the detailed description of needs and plans can facilitate targeted interventions. The findings indicate an urgent need to change the practice culture to be systematic in addressing and identifying survivorship care needs among patients with cancer. Further the findings call for considering the development of a new needs assessment form with involvement of both patients and healthcare professionals.
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Affiliation(s)
- Charlotte Handberg
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
| | - Charlotte Maria Jensen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
| | - Thomas Maribo
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
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Öhlén J, Cohen J, Håkanson C. Determinants in the place of death for people with different cancer types: a national population-based study. Acta Oncol 2017; 56:455-461. [PMID: 27835053 DOI: 10.1080/0284186x.2016.1250946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Place of death has for the past decade increasingly come to be regarded as a robust indicator of how palliative care is organized and provided, and is also recognized as an important factor for well being at the end of life. Variations in place of cancer deaths have previously been reported in the context of country-specific healthcare organization, but without differentiating between cancer types and national regional variations. Our aim was to examine, at a population level, where people with cancer diseases die in Sweden, and to investigate associations of place of death and cancer type with individual, socioeconomic and geographical characteristics of the deceased. MATERIAL AND METHODS This population level study is based on death certificate data (sex; age; underlying cause of death and place of death) and population register data (educational attainment, marital status, living arrangements, area of residence, degree of urbanization, and healthcare region) of all 2012 cancer deaths in Sweden, with a registered place of death (hospital, nursing home, home, other places). Data were explored descriptively. To investigate associations between place of death and cancer types, and individual, socioeconomic and environmental characteristics, a series of multivariable logistic regression analyses were performed. RESULTS The most frequent type of cancer death occurring at home was upper gastrointestinal cancer (25.6%) and the least frequent was hematological cancer (15.2%). Regional variations in cancer deaths occurring at home ranged from 17.1% to 28.4%. Factors associated with place of death by cancer type were age, educational attainment, marital status, healthcare regions and degree of urbanization. CONCLUSION Large healthcare regional variations in place of death among different cancer types were found. The socioeconomic inequality previously demonstrated for screening, diagnostic and treatment processes, rehabilitation and survival thus also seems to be reflected in the place of death.
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Affiliation(s)
- Joakim Öhlén
- Department of Health Care Science, Palliative Research Centre (JÖ, CH), Ersta Sköndal University College, Stockholm, Sweden
- Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care (JÖ), Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group (JC), Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Cecilia Håkanson
- Department of Health Care Science, Palliative Research Centre (JÖ, CH), Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society (CH), Karolinska Institutet, Stockholm, Sweden
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Knight JM, Syrjala KL, Majhail NS, Martens M, Le-Rademacher J, Logan BR, Lee SJ, Jacobsen PB, Wood WA, Jim HSL, Wingard JR, Horowitz MM, Abidi MH, Fei M, Rawls L, Rizzo JD. Patient-Reported Outcomes and Socioeconomic Status as Predictors of Clinical Outcomes after Hematopoietic Stem Cell Transplantation: A Study from the Blood and Marrow Transplant Clinical Trials Network 0902 Trial. Biol Blood Marrow Transplant 2016; 22:2256-2263. [PMID: 27565521 PMCID: PMC5116244 DOI: 10.1016/j.bbmt.2016.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/15/2016] [Indexed: 01/15/2023]
Abstract
This secondary analysis of a large, multicenter Blood and Marrow Transplant Clinical Trials Network randomized trial assessed whether patient-reported outcomes (PROs) and socioeconomic status (SES) before hematopoietic stem cell transplantation (HCT) are associated with each other and predictive of clinical outcomes, including time to hematopoietic recovery, acute graft-versus-host disease, hospitalization days, and overall survival (OS) among 646 allogeneic and autologous HCT recipients. Pretransplantation Cancer and Treatment Distress (CTXD), Pittsburgh Sleep Quality Index (PSQI), and mental and physical component scores of the Short-Form 36 were correlated with each other and with SES variables. PROs and SES variables were further evaluated as predictors of clinical outcomes, with the PSQI and CTXD evaluated as OS predictors (P < .01 considered significant given multiple testing). Lower attained education was associated with increased distress (P = .002), lower income was related to worse physical functioning (P = .005) and increased distress (P = .008), lack of employment before transplantation was associated with worse physical functioning (P < .01), and unmarried status was associated with worse sleep (P = .003). In this large heterogeneous cohort of HCT recipients, although PROs and SES variables were correlated at baseline, they were not associated with any clinical outcomes. Future research should focus on HCT recipients at greater psychosocial disadvantage.
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Affiliation(s)
- Jennifer M Knight
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | | | - Michael Martens
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephanie J Lee
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Heather S L Jim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muneer H Abidi
- Spectrum Health and Michigan State University, Grand Rapids, Michigan
| | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Glintborg C, Hansen TGB. Bio-psycho-social effects of a coordinated neurorehabilitation programme: A naturalistic mixed methods study. NeuroRehabilitation 2016; 38:99-113. [PMID: 26889730 DOI: 10.3233/nre-161301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Best practice guidelines for neurorehabilitation recommend coordinated rehabilitation programmes to ensure seamless service transitions and comprehensive rehabilitation practices. However, this recommendation for practice and the evidence informing its advancement is based on unexamined assumptions. Therefore, this study investigates bio-psycho-social outcomes and perceptions of a coordinated rehabilitation programme. METHOD In a prospective, naturalistic mixed methods study, rehabilitation outcomes for 82 adults (18-66 years) with moderate to severe acquired brain injury were investigated. Clients who received the coordinated rehabilitation programme KORE (n = 27) were compared to clients from the same area who received standard rehabilitation prior to the implementation of the KORE programme (n = 37) and clients who received other coordinated efforts elsewhere (n = 18). The study employed quantitative data from standardized tests (Functional Independence Measure, Major Depression Inventory, Quality of life, and Impact on Participation and Autonomy Questionnaire, as well as information on return to work and qualitative interviews with clients (n = 82) and their relatives (n = 40). RESULTS Outcomes did not improve from hospital discharge to two years later. Notably, physiological recovery had probably been achieved to the extent possible, but depression and reduced psychological well-being remained prevalent across groups. Qualitative interviews suggested several barriers to improvement, such as identity dilemmas and unmet needs for psychological support, while rehabilitation services focused on physical and practical training. CONCLUSION Coordinated interventions do not guarantee comprehensive rehabilitation and better outcomes for clients with acquired brain injury. Psychological support seems to be important and largely unaddressed.
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Moriceau G, Bourmaud A, Tinquaut F, Oriol M, Jacquin JP, Fournel P, Magné N, Chauvin F. Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study. Oncotarget 2016; 7:1055-65. [PMID: 26540571 PMCID: PMC4808051 DOI: 10.18632/oncotarget.6274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
Context The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center. Methods retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed. Results 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD. Conclusions Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.
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Affiliation(s)
- Guillaume Moriceau
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France
| | - Fabien Tinquaut
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Mathieu Oriol
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - Pierre Fournel
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Nicolas Magné
- Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Franck Chauvin
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.,Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France
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Smailyte G, Jasilionis D, Vincerzevskiene I, Shkolnikov VM. Education, survival, and avoidable deaths in Lithuanian cancer patients, 2001-2009. Acta Oncol 2016; 55:859-64. [PMID: 27070947 DOI: 10.3109/0284186x.2016.1156739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Our aim in this study is to provide a systematic assessment of the site-specific cancer survival rates of patients with different educational levels, using population-based census-linked registry data covering the entire population of Lithuania. Material and methods The study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 6 April 2001 and 31 December 2009. Results For the vast majority of cancer sites we found an inverse gradient in survival, with the worst survival indicators in the lowest educational group. We estimated that 18.6% of the deaths in Lithuanian cancer patients could have potentially been postponed, if all the patients had the same cancer mortality as the patients with the highest educational level. Conclusion Our findings offer a warning that although the survival rates of cancer patients are improving, this progress hides disparities between different groups of patients.
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Affiliation(s)
- Giedre Smailyte
- Lithuanian Cancer Registry, National Cancer Institute, Vilnius, Lithuania
- Centre for Demographic Research, Vytautas Magnus University, Kaunas, Lithuania
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
- Centre for Demographic Research, Vytautas Magnus University, Kaunas, Lithuania
| | | | - Vladimir M. Shkolnikov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
- Centre for Demographic Research, New Economic School, New Economic School, Moscow, Russian Federation
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Frier A, Barnett F, Devine S. The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review. Disabil Rehabil 2016; 39:941-948. [DOI: 10.3109/09638288.2016.1172672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amanda Frier
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Fiona Barnett
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sue Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer 2016; 24:2359-2379. [DOI: 10.1007/s00520-015-3066-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
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Thielen K, Kolodziejczyk C, Andersen I, Heinesen E, Diderichsen F. Cancer stage, comorbidity, and socioeconomic differences in the effect of cancer on labour market participation: a danish register-based follow-up study. PLoS One 2015; 10:e0128621. [PMID: 26030914 PMCID: PMC4451757 DOI: 10.1371/journal.pone.0128621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/30/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Socioeconomic inequality in return to work after cancer treatment and rehabilitation have been documented, but less is known about its causes. This paper investigates the role played by breast cancer stage at diagnosis and comorbidity. Methods We used the comprehensive Danish Cancer Registry to follow 7372 women aged 30-60, who were in the labour force when diagnosed with breast cancer in 2000-06 and survived at least three years. Controls were 213,276 women without breast cancer. Inequalities in employment outlook were estimated as interaction effects in linear regression between educational attainment and disease on employment. Results There is significant interaction between education and breast cancer, but it is only marginally affected by including stage and comorbidity in the regression models. Education, breast cancer stage, and comorbidity all have strong effects on later employment, and a considerable amount of the educational effect is mediated by comorbidity and pre-cancer labour market participation and income. Conclusion The result of the study is negative in the sense that the stronger effect of breast cancer on employment among low-educated compared to highly educated individuals is not explained by cancer stage or comorbidity. The fact that comorbidity has little impact on inequality may be due to a different social patterning of most comorbidity compared to breast cancer.
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Affiliation(s)
- Karsten Thielen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Ingelise Andersen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
- * E-mail:
| | - Eskil Heinesen
- Rockwool Foundation Research Unit, Copenhagen K, Denmark
| | - Finn Diderichsen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
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