1
|
Dalton SO, Johansen C. Integrating management of treatment toxicity on patient quality of life in real-world cancer clinics. Lancet 2024; 403:1312-1313. [PMID: 38490232 DOI: 10.1016/s0140-6736(24)00303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Oncology and Palliative Services, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, Copenhagen University, 2200 Denmark; Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, Copenhagen, Denmark.
| | - Christoffer Johansen
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, 2200 Denmark; Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Saltbæk L, Bidstrup PE, Karlsen RV, Høeg BL, Horsboel TA, Belmonte F, Andersen EAW, Zoffmann V, Friberg AS, Svendsen MN, Christensen HG, Glavicic V, Nielsen DL, Dalton SO, Johansen C. Nurse-Led Individualized Follow-Up Versus Regular Physician-Led Visits After Early Breast Cancer (MyHealth): A Phase III Randomized, Controlled Trial. J Clin Oncol 2024:JCO2301447. [PMID: 38498781 DOI: 10.1200/jco.23.01447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Follow-up after breast cancer with regular visits has failed to detect recurrences, be cost-effective, and address patient needs. METHODS MyHealth is a phase III randomized controlled trial (ClinicalTrials.gov identifier: NCT02949167). Patients, who recently completed primary treatment for stage I-II breast cancer, were randomly assigned in variable block sizes and stratified by age and human epidermal growth factor receptor 2 status to intervention or control follow-up. The nurse-led intervention comprised three to five individual self-management sessions, regular reporting of symptoms, and navigation to health care services. The control follow-up comprised regular outpatient visits with the physician. The primary outcome was breast cancer-specific quality of life (QoL) measured by the Trial Outcome Index-Physical/Functional/Breast summary score of the Functional Assessment of Cancer Therapy-Breast 2 years after random assignment. Secondary outcomes were fear of recurrence, anxiety, depression, and health care utilization. Analyses were intention-to-treat and P values were two-sided with 95% confidence level set at 0.005 because of multiple comparisons. RESULTS Among 1,101 eligible patients, 875 were invited and 503 were randomly assigned to control (n = 252) or intervention (n = 251) follow-up. At 2 years, patients in the intervention group reported a significantly and clinically relevant higher QoL (mean, 75.69 [standard deviation [SD], 12.27]) than patients in the control group (71.26 [SD, 14.08]), with a mean difference of 5.05 (95% CI, 3.30 to 6.79; P < .001). The intervention group reported significantly less fear of recurrence, anxiety, and depression; they had fewer physician consultations but more nurse contacts and an unchanged diagnostic imaging pattern. The effect on all outcomes was stable through a 3-year follow-up. CONCLUSION The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in QoL.
Collapse
Affiliation(s)
- Lena Saltbæk
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, Faculty of Social Sciences, Copenhagen University, Copenhagen, Denmark
| | - Randi V Karlsen
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Beverley L Høeg
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Trine A Horsboel
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | | | - Vibeke Zoffmann
- Research Unit of Women's and Children's Health, the Juliane Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne S Friberg
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Mads N Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Helle G Christensen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Vesna Glavicic
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Dorte L Nielsen
- Department of Oncology, Herlev and Gentofte University Hospital, Herlev, Denmark
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Susanne O Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
- Department of Oncology, CASTLE, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
3
|
Feychting M, Schüz J, Toledano MB, Vermeulen R, Auvinen A, Harbo Poulsen A, Deltour I, Smith RB, Heller J, Kromhout H, Huss A, Johansen C, Tettamanti G, Elliott P. Mobile phone use and brain tumour risk - COSMOS, a prospective cohort study. Environ Int 2024; 185:108552. [PMID: 38458118 DOI: 10.1016/j.envint.2024.108552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Each new generation of mobile phone technology has triggered discussions about potential carcinogenicity from exposure to radiofrequency electromagnetic fields (RF-EMF). Available evidence has been insufficient to conclude about long-term and heavy mobile phone use, limited by differential recall and selection bias, or crude exposure assessment. The Cohort Study on Mobile Phones and Health (COSMOS) was specifically designed to overcome these shortcomings. METHODS We recruited participants in Denmark, Finland, the Netherlands, Sweden, and the UK 2007-2012. The baseline questionnaire assessed lifetime history of mobile phone use. Participants were followed through population-based cancer registers to identify glioma, meningioma, and acoustic neuroma cases during follow-up. Non-differential exposure misclassification was reduced by adjusting estimates of mobile phone call-time through regression calibration methods based on self-reported data and objective operator-recorded information at baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for glioma, meningioma, and acoustic neuroma in relation to lifetime history of mobile phone use were estimated with Cox regression models with attained age as the underlying time-scale, adjusted for country, sex, educational level, and marital status. RESULTS 264,574 participants accrued 1,836,479 person-years. During a median follow-up of 7.12 years, 149 glioma, 89 meningioma, and 29 incident cases of acoustic neuroma were diagnosed. The adjusted HR per 100 regression-calibrated cumulative hours of mobile phone call-time was 1.00 (95 % CI 0.98-1.02) for glioma, 1.01 (95 % CI 0.96-1.06) for meningioma, and 1.02 (95 % CI 0.99-1.06) for acoustic neuroma. For glioma, the HR for ≥ 1908 regression-calibrated cumulative hours (90th percentile cut-point) was 1.07 (95 % CI 0.62-1.86). Over 15 years of mobile phone use was not associated with an increased tumour risk; for glioma the HR was 0.97 (95 % CI 0.62-1.52). CONCLUSIONS Our findings suggest that the cumulative amount of mobile phone use is not associated with the risk of developing glioma, meningioma, or acoustic neuroma.
Collapse
Affiliation(s)
- Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Mireille B Toledano
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council (MRC) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK; Mohn Centre for Children's Health and Wellbeing, School of Public Health, Imperial College London, London, UK
| | - Roel Vermeulen
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands; University Medical Center Utrecht, Julius Center, the Netherlands
| | - Anssi Auvinen
- STUK - Radiation and Nuclear Safety Authority, Environmental Surveillance, Vantaa, Finland; Tampere University, Faculty of Social Sciences/Health Sciences, Tampere, Finland
| | | | - Isabelle Deltour
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Rachel B Smith
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council (MRC) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK; Mohn Centre for Children's Health and Wellbeing, School of Public Health, Imperial College London, London, UK
| | - Joel Heller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Hans Kromhout
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
| | - Anke Huss
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
| | - Christoffer Johansen
- CASTLE Cancer Late Effect Research Oncology Clinic, Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council (MRC) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK.
| |
Collapse
|
4
|
Kjaer TK, Johansen C, Dalton SO. Uncovering causal clues in the development of second primary cancers - Authors' reply. Lancet Oncol 2024; 25:e98. [PMID: 38423066 DOI: 10.1016/s1470-2045(24)00090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Affiliation(s)
| | - Christoffer Johansen
- Center for Cancer Late Effects Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, DK-2100 Copenhagen, Denmark; Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative care, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Christensen ME, Grand MK, Kriegbaum M, Lind BS, Grønbæk K, Persson F, Johansen C, Andersen CL. Blood sampling patterns in primary care change several years before a cancer diagnosis. Acta Oncol 2024; 63:17-22. [PMID: 38349122 DOI: 10.2340/1651-226x.2024.28559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Mathilde Egelund Christensen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark; Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark.
| | | | - Margit Kriegbaum
- Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark
| | - Bent Struer Lind
- Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirsten Grønbæk
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Christoffer Johansen
- Department of Clinical Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark; Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark
| |
Collapse
|
6
|
Levinsen AKG, Dalton SO, Thygesen LC, Jakobsen E, Gögenur I, Borre M, Zachariae R, Christiansen P, Laurberg S, Christensen P, Hölmich LR, Brown PDN, Johansen C, Kjær SK, van de Poll-Franse L, Kjaer TK. Cohort Profile: The Danish SEQUEL cohort. Int J Epidemiol 2024; 53:dyad189. [PMID: 38205845 DOI: 10.1093/ije/dyad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter de Nully Brown
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Cancer Late Effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lonneke van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | |
Collapse
|
7
|
Rafn BS, Bodilsen A, von Heymann A, Lindberg MJ, Byllov S, Andreasen TG, Johansen C, Christiansen P, Zachariae R. Examining the efficacy of treatments for arm lymphedema in breast cancer survivors: an overview of systematic reviews with meta-analyses. EClinicalMedicine 2024; 67:102397. [PMID: 38152415 PMCID: PMC10751832 DOI: 10.1016/j.eclinm.2023.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
Background Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survivors. Methods In this overview of systematic reviews with meta-analyses (SRMAs), five databases were searched for SRMAs of randomised controlled trials (RCTs) reporting effects of medications, surgery, exercise, laser therapy, acupuncture, kinesio taping, or complex decongestive physiotherapy (CDP) for breast cancer-related lymphedema published from database inception up to March 7, 2023. Data extraction was performed for the SRMAs and RCTs, and SRMAs were appraised with AMSTAR2. Random effects meta-analyses of the RCTs provided estimates of the pooled effects sizes (Hedges' g) for each treatment modality. This study is registered with PROSPERO, CRD42020184813. Findings 1569 studies were identified by the search and eighteen SRMAs with 51 RCTs were included, investigating manual lymphatic drainage (MLD), compression pump, exercise, kinesio taping, laser, and acupuncture. Overall, the methodological quality of the SRMAs was low. SRMAs reached different conclusions for all treatment modalities, except for kinesio taping where the two SRMAs found no effect. The analysis of 40 RCTs with 1970 participants revealed a small effect across all interventions compared to any control (g = 0.20, p = 0.047, I2 = 0.79), corresponding to volume reductions of 119.7 ml (95% CI 135-104) and 88.0 ml (95% CI 99-77) in the intervention and control groups, respectively, and a small effect of exercise (g = 0.26, p = 0.022, I2 = 0.44). The between-group differences in volume reduction were small and did not reach statistical significance for any one treatment modality. Interpretation Based on the available data, there is no evidence of superiority of any one treatment on volume reduction nor any solid research refuting these treatments. Thus, definitive conclusions to inform clinical practice about the efficacy of these treatments cannot be drawn. Due to poor-quality evidence, more research is needed to untangle the efficacy of each treatment component for different stages of lymphedema. Funding Danish Cancer Society.
Collapse
Affiliation(s)
- Bolette Skjødt Rafn
- Cancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Sofia Byllov
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark
| | - Tine Ginnerup Andreasen
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE) - Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Unit for Psycho-oncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| |
Collapse
|
8
|
Kjaer TK, Andersen EAW, Ursin G, Larsen SB, Bidstrup PE, Winther JF, Borre M, Johansen C, Dalton SO. Cumulative incidence of second primary cancers in a large nationwide cohort of Danish cancer survivors: a population-based retrospective cohort study. Lancet Oncol 2024; 25:126-136. [PMID: 38048803 DOI: 10.1016/s1470-2045(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND A new primary cancer is a serious late effect of a pre-existing cancer diagnosis, and can be attributed to hereditary cancer syndromes, immune or hormonal factors, cancer treatment, or modifiable lifestyle or environmental factors. We investigated the absolute and relative incidence of second primary cancers in a large cohort of Danish cancer survivors. Furthermore, we examined the association between alcohol-related, smoking-related, virus-related, and hormone-related first and second primary cancers. METHODS In this retrospective cohort study, we identified a cohort of Danish adults (aged ≥40 years) diagnosed with cancer from Jan 1, 1997, to Dec 31, 2014 and alive 1 year after diagnosis. Follow-up was from date of first cancer diagnosis and lasted up to 24 years, ending on Dec 31, 2020. Cohort identification and information on second primary cancers was obtained from the Danish Cancer Registry, and comorbidity and sociodemographic information was obtained from Danish population-based registries. Overall, and for 27 cancer types, cumulative incidence functions and Cox proportional hazard regression models were used to estimate the incidence of second primary cancer and death, and hazard ratios (HRs) and 95% CIs of second primary cancer adjusted for sex, age and year of diagnosis, cohabitation status, income, and comorbidity. FINDINGS 457 334 Danish adults were included in our study (230 150 [50·3%] male individuals and 227 184 [49·7%] female individuals; median age at diagnosis 68·3 years, IQR 59·7-76·6; median follow-up 3·6 years, IQR 0·6-9·3). The cumulative incidence of second primary cancer increased over time from 6·3% (95% CI 6·2-6·4) 5 years after diagnosis to 10·5% (10·4-10·6) 10 years after diagnosis and to 13·5% (13·4-13·7) 15 years after diagnosis. The highest cumulative incidence of second primary cancer 10 years after diagnosis was observed in survivors of cancers in the larynx (21·8%, 20·5-23·1), oropharynx and oral cavity (19·5%, 18·7-20·3), and bladder and urinary tract (18·5%, 18·0-19·0). Survivors of cancers related to alcohol (HR 1·09, 95% CI 1·06-1·13), smoking (1·73, 1·68-1·78), diet high in red or processed meat (1·32, 1·24-1·39), or virus (1·23, 1·13-1·35) were at increased risk of developing a second cancer with the same aetiology, whereas having had a hormone-related first cancer was associated with lower risk of a second hormone-related cancer (0·77, 0·73-0·81). INTERPRETATION Our results could help optimise prevention efforts targeting modifiable risk factors to reduce risk of developing a second primary cancer. FUNDING Nordic Cancer Union and The Health Foundation (Helsefonden).
Collapse
Affiliation(s)
| | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Signe Benzon Larsen
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Pappot H, Björnsson BP, Krause O, Bæksted C, Bidstrup PE, Dalton SO, Johansen C, Knoop A, Vogelius I, Holländer-Mieritz C. Machine learning applied in patient-reported outcome research-exploring symptoms in adjuvant treatment of breast cancer. Breast Cancer 2024; 31:148-153. [PMID: 37940813 DOI: 10.1007/s12282-023-01515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Patient-reported outcome (PRO) data may help us better understand the life of breast cancer patients. We have previously collected PRO data in a national Danish breast cancer study in patients undergoing adjuvant chemotherapy. The aim of the present post-hoc explorative study is to apply Machine Learning (ML) algorithms using permutation importance to explore how specific PRO symptoms influence nonadherence to six cycles of planned adjuvant chemotherapy in breast cancer patients. METHODS We here investigate ePRO-data from the 347 patients. The ePRO presented 42 PROCTCAE questions on 25 symptoms. Patients completed the ePRO before each cycle of chemotherapy. Number of patients with completion of the scheduled six cycles of chemotherapy were registered. Two ML models were applied. One aimed at discovering the individual relative importance of the different questions in the dataset while the second aimed at discovering the relationships between the questions. Permutation importance was used. RESULTS Out of 347 patients 238 patients remained in the final dataset, 15 patients dropped out. Two symptoms: aching joints and numbness/tingling, were the most important for dropout in the final dataset, each with an importance value of about 0.04. Model's average ROC-AUC-score being 0.706. In the second model a low performance score made the results very unreliable. CONCLUSION In conclusion, this explorative data analysis using ML methodologies in an ePRO dataset from a population of women with breast cancer treated with adjuvant chemotherapy unravels that the symptoms aching joints and numbness/tingling could be important for drop out of planned adjuvant chemotherapy.
Collapse
Affiliation(s)
- Helle Pappot
- Department of Oncology, Rigshospitalet Section 5073, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Benóný P Björnsson
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Oswin Krause
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Pernille E Bidstrup
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne O Dalton
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet Section 5073, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet Section 5073, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ivan Vogelius
- Department of Oncology, Rigshospitalet Section 5073, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Holländer-Mieritz
- Department of Oncology, Rigshospitalet Section 5073, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
10
|
Bosch de Basea Gomez M, Thierry-Chef I, Harbron R, Hauptmann M, Byrnes G, Bernier MO, Le Cornet L, Dabin J, Ferro G, Istad TS, Jahnen A, Lee C, Maccia C, Malchair F, Olerud H, Simon SL, Figuerola J, Peiro A, Engels H, Johansen C, Blettner M, Kaijser M, Kjaerheim K, Berrington de Gonzalez A, Journy N, Meulepas JM, Moissonnier M, Nordenskjold A, Pokora R, Ronckers C, Schüz J, Kesminiene A, Cardis E. Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med 2023; 29:3111-3119. [PMID: 37946058 PMCID: PMC10719096 DOI: 10.1038/s41591-023-02620-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1-2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.
Collapse
Affiliation(s)
- Magda Bosch de Basea Gomez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Richard Harbron
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Graham Byrnes
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Maria-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Lucian Le Cornet
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Gilles Ferro
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Tore S Istad
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Hilde Olerud
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
- Norwegian Radiation Protection Authority, Østerås, Norway
- University of South-Eastern Norway, Kongsberg, Norway
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Peiro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Hilde Engels
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Christoffer Johansen
- Cancer Late Effect Research Oncology Clinic (CASTLE), Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Institute of Cancer Research, London, UK
| | - Neige Journy
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | | | - Monika Moissonnier
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Arvid Nordenskjold
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cecile Ronckers
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
- Pompeu Fabra University, Barcelona, Spain.
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
11
|
Thomsen MK, Løppenthin KB, Bidstrup PE, Andersen EW, Dalton S, Petersen LN, Pappot H, Mortensen CE, Christensen MB, Frølich A, Lassen U, Johansen C. Impact of multimorbidity and polypharmacy on mortality after cancer: a nationwide registry-based cohort study in Denmark 2005-2017. Acta Oncol 2023; 62:1653-1660. [PMID: 37874076 DOI: 10.1080/0284186x.2023.2270145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Concurrent chronic diseases and treatment hereof in patients with cancer may increase mortality. In this population-based study we examined the individual and combined impact of multimorbidity and polypharmacy on mortality, across 20 cancers and with 13-years follow-up in Denmark. MATERIALS AND METHODS This nationwide study included all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015, and followed until the end of 2017. We defined multimorbidity as having one or more of 20 chronic conditions in addition to cancer, registered in the five years preceding diagnosis, and polypharmacy as five or more redeemed medications 2-12 months prior to cancer diagnosis. Cox regression analyses were used to estimate the effects of multimorbidity and polypharmacy, as well as the combined effect on mortality. RESULTS A total of 261,745 cancer patients were included. We found that patients diagnosed with breast, prostate, colon, rectal, oropharynx, bladder, uterine and cervical cancer, malignant melanoma, Non-Hodgkin lymphoma, and leukemia had higher mortality when the cancer diagnosis was accompanied by multimorbidity and polypharmacy, while in patients with cancer of the lung, esophagus, stomach, liver, pancreas, kidney, ovarian and brain & central nervous system, these factors had less impact on mortality. CONCLUSION We found that multimorbidity and polypharmacy was associated with higher mortality in patients diagnosed with cancer types that typically have a favorable prognosis compared with patients without multimorbidity and polypharmacy. Multimorbidity and polypharmacy had less impact on mortality in cancers that typically have a poor prognosis.
Collapse
Affiliation(s)
- Mette K Thomsen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
| | | | | | | | - Susanne Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | | | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity and Chronic Conditions, Slagelse, Denmark
- Section of General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
- Department of Oncology, Copenhagen, Denmark
| |
Collapse
|
12
|
Bojesen RD, Dalton SO, Skou ST, Jørgensen LB, Walker LR, Eriksen JR, Grube C, Justesen TF, Johansen C, Slooter G, Carli F, Gögenur I. Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial. BJS Open 2023; 7:zrad134. [PMID: 38060453 PMCID: PMC10702628 DOI: 10.1093/bjsopen/zrad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery. METHOD The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8. RESULTS In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference. CONCLUSION Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- Rasmus Dahlin Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology, Zealand University Hospital, Næstved, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Lars Bo Jørgensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
| | | | - Jens Ravn Eriksen
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Camilla Grube
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | | | - Christoffer Johansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit CASTLE, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Gerrit Slooter
- Department of Surgery, Maxima Medical Center, Eindhoven, The Netherlands
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| |
Collapse
|
13
|
Helvind NM, Brinch-Møller Weitemeyer M, Chakera AH, Hendel HW, Ellebæk E, Svane IM, Kjærskov MW, Bojesen S, Skyum H, Petersen SK, Bastholt L, Johansen C, Bidstrup PE, Hölmich LR. Stage-Specific Risk of Recurrence and Death From Melanoma in Denmark, 2008-2021: A National Observational Cohort Study of 25 720 Patients With Stage IA to IV Melanoma. JAMA Dermatol 2023; 159:1213-1222. [PMID: 37650576 PMCID: PMC10472263 DOI: 10.1001/jamadermatol.2023.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023]
Abstract
Importance To ensure optimal treatment and surveillance of patients with melanoma, knowledge of the clinical stage-specific risk of recurrence, mortality, and recurrence patterns across the American Joint Committee on Cancer Eighth Edition (AJCC8) substages is needed. Objective To estimate stage-specific recurrence and melanoma-specific mortality rates, assess absolute stage-specific risks of recurrence and mortality, and describe stage-specific recurrence patterns, including conditional rates. Design Retrospective cohort study of prospectively collected nationwide population-based registry data. Setting Nationwide, population-based cohort study. Participants The 25 720 Danish patients, 18 years or older, diagnosed with first-time stage IA to IV cutaneous melanoma between January 1, 2008, and December 31, 2019, were included and followed up from time of primary treatment until December 31, 2021. Exposures First diagnosis of stage IA to IV cutaneous melanoma. Main Outcomes Stage-specific cumulative incidence of recurrence and melanoma-specific mortality, melanoma-specific recurrence-free survival, and assessed absolute stage-specific risks of recurrence and melanoma-specific mortality. Secondary outcomes were stage-specific recurrence patterns, including conditional rates, and melanoma-specific survival. Results We followed up 25 720 patients for a median of 5.9 years (95% CI, 58.9-59.3 years). Mean age was 59.1 years (95% CI, 58.9-59.3 years). Patients with stage IIB to IIC melanoma were older, had more comorbidities at diagnosis, and had the lowest rate of pathologic staging by sentinel node biopsy (81.6%-87.4%). A total of 10.6% of patients developed recurrence; first recurrence included distant recurrence, alone or with synchronous locoregional recurrence, in 56.6% of patients. We found a comparable risk of recurrence in stages IIIA and IIB (29.7% vs 33.2%) and in stages IIIB and IIC (35.9% vs 36.8%), respectively. Melanoma-specific mortality was comparable between stages IIIA and IIA (13.0% vs 13.6%) and between stages IIIB and IIB (18.4% vs 22.0%), respectively. These risk patterns persisted in cause-specific hazards models. Conclusions and Relevance This nationwide, population-based cohort study found that the increasing stages of the current AJCC8 staging system do not accurately reflect an increasing risk of recurrence and mortality in melanoma. The high proportion of distant recurrences suggests that hematogenous spread is a more common metastatic pathway than previously assumed, and surveillance with routine functional/cross-sectional imaging should be considered for stages IIB to IV. Future efforts should be put toward developing new tools for risk stratification and determining the survival effect of routine imaging in surveillance.
Collapse
Affiliation(s)
- Neel M. Helvind
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | | | - Annette H. Chakera
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Helle W. Hendel
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Eva Ellebæk
- National Center for Cancer Immune Therapy, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Inge Marie Svane
- National Center for Cancer Immune Therapy, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Mette W. Kjærskov
- Department of General and Plastic Surgery, Vejle Hospital, Vejle, Denmark
| | - Sophie Bojesen
- Department of Plastic Surgery, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Helle Skyum
- Department of Plastic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Christoffer Johansen
- Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Pernille E. Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lisbet R. Hölmich
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| |
Collapse
|
14
|
Taarnhøj GA, Johansen C, Carus A, Dahlrot RH, Dohn LH, Hjøllund NH, Knudsen MB, Tolver A, Lindberg H, Pappot H. The iBLAD study: patient-reported outcomes in bladder cancer during oncological treatment: a multicenter national randomized controlled trial. J Patient Rep Outcomes 2023; 7:99. [PMID: 37812306 PMCID: PMC10562329 DOI: 10.1186/s41687-023-00640-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/24/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are getting widely implemented, but little is known of the impact of applying PROs in specific cancer diagnoses. We report the results of a randomized controlled trial (RCT) of the active use of PROs in patients with locally advanced or metastatic bladder cancer (BC) undergoing medical oncological treatment (MOT) with focus on determining the clinical effects of using PROs during chemo- or immunotherapy compared to standard of care. METHODS We recruited patients from four departments of oncology from 2019 to 2021. Inclusion criteria were locally advanced or metastatic BC, initiating chemo- or immunotherapy. Patients were randomized 1:1 between answering selected PRO-CTCAE questions electronically once weekly with a built-in alert-algorithm instructing patients of how to handle reported symptoms as a supplement to standard of care for handling of side effects (intervention arm (IA)) vs standard procedure for handling of side effects (control arm (CA)). No real-time alerts were sent to the clinic when PROs exceeded threshold values. Clinicians were prompted to view the completed PROs in the IA at each clinical visit. The co-primary clinical endpoints were hospital admissions and treatment completion rate. Secondary endpoints were overall survival (OS), quality of life (EORTC's QLQ-C30 and QLQ-BLM30) and dose reductions. RESULTS 228 patients with BC were included, 76% were male. 141 (62%) of the patients had metastatic disease. 51% of patients in the IA completed treatment vs. 56% of patients in the CA, OR 0.83 (95% CI 0.47-1.44, p = 0.51). 41% of patients in the IA experienced hospitalization vs. 32% in the CA, OR 1.48 (95% CI 0.83-2.65, p = 0.17). OS was comparable between the two arms (IA: median 22.3mo (95% CI 17.0-NR) vs. CA: median 23.1mo (95% CI 17.7-NR). Patient and clinician compliance was high throughout the study period (80% vs 94%). CONCLUSIONS This RCT did not show an effect of PRO on completion of treatment, hospitalizations or OS for BC patients during MOT despite a high level of patient and clinician compliance. The lack of real-time response to alerts remains the greatest limitation to this study.
Collapse
Affiliation(s)
- Gry Assam Taarnhøj
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- CASTLE: Cancer Survivorship and Treatment, Late Effects National Research Center, Blegdamsvej 58, 2100, Copehnagen Ø, Denmark
| | - Andreas Carus
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University and Clinical Cancer Research Center, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Rikke Hedegaard Dahlrot
- Department of Oncology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Line Hammer Dohn
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Mark Bech Knudsen
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2100, Copenhagen Ø, Denmark
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| |
Collapse
|
15
|
Levinsen AKG, Kjaer TK, Thygesen LC, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Christensen P, Laurberg S, de Nully Brown P, Hölmich LR, Johansen C, Kjær SK, van de Poll‐Franse L, Saltbæk L, Dalton SO. Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark. Cancer Med 2023; 12:20150-20162. [PMID: 37772475 PMCID: PMC10587985 DOI: 10.1002/cam4.6596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND With a growing population of cancer survivors in Denmark, the evaluation of health-related quality of life (HRQoL) has become increasingly important. We describe variations in HRQoL between educational groups in a national population of cancer survivors. METHODS We conducted a cross-sectional questionnaire study among breast, prostate, lung, and colon cancer survivors diagnosed in 2010-2019 in Denmark. We used the EORTC QLQ-C30 to assess HRQoL including physical, role, emotional, cognitive, social functioning, and symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Information on educational level and clinical data were extracted from national registers and clinical databases. Levels of impaired functioning and severe symptoms were identified using newly established thresholds for clinical importance. Multivariate logistic regression was used to examine associations between education and HRQoL. All statistical tests were 2-sided. RESULTS In total, 27,857 (42%) participated in the study. Up to 72% and 75% of cancer survivors with short education (≤9 years) reported impaired functioning and severe symptoms, respectively. Cancer survivors with short compared to long education (>12 years) were more likely to report impaired functioning and severe symptoms, with for example significantly higher odds ratios (ORs) for impaired physical function (breast OR = 2.41, 99% CI = 2.01-2.89; prostate OR = 1.81, 99% CI = 1.48-2.21; lung OR = 2.97, 99% CI = 1.95-4.57; and colon cancer OR = 1.69, 99% CI = 1.28-2.24). CONCLUSIONS Cancer survivors with short education are at greater risk of impaired HRQoL than survivors with long education 2-12 years after diagnosis. This underscores the need for systematic screening and symptom management in cancer aftercare, in order to reach all cancer survivors, also cancer survivors with short education.
Collapse
Affiliation(s)
| | | | - Lau Caspar Thygesen
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
| | - Thomas Maltesen
- Statistics and Data AnalysisDanish Cancer InstituteCopenhagenDenmark
| | - Erik Jakobsen
- Department of Thoracic surgeryOdense University hospitalOdenseDenmark
| | - Ismail Gögenur
- Dept. Surgery, Center for Surgical ScienceZealand University HospitalKøgeDenmark
- Institute for Clinical MedicineCopenhagen UniversityCopenhagenDenmark
| | - Michael Borre
- Department of UrologyAarhus University HospitalAarhusDenmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late EffectsAarhusDenmark
- Department of Plastic and Breast SurgeryAarhus University HospitalAarhusDenmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late EffectsAarhusDenmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of SurgeryAarhus University HospitalAarhusDenmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of SurgeryAarhus University HospitalAarhusDenmark
| | | | | | | | - Susanne K. Kjær
- Unit of Virus, Lifestyle and GenesDanish Cancer InstituteCopenhagenDenmark
- Department of Gynecology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lonneke van de Poll‐Franse
- Department of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Lena Saltbæk
- Survivorship and Inequality in CancerDanish Cancer InstituteCopenhagenDenmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative CareZealand University HospitalNæstvedDenmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in CancerDanish Cancer InstituteCopenhagenDenmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative CareZealand University HospitalNæstvedDenmark
| |
Collapse
|
16
|
Tauber NM, O'Toole MS, Jensen AB, Butow PN, Thewes B, Elkjaer E, Knutzen S, von Heymann A, Johansen C, Zachariae R. ConquerFear-Group: A randomized controlled trial of an online-delivered group-based psychological intervention for fear of cancer recurrence in breast cancer survivors. Psychooncology 2023; 32:1424-1432. [PMID: 37489745 DOI: 10.1002/pon.6193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a distressing concern among cancer survivors. Interventions to address FCR need to be effective but also accessible and low cost. This randomized controlled trial evaluated the efficacy of an online group-based psychological intervention for FCR (ConquerFear-Group). METHODS Eligible breast cancer (BC) survivors had completed primary treatment 3 months-5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Participants were randomized to online ConquerFear-Group (focusing on metacognitive strategies, values-clarification, and education about follow-up behavior) or online group-based relaxation training (active control). Questionnaires were completed at baseline (T1), 1 week post-intervention (T2), three (T3) and six (T4) months later. The primary outcome was FCR (FCRI total). A number of secondary and process outcomes were also collected. Treatment effects were evaluated with mixed linear models. RESULTS Of 866 eligible BC survivors, 475 (55%) completed the FCR screening, and 85 (18%) were randomized to ConquerFear-Group or relaxation training (2 × 6 groups). Compared with control participants, ConquerFear-Group participants experienced larger reductions in FCR (Cohen's d = 0.47, p = 0.001) and FCR severity (d = 0.57, p < 0.001), as well as mindfulness and decentering from baseline through follow-up, and improvements in emotion regulation (T2), worry (T2, T3) and rumination (T2) at some time points. CONCLUSIONS The results demonstrated statistically significant and stable effects of ConquerFear-Group on FCR that were maintained over a 6-month period. It is suggested to investigate the program in a real-life setting, where a pragmatic trial can further demonstrate feasibility and effectiveness.
Collapse
Affiliation(s)
- Nina M Tauber
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mia S O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
| | - Phyllis N Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Thewes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Elkjaer
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Sofie Knutzen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
| |
Collapse
|
17
|
van Leeuwen M, Kieffer JM, Young TE, Annunziata MA, Arndt V, Arraras JI, Autran D, Hani HB, Chakrabarti M, Chinot O, Cho J, da Costa Vieira RA, Darlington AS, Debruyne PR, Dirven L, Doege D, Eller Y, Eichler M, Fridriksdottir N, Gioulbasanis I, Hammerlid E, van Hemelrijck M, Hermann S, Husson O, Jefford M, Johansen C, Kjaer TK, Kontogianni M, Lagergren P, Lidington E, Lisy K, Morag O, Nordin A, Al Omari ASH, Pace A, De Padova S, Petranovia D, Pinto M, Ramage J, Rammant E, Reijneveld J, Serpentini S, Sodergren S, Vassiliou V, Leeuw IVD, Vistad I, Young T, Aaronson NK, van de Poll-Franse LV. Phase III study of the European Organisation for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire. J Cancer Surviv 2023; 17:1111-1130. [PMID: 35088246 DOI: 10.1007/s11764-021-01160-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to develop a European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG) questionnaire that captures the full range of physical, mental, and social health-related quality of life (HRQOL) issues relevant to disease-free cancer survivors. In this phase III study, we pretested the provisional core questionnaire (QLQ-SURV111) and aimed to identify essential and optional scales. METHODS We pretested the QLQ-SURV111 in 492 cancer survivors from 17 countries with one of 11 cancer diagnoses. We applied the EORTC QLG decision rules and employed factor analysis and item response theory (IRT) analysis to assess and, where necessary, modify the hypothesized questionnaire scales. We calculated correlations between the survivorship scales and the QLQ-C30 summary score and carried out a Delphi survey among healthcare professionals, patient representatives, and cancer researchers to distinguish between essential and optional scales. RESULTS Fifty-four percent of the sample was male, mean age was 60 years, and, on average, time since completion of treatment was 3.8 years. Eleven items were excluded, resulting in the QLQ-SURV100, with 12 functional and 9 symptom scales, a symptom checklist, 4 single items, and 10 conditional items. The essential survivorship scales consist of 73 items. CONCLUSIONS The QLQ-SURV100 has been developed to assess comprehensively the HRQOL of disease-free cancer survivors. It includes essential and optional scales and will be validated further in an international phase IV study. IMPLICATIONS FOR CANCER SURVIVORS The availability of this questionnaire will facilitate a standardized and robust assessment of the HRQOL of disease-free cancer survivors.
Collapse
Affiliation(s)
- Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Jacobien M Kieffer
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Teresa E Young
- Lynda Jackson Macmillan Centre, North Hertfordshire NHS Trust Including Mount Vernon Cancer Centre, East &, Northwood, UK
| | | | - Volker Arndt
- Unit of Cancer Survivorship Research, Division of Clinical Epidemiology and Aging Research & Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Didier Autran
- Pole Neurosciences Cliniques, Service de Neuro-Oncologie, Aix-Marseille Universite, Marseille, France
| | | | | | - Olivier Chinot
- Pole Neurosciences Cliniques, Service de Neuro-Oncologie, Aix-Marseille Universite, Marseille, France
| | - Juhee Cho
- Center for Clinical Epidemiology and Cancer Education Center, Samsung Medical Center, School of Medicine Sungkyunkwan University, Seoul, Korea
| | | | | | - Philip R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniela Doege
- Unit of Cancer Survivorship Research, Division of Clinical Epidemiology and Aging Research & Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yannick Eller
- Centre for Medical Education, University of Dundee, Dundee, UK
| | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Nanna Fridriksdottir
- National University Hospital of Iceland, Ugo De Giorgi, Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, 47014, Italy
| | | | - Eva Hammerlid
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Mieke van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Silke Hermann
- Epidemiological Cancer Registry Baden-Wurttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christoffer Johansen
- Oncology Clinic, Finsen Center, Copenhagen Colin Johnson, University Surgical Unit, University Hospitals Southampton, Southampton, UK
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Meropi Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ofir Morag
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, Margate, UK
| | | | - Andrea Pace
- Neuroncology Unit, National Cancer Institute Regina Elena, Rome, Italy
| | - Silvia De Padova
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, 47014, Italy
| | - Duska Petranovia
- Hematology Department, University Clinical Hospital Center Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Monica Pinto
- Rehabilitation Medicine Unit, Department of Strategic Health Services, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - John Ramage
- Department of Gastroenterology and Hepatology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Elke Rammant
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jaap Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Samantha Serpentini
- Unit of Psychoncology-Breast Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Sam Sodergren
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Irma Verdonck-de Leeuw
- Department of Otolaryngology / Head & Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingvild Vistad
- Department of Gynecology and Obstetrics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Teresa Young
- Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | |
Collapse
|
18
|
Hovdenak I, Thaysen HV, Bernstein IT, Christensen P, Hauberg A, Iversen LH, Johansen C, Larsen SL, Laurberg S, Madsen AH, Madsen MR, Rasmussen HV, Thorlacius-Ussing O, Juul T. Quality of life and symptom burden after rectal cancer surgery: a randomised controlled trial comparing patient-led versus standard follow-up. J Cancer Surviv 2023:10.1007/s11764-023-01410-4. [PMID: 37395934 DOI: 10.1007/s11764-023-01410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE After curatively intended rectal cancer (RC) surgery, new follow-up strategies are warranted, seeking more individualised care and targeting health-related quality of life (HRQoL) and functional outcomes. The FURCA trial aimed to investigate the effect of patient-led follow-up on HRQoL and symptom burden 3 years after surgery. METHODS RC patients from four Danish centres were randomised 1:1 to intervention (patient-led follow-up with patient education and self-referral to a specialist nurse) or control (standard follow-up with five routine doctor visits). Patients in both groups had a computed tomography (CT) at 1 and 3 years. The primary outcome (HRQoL) was assessed by the Functional Assessment of Cancer Therapy - colorectal (FACT-C) score (Ward et al. in Qual Life Res. 8(3):181-95, 18). Secondary outcomes were functional measures, patient involvement and satisfaction and cancer recurrence at 3 years. RESULTS From Feb 2016 to Aug 2018, 336 patients were included of whom 248 completed 3 years of follow-up. Between-group differences were found neither for the primary endpoint, nor for functional outcomes. The recurrence rate did not differ between the groups. Patient involvement and satisfaction were higher in the intervention group with statistical significance in almost half of the items. CONCLUSIONS We found no effect on HRQoL and symptom burden from patient-led follow-up, although it may improve patient-perceived involvement and satisfaction. IMPLICATIONS FOR CANCER SURVIVORS The findings in this study suggest that patient-led follow-up is a more tailored approach to meet cancer survivors' needs and might improve their ability to cope with survivorship. CLINICALTRIALS GOV IDENTIFIER R97-A6511-14-S23.
Collapse
Affiliation(s)
- Ida Hovdenak
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Henriette Vind Thaysen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Inge Thomsen Bernstein
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Ann Hauberg
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Lene Hjerrild Iversen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christoffer Johansen
- Late Effect Research Unit, Oncology Clinic, University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Susie Lindhardt Larsen
- Department of Surgery, Regional Hospital Gødstrup, Hospitalsparken 15, 7400, Herning, Denmark
| | - Søren Laurberg
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Anders Husted Madsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Surgery, Regional Hospital Gødstrup, Hospitalsparken 15, 7400, Herning, Denmark
| | - Mogens Rørbæk Madsen
- Department of Surgery, Regional Hospital Gødstrup, Hospitalsparken 15, 7400, Herning, Denmark
| | - Helle Vindfeldt Rasmussen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Clinical Cancer Research Unit, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| |
Collapse
|
19
|
von Heymann A, Finsted E, Guldin MB, Andersen EAW, Dammeyer J, Sjøgren P, von der Maase H, Benthien KS, Kjellberg J, Johansen C, Bidstrup P. Effects of home-based specialized palliative care and dyadic psychological intervention on caregiver burden: results from a randomized controlled trial. Acta Oncol 2023; 62:803-807. [PMID: 37010505 DOI: 10.1080/0284186x.2023.2194491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
Background The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden.Material and Methods Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models.Results A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups (p = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden (p = 0.5046) or burden subscales measuring role and personal strain.Conclusion In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.
Collapse
Affiliation(s)
- Annika von Heymann
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Finsted
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Public Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine S Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Ebbestad FE, Ammitzbøll G, Horsbøll TA, Andersen I, Johansen C, Zehran B, Dalton SO. The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors. Acta Oncol 2023; 62:706-713. [PMID: 36912039 DOI: 10.1080/0284186x.2023.2185909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Fatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioning. MATERIAL AND METHODS Latent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery. RESULTS Two symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year. DISCUSSION These findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.
Collapse
Affiliation(s)
- Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
| | | | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
| | - Bo Zehran
- Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
| |
Collapse
|
21
|
Dalton SO, Johansen C. Survivorship - the situation room. Acta Oncol 2023; 62:673-675. [PMID: 37605618 DOI: 10.1080/0284186x.2023.2245563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Susanne Oksbjerg Dalton
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Christoffer Johansen
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Oncology, Center for Cancer and Organ Diseases, Late Effect Research Unit (CASTLE), Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
22
|
Skjødt Rafn B, Jensen S, Bjerre ED, Wittenkamp MC, Benjaminsen K, Christensen LP, Flyger H, Christiansen P, Johansen C. Prospective surveillance for breast cancer-related lymphedema (PROTECT). Acta Oncol 2023; 62:808-813. [PMID: 37042161 DOI: 10.1080/0284186x.2023.2197125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Bolette Skjødt Rafn
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sandra Jensen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Merete Celano Wittenkamp
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Louise Pia Christensen
- Department of Occupational and Physical Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
23
|
Degett TH, Moustsen-Helms IR, Larsen SB, Kjær TK, Tjønneland A, Kjær SK, Johansen C, Gögenur I, Dalton SO. Cardiovascular events after elective colorectal cancer surgery in patients with stage I-III disease with no previous cardiovascular disease. Acta Oncol 2023; 62:728-736. [PMID: 37262420 DOI: 10.1080/0284186x.2023.2212844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/28/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The risk of cardiovascular events in patients treated for colorectal cancer is debated due to diverging results in previous studies. Colorectal cancer and cardiovascular disease share several risk factors such as physical inactivity, obesity, and smoking. Information about confounding covariates and follow-up time are therefore essential to address the issue. This study aims to investigate the risk of new-onset cardiovascular events for patients with stage I-III colorectal cancer receiving elective surgery compared to a matched population. MATERIAL AND METHODS Using a prospective cohort, we compared cardiovascular events among 876 patients treated with elective surgery for incident stage I-III colorectal cancer diagnosed between January 1st, 2001 and December 31st, 2016 to a cancer-free cohort matched by age, sex, and time since enrollment (N = 3504). Regression analyses were adjusted for lifestyle, cardiovascular risk factors, and comorbidity. Multivariable analyses were used to identify risk factors associated with cardiovascular events in the postoperative (<90 days of elective surgery) and long-term phase (>90 days after elective surgery). RESULTS After a median follow-up of 3.9 years, the hazard ratio (HR) for incident heart failure was 1.53 (95% CI 1.02-2.28) among patients operated for colorectal cancer. The postoperative risk of myocardial infarction or angina pectoris was associated with the use of lipid-lowering drugs. Long-term risks of cardiovascular events were ASA-score of III+IV and lipid-lowering drugs with HRs ranging from 2.20 to 15.8. Further, the use of antihypertensive drugs was associated with an HR of 2.09 (95% CI 1.06-4.13) for angina pectoris or acute myocardial infarction. Heart failure was associated with being overweight, diabetes, and anastomosis leakage. CONCLUSION We observed an increased hazard of heart failure in patients operated on for stage I-III colorectal cancer compared to cancer-free comparisons. We identified several potential risk factors for cardiovascular events within and beyond 90 days of elective surgery.
Collapse
Affiliation(s)
- Thea Helene Degett
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
- Centre for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
| | - Ida Rask Moustsen-Helms
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
- Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Trille Kristina Kjær
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Krüger Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Center for Cancer and Organ Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ismail Gögenur
- Centre for Surgical Science (CSS), Zealand University Hospital, Køge, Denmark
- Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Næstved Hospital, Næstved, Denmark
| |
Collapse
|
24
|
Stormoen DR, Taarnhøj GA, Friis RB, Johansen C, Pappot H. Association of patient-reported pain with survival in bladder cancer: a post-hoc analysis of the iBLAD trial. Acta Oncol 2023; 62:814-819. [PMID: 37071772 DOI: 10.1080/0284186x.2023.2199461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Affiliation(s)
| | | | | | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
25
|
Larsen C, Kirchhoff KS, Saltbæk L, Thygesen LC, Karlsen RV, Svendsen MN, Høeg BL, Horsbøl TA, Bidstrup PE, Christensen HG, Johansen C, Dalton SO. The association between education and fear of recurrence among breast cancer patients in follow-up - and the mediating effect of self-efficacy. Acta Oncol 2023; 62:714-718. [PMID: 37039679 DOI: 10.1080/0284186x.2023.2197122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Major restructuring of surveillance after breast cancer treatment with less follow-up consultations may result in insecurity and fear of recurrence (FCR) among the less resourceful breast cancer patients. We investigate the association between breast cancer patients' education and FCR and if self-efficacy mediates the associations between education and FCR. MATERIAL AND METHODS A questionnaire survey was conducted from 2017 to 2019, among 1773 breast cancer patients shortly after having their follow-up switched from regular outpatient visits with an oncologist to either nurse-led or patient-initiated follow-up, with a subsequent questionnaire after 12 months. Data on disease and treatment characteristics were extracted from medical records and the Danish Breast Cancer Group Database. Logistic regression analyses were used to examine the association between education and FCR. Separate analyses were conducted for patients ≤ and >5 years since diagnosis and all models were adjusted for age and cohabitation status. To explore potential mediation by self-efficacy, we conducted regression analyses on education and FCR further adjusting for self-efficacy. RESULTS The participation rate was 57%, and after the exclusion of patients due to missing data, 917 were included in analyses. Patients with long education had significantly less FCR compared to patients with short education (OR (95% CI) 0.71 (0.51;0,99)). When separated by time since diagnosis, there was no association among patients >5 years since diagnosis while the OR was 0.51 (95% CI, 0.30;0.85) for patients ≤5 years since diagnosis. Further adjusting for self-efficacy among patients <5 years since diagnosis resulted in an OR of 0.56 (95% CI, 0.33;0.95) among patients with long compared to short education. CONCLUSION Up to 5 years after diagnosis, breast cancer patients with long education are less likely to experience FCR than patients with short education. Self-efficacy mediated only a very small part of this association, indicating that other factors play a role in socioeconomic differences in FCR among breast cancer patients.
Collapse
Affiliation(s)
- Cecilie Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Surgery and Center of Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Kirstine S Kirchhoff
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Randi V Karlsen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mads N Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Beverley L Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine A Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle G Christensen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Christoffer Johansen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- CASTLE, Danish Cancer Society Research Center for Late Effects after Cancer, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Susanne O Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| |
Collapse
|
26
|
Levinsen AKG, Kjaer TK, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Laurberg S, Christensen P, Kroman N, Larsen SB, Degett TH, Hölmich LR, Brown PDN, Johansen C, Kjær SK, Thygesen LC, Dalton SO. Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study. BMC Health Serv Res 2023; 23:674. [PMID: 37349718 DOI: 10.1186/s12913-023-09683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors. METHODS A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors. RESULTS Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts. CONCLUSION Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.
Collapse
Affiliation(s)
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
| | - Søren Laurberg
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Urological Research Unit, Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thea Helene Degett
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | | | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer late effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| |
Collapse
|
27
|
Bandak M, Nielsen KS, Kreiberg M, Wagner T, Rosenvilde J, Pisinger C, Johansen C, Daugaard G, Lauritsen J. Smoking as a prognostic factor for survival in patients with disseminated germ cell cancer. J Natl Cancer Inst 2023; 115:753-756. [PMID: 36806937 PMCID: PMC10248846 DOI: 10.1093/jnci/djad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
We investigated the impact of smoking on overall survival (OS) in testicular germ cell cancer (TC) patients receiving first-line combination chemotherapy (bleomycin-etoposide-cisplatin [BEP]). Patients who received BEP for metastatic TC were identified in the Danish Testicular Cancer database. Information on smoking status at the time of diagnosis was obtained by medical record review. OS and cause of death were compared between current smokers and never-smokers. Of 1883 eligible patients, information on smoking status was available in 1156 patients, of whom 602 were current smokers. The 10-year OS was 92% in never-smokers compared with 83% in current smokers (P < .001) (hazard ratio for death = 1.85, 95% confidence interval = 1.29 to 2.66, P = .001). A higher proportion of current smokers died of TC compared with nonsmokers (P < .01). Smoking negatively affects survival after BEP in patients with disseminated TC. Vigorous smoking cessation programs are advocated in TC patients.
Collapse
Affiliation(s)
- Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Heart Foundation, Copenhagen, Denmark
| | - Christoffer Johansen
- Late Effect Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
28
|
Bidstrup PE, Johansen C, Kroman N, Belmonte F, Duriaud H, Dalton SO, Andersen KG, Mertz B. Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer: The REBECCA Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2319591. [PMID: 37351885 DOI: 10.1001/jamanetworkopen.2023.19591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Importance The unmet needs regarding symptom management of psychological distress among patients with breast cancer must be addressed. However, little evidence exists on effective interventions, such as nurse navigation. Objective To compare the long-term effects of the REBECCA (Rehabilitation After Breast Cancer) nurse navigation intervention vs usual care in patients with breast cancer who were psychologically vulnerable. Design, Setting, and Participants This parallel randomized clinical trial recruited and evaluated for eligibility adult female patients with newly diagnosed breast cancer and symptoms of psychological distress (distress score of ≥7 points on Distress Thermometer) at Rigshospitalet in Copenhagen, Denmark, from August 2017 to October 2019. This study continued the work of a pilot study, extending the follow-up to 18 months. Patients who met the inclusion criteria were randomized to either standard care or the REBECCA intervention. Intention-to-treat analyses were performed from June 2021 to October 2022. Interventions Patients who were randomized to the REBECCA intervention received nurse navigation and symptom screening as well as standard care. Standard care included regular treatment, nurse support at chemotherapy and radiotherapy appointments, and municipality-based rehabilitation. Main Outcomes and Measures The primary outcome was distress, as measured using the Distress Thermometer. The secondary outcomes included symptoms of anxiety, symptoms of depression, breast cancer-specific health-related quality of life, fear of recurrence, sleep, cognitive function, patient activation, pain, health behavior, body mass index, and need for support. Long-term effects at 6, 12, and 18 months were examined using mixed-effect models, adjusting for randomization strata of age and treatment modality. Results A total of 309 female patients were included in the analysis, with 153 patients randomized to the standard care group and 156 patients randomized to the REBECCA intervention group. Mean (SD) age was 56 (11) years with only small between-group differences. Patients receiving the REBECCA intervention compared with standard care had reduced (although not significant) symptoms of distress, especially at the 12-month follow-up (estimated effect = -0.51 [95% CI, -1.05 to 0.04]; effect size [ES] = -0.49). Significant effects were seen for symptoms of depression at 6 months (estimated effect = -1.39 [95% CI, -2.33 to -0.44]; ES = -0.27), and breast cancer-specific health-related quality of life at 12 months (estimated effect = 4.03 [95% CI, 1.28- 6.77]; ES = 0.31). Nonsignificant reductions were seen for symptoms of anxiety at 6 months (estimated effect = -1.00 [95% CI, -1.95 to -0.06]; ES = -0.21) and 12 months (estimated effect = -1.01 [95% CI, -1.97 to -0.04]; ES = -0.21), and a nonsignificant increase was seen for patient activation at 18 months (estimated effect = 3.52 [95% CI, -0.09 to 7.12]; ES = 0.25). Stronger intervention effects were observed for younger age, low patient activation, less education, and low social support. Conclusions and Relevance Results of this study indicate that patients with breast cancer who were psychologically vulnerable (ie, having moderate to high psychological distress) did not experience significant reduction in distress with nurse navigation. Further research is needed to develop the intervention's framework and investigate its potential use in clinical practice. Trial Registration ClinicalTrials.gov Identifier: NCT03254875.
Collapse
Affiliation(s)
- Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit, CASTLE, Oncology Clinic, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Danish Cancer Society, Copenhagen, Denmark
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle Duriaud
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, 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, Næstved, Denmark
| | - Kenneth Geving Andersen
- Department of Anesthesiology, Hvidovre Hospital, Copenhagen, Denmark
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Mertz
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| |
Collapse
|
29
|
Ammitzbøll G, Hyldegaard O, Forchhammer M, Rottensten H, Lanng C, Kroman N, Zerahn B, Jensen LT, Johansen C, Dalton SO. Effects of an early intervention with Hyperbaric Oxygen Treatment on arm lymphedema and quality of life after breast cancer-an explorative clinical trial. Support Care Cancer 2023; 31:313. [PMID: 37126076 DOI: 10.1007/s00520-023-07774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Lymphedema (LE) is a common complication after breast cancer treatment, which negatively affects the quality of life (QOL). Hyperbaric Oxygen Treatment (HBOT) is an established treatment for radiation-induced tissue injury, but evidence of effect on breast cancer-related LE is inconclusive. We aimed to explore effects of HBOT on early breast cancer-related LE and the implications for QOL. METHODS We invited women with breast cancer treated with surgery, axillary dissection and radiotherapy, who had participated in a randomized controlled trial and who presented with LE 1 year after surgery. In a prospective observational study design, change in LE was assessed with perometry, dual-energy X-ray absorptiometry (DXA) and lymphoscintigraphy, and QOL by validated self-report scales. Participants were offered 40 sessions of HBOT on every weekday for 8 weeks and were followed for 6 months. RESULTS Out of 50 eligible participants, 20 women accepted participation. Nineteen women initiated and completed treatment and follow-up. None of the objective measures of LE severity showed consistent changes during the study period, but participants reported significant improvements in QOL (physical functioning, fatigue, insomnia and breast and arm symptoms), with improvements peaking at 6-month follow-up. CONCLUSION Participants receiving HBOT experienced improved QOL without consistently significant changes in arm mass, volume or lymphatic drainage. These results call for studies into differential effect in patient sub-groups, and a large-scale, randomized placebo-controlled trial with long-term follow-up to assess the effect of HBOT in patients with soft tissue radiation injuries after breast cancer seems warranted. TRIAL REGISTRATION Danish Health and Medicines Authority, EUDRACT no. 2015-000,604-25 Ethical committee of the Capitol Region, No. R96-A6604-14-S22.
Collapse
Affiliation(s)
- Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark.
| | - Ole Hyldegaard
- Department for Anaesthesia, Section for Hyperbaric Medicine, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Forchhammer
- Department for Anaesthesia, Section for Hyperbaric Medicine, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Rottensten
- Department for Anaesthesia, Section for Hyperbaric Medicine, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Copenhagen University Hospital, Herlev/Gentofte, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Herlev/Gentofte, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Nuclear Medicine, Copenhagen University Hospital, Herlev/Gentofte, Denmark
| | - Lars Thorbjørn Jensen
- Department of Nuclear Medicine, Copenhagen University Hospital, Herlev/Gentofte, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Oncology Clinic, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| |
Collapse
|
30
|
Kirkegaard AM, Dalton SO, Boesen EH, Karlsen RV, Flyger H, Johansen C, von Heymann A. Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial. Acta Oncol 2023; 62:422-428. [PMID: 37102368 DOI: 10.1080/0284186x.2023.2203329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. METHODS A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. RESULTS The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11). CONCLUSIONS We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.
Collapse
Affiliation(s)
- Anne Marie Kirkegaard
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Randi V Karlsen
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, University Hospital Herlev, Denmark Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| |
Collapse
|
31
|
Helvind NM, Weitemeyer MBM, Chakera AH, Hendel HW, Ellebæk E, Svane IM, Kjærskov MW, Bojesen S, Skyum H, Petersen SK, Bastholt L, Johansen C, Bidstrup PE, Hölmich LR. ASO Visual Abstract: Earlier Recurrence Detection Using Routine FDG PET-CT Scans in Surveillance of Stage IIB to IIID Melanoma-A National Cohort Study of 1480 Patients. Ann Surg Oncol 2023; 30:2389-2390. [PMID: 36715857 DOI: 10.1245/s10434-022-13082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Neel Maria Helvind
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Marie Brinch-Møller Weitemeyer
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Annette Hougaard Chakera
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Helle Westergren Hendel
- Department of Nuclear Medicine, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Eva Ellebæk
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Inge Marie Svane
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | | | - Sophie Bojesen
- Department of Plastic Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Helle Skyum
- Department of Plastic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Christoffer Johansen
- CASTLE - Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Rigshospitalet, Denmark
| | | | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| |
Collapse
|
32
|
Helvind NM, Weitemeyer MBM, Chakera AH, Hendel HW, Ellebæk E, Svane IM, Kjærskov MW, Bojesen S, Skyum H, Petersen SK, Bastholt L, Johansen C, Bidstrup PE, Hölmich LR. Earlier Recurrence Detection Using Routine FDG PET-CT Scans in Surveillance of Stage IIB to IIID Melanoma: A National Cohort Study of 1480 Patients. Ann Surg Oncol 2023; 30:2377-2388. [PMID: 36752970 DOI: 10.1245/s10434-022-13034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The effect of routine imaging in melanoma surveillance is unknown. In 2016, Denmark was the first country in the world to implement routine imaging with positron emission tomography-computed tomography with fluorodeoxyglucose (FDG PET-CT) in a nationwide, population-based surveillance program. This study aimed to determine the impact of surveillance with routine FDG PET-CT on hazard, cumulative incidence, and absolute risk of overall, locoregional, and distant recurrence detection in patients with stage IIB to IIID cutaneous melanoma. METHODS This retrospective, population-based, nationwide cohort study used prospectively collected data from five national health registries to compare hazard, cumulative incidence, and absolute risk of recurrence in patients with cutaneous melanoma diagnosed in 2008-2010 (cohort 1, followed with clinical examinations) and patients with cutaneous melanoma diagnosed in 2016-2017 (cohort 2, followed with clinical examinations and routine FDG PET-CT at 6, 12, 24, and 36 months). RESULTS The study included 1480 patients with stage IIB to IIID cutaneous melanoma. Cumulative incidences of overall and distant recurrence were higher in cohort 2, with a peak difference at three years (32.3 % vs 27.5 % and 25.8 % vs. 18.5 %, respectively). The hazard of recurrence was higher in cohort 2 during the first two years, with hazard rates for overall and distant recurrence of 1.16 (95 % confidence interval [CI], 0.93-1.44) and 1.51 (95 % CI, 1.16-1.96), respectively. The patterns persisted in absolute risk estimates. CONCLUSIONS Patients with stage IIB to IIID melanoma followed with routine FDG PET-CT had a 51 % increased hazard of distant recurrence detection within the first two years of surveillance. Future studies must determine whether this earlier recurrence detection translates into improved survival.
Collapse
Affiliation(s)
- Neel Maria Helvind
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark.
| | | | - Annette Hougaard Chakera
- Department of Plastic Surgery, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Helle Westergren Hendel
- Department of Nuclear Medicine, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Eva Ellebæk
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | - Inge Marie Svane
- Department of Oncology, Copenhagen University Hospital: Herlev and Gentofte, Herlev, Denmark
| | | | - Sophie Bojesen
- Department of Plastic Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Helle Skyum
- Department of Plastic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Christoffer Johansen
- CASTLE-Cancer Late Effect Research, Center for Surgery and Cancer, Oncology Clinic, Rigshospitalet, Copenhagen, Denmark
| | | | | |
Collapse
|
33
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
34
|
Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
Collapse
Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
35
|
Jensen S, Bloch Z, Quist M, Hansen TTD, Johansen C, Pappot H, Suetta C, Skjødt Rafn B. Sarcopenia and loss of muscle mass in patients with lung cancer undergoing chemotherapy treatment: a systematic review and meta-analysis. Acta Oncol 2023; 62:318-328. [PMID: 37051865 DOI: 10.1080/0284186x.2023.2180660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND In patients with cancer, sarcopenia is associated with treatment related complications, treatment cessation, poor quality of life and reduced overall survival. Despite this, there is limited knowledge about changes in skeletal muscle mass during chemotherapy. The aim of this systematic review and meta-analysis was to investigate the change of skeletal muscle mass and sarcopenia during chemotherapy treatment among patients with lung cancer. METHODS A systematic literature search was conducted in three databases, PubMed, EMBASE and Web of Science. Observational studies with patients with lung cancer were eligible for inclusion if skeletal muscle mass was measured before and after receiving chemotherapy treatment. RESULTS Ten cohort studies with a total of 867 participants met the inclusion criteria. During 5.2 ± 2.9 months of chemotherapy treatment, patients with lung cancer experienced a significant loss of skeletal muscle mass with a standardized mean difference (SMD) of: -0.25 (95% CI -0.47 to -0.03). The pretreatment prevalence of sarcopenia varied across studies from 35% to 74%. Only one study reported prevalence of sarcopenia both before and after chemotherapy treatment with an increase from 35% to 59%. CONCLUSION The present data demonstrate a marked loss of skeletal muscle mass in patients with lung cancer undergoing chemotherapy treatment, as well as a high prevalence of sarcopenia. As sarcopenia is associated with poor clinical outcomes, it seems important to include and use assessments of skeletal muscle mass in clinical practice to identify patients in need for interventions. Moreover, interventional studies to hinder development of sarcopenia are needed.
Collapse
Affiliation(s)
- Sandra Jensen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Zina Bloch
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Morten Quist
- University Hospitals, Centre for Health Research Department, University of Copenhagen, Rigshospitalet, Denmark
| | - Tobias Tuse Dunk Hansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
- Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital-Bispebjerg, Copenhagen, Denmark
| | - Bolette Skjødt Rafn
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
36
|
Bidstrup PE, Salem H, Andersen EW, Schmiegelow K, Rosthøj S, Wehner PS, Hasle H, Dalton SO, Johansen C, Kazak AE. Effects on Pediatric Cancer Survivors: The FAMily-Oriented Support (FAMOS) Randomized Controlled Trial. J Pediatr Psychol 2023; 48:29-38. [PMID: 35849020 DOI: 10.1093/jpepsy/jsac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine as secondary analyses the effect the FAMily-Oriented Support (FAMOS) family therapy program on reducing parent-reported medical traumatic stress in the sub-sample of pediatric cancer survivors, age 2-5 years. METHODS The FAMOS study was a national multicenter randomized controlled trial with all four pediatric oncology departments in Denmark (Clinicaltrials.gov [NCT02200731]). Families were randomized in parallel design (1:1) to intervention or usual care. The FAMOS program includes seven home-based psychotherapeutic sessions and is based on family systems therapy to address the individuals in the family system using cognitive behavioral, problem-solving and goal-setting techniques. Questionnaires were completed by parents at baseline, 6, and 12 months. In linear mixed-effects models, the effect of FAMOS on reducing children's trauma-related behavior after 6 and 12 months was examined in 62 children (31 in the intervention and 29 in the control group, respectively). It was also examined if a trauma-related behavior effect was mediated through reduced symptoms of depression in mothers and fathers, respectively. RESULTS On average, children in the intervention group experienced significantly larger decreases in trauma-related behaviors at 6 and 12 months than the control group (predicted mean difference -3.89, p = .02 and -6.24, p = .003, respectively). The effect on trauma-related behavior was partly mediated through reduced symptoms of depression in mothers, but not fathers. CONCLUSIONS Adding to previously reported positive effects of the FAMOS intervention on parents' symptoms of post-traumatic stress and depression, significant improvements were found in young children's trauma related-behavior. Further research is needed to develop therapy for children with cancer.
Collapse
Affiliation(s)
- Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark.,Department of Psychology, University of Copenhagen, Denmark
| | - Hanin Salem
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark
| | | | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, and Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Steen Rosthøj
- Pediatric Department, Aalborg University Hospital, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, H.C. Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Denmark
| | - Susanne O Dalton
- Survivorship and Social Inequality in Cancer, Danish Cancer Society Research Center, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effect Research, Oncology Clinic, University Hospital Rigshospitalet, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark
| | - Anne E Kazak
- Nemours Children's Health, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, USA
| |
Collapse
|
37
|
Friberg AS, Carlsson SV, Vickers AJ, Dalton SO, Larsen SB, Saltbæk L, Høeg BL, Bidstrup PE, Helgstrand T, Røder A, Brasso K, Johansen C. Impact of previous depression on the risk of suicide among prostate cancer patients. Acta Oncol 2023; 62:89-99. [PMID: 36749737 PMCID: PMC10320769 DOI: 10.1080/0284186x.2023.2173536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prior studies of suicide risk among prostate cancer patients are conflicting. We compared the risk of suicide in prostate cancer patients to cancer-free men including adjustment for clinical stage, socioeconomic position, somatic comorbidity, and previous depression. MATERIALS AND METHODS A cohort of 37,527 men diagnosed with prostate cancer in Denmark during 1998-2011 was identified in the Danish Prostate Cancer Registry (DaPCaR) and compared with 357,384 cancer-free men matched by age at the time of diagnosis. The primary outcome was death from suicide. Data were analyzed using cumulative incidence functions and multivariable Cox regression models. RESULTS Among prostate cancer patients, 3813 had a previous depression, defined as filed antidepressant prescription within three years before diagnosis. In the study period, 108 prostate cancer patients were registered with suicide as the cause of death, hereof 26 with previous depression. There was no difference in the cumulative incidence of suicide between prostate cancer patients and cancer-free men. There was no effect modification of previous depression on the risk of suicide (p = .12). The hazard ratio (HR) for suicide varied with time since diagnosis. A sensitivity analysis showed that the risk of suicide was highest within the first year of diagnosis where prostate cancer patients had a 1.70-fold increased hazard compared with cancer-free men (95% CI, 1.11-2.59). Men with prostate cancer and previous depression had a three-fold increased hazard for suicide compared with prostate cancer patients without a history of depression (HR 2.84, 95% CI, 1.82-4.45). CONCLUSION The absolute risk of suicide is low following a prostate cancer diagnosis. Time since diagnosis and a history of depression was associated with the highest risk of suicide. Healthcare professionals should be aware of an increased risk of suicide among men with previous depression, especially in the immediate aftermath of the diagnosis.
Collapse
Affiliation(s)
- Anne Sofie Friberg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Services, Zealand University Hospital Næstved, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Services, Zealand University Hospital Næstved, Denmark
| | - Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| |
Collapse
|
38
|
Hauptmann M, Byrnes G, Cardis E, Bernier MO, Blettner M, Dabin J, Engels H, Istad TS, Johansen C, Kaijser M, Kjaerheim K, Journy N, Meulepas JM, Moissonnier M, Ronckers C, Thierry-Chef I, Le Cornet L, Jahnen A, Pokora R, Bosch de Basea M, Figuerola J, Maccia C, Nordenskjold A, Harbron RW, Lee C, Simon SL, Berrington de Gonzalez A, Schüz J, Kesminiene A. Brain cancer after radiation exposure from CT examinations of children and young adults: results from the EPI-CT cohort study. Lancet Oncol 2023; 24:45-53. [PMID: 36493793 DOI: 10.1016/s1470-2045(22)00655-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer. METHODS We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no previous diagnosis of cancer or benign brain tumour, and were alive and cancer-free at least 5 years after the first CT. Participants were identified through the Radiology Information System in 276 hospitals. Participants were linked with national or regional registries of cancer and vital status, and eligible cases were patients with brain cancers according to WHO International Classification of Diseases for Oncology. Gliomas were analysed separately to all brain cancers. Organ doses were reconstructed using historical machine settings and a large sample of CT images. Excess relative risks (ERRs) of brain cancer per 100 mGy of cumulative brain dose were calculated with linear dose-response modelling. The outcome was the first reported diagnosis of brain cancer after an exclusion period of 5 years after the first electronically recorded CT examination. FINDINGS We identified 948 174 individuals, of whom 658 752 (69%) were eligible for our study. 368 721 (56%) of 658 752 participants were male and 290 031 (44%) were female. During a median follow-up of 5·6 years (IQR 2·4-10·1), 165 brain cancers occurred, including 121 (73%) gliomas. Mean cumulative brain dose, lagged by 5 years, was 47·4 mGy (SD 60·9) among all individuals and 76·0 mGy (100·1) among people with brain cancer. A significant linear dose-response relationship was observed for all brain cancers (ERR per 100 mGy 1·27 [95% CI 0·51-2·69]) and for gliomas separately (ERR per 100 mGy 1·11 [0·36-2·59]). Results were robust when the start of follow-up was delayed beyond 5 years and when participants with possibly previously unreported cancers were excluded. INTERPRETATION The observed significant dose-response relationship between CT-related radiation exposure and brain cancer in this large, multicentre study with individual dose evaluation emphasises careful justification of paediatric CTs and use of doses as low as reasonably possible. FUNDING EU FP7; Belgian Cancer Registry; La Ligue contre le Cancer, L'Institut National du Cancer, France; Ministry of Health, Labour and Welfare of Japan; German Federal Ministry of Education and Research; Worldwide Cancer Research; Dutch Cancer Society; Research Council of Norway; Consejo de Seguridad Nuclear, Generalitat de Catalunya, Spain; US National Cancer Institute; UK National Institute for Health Research; Public Health England.
Collapse
Affiliation(s)
- Michael Hauptmann
- Institute of Biostatistics and Registry Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Graham Byrnes
- International Agency for Research on Cancer (IARC/WHO), Environmental and Lifestyle Epidemiology Branch, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Hilde Engels
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Tore S Istad
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
| | - Christoffer Johansen
- Cancer Late Effect Research Oncology Clinic (CASTLE), Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Neige Journy
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France; French National Institute of Health and Medical Research (Inserm), U1018, Centre for Research in Epidemiology and Population Health (CESP), Radiation Epidemiology Group, Gustave Roussy, Paris-Saclay, Paris-Sud University, Gustave Roussy, Villejuif, France
| | | | - Monika Moissonnier
- International Agency for Research on Cancer (IARC/WHO), Environmental and Lifestyle Epidemiology Branch, Lyon, France
| | - Cecile Ronckers
- Institute of Biostatistics and Registry Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Isabelle Thierry-Chef
- International Agency for Research on Cancer (IARC/WHO), Environmental and Lifestyle Epidemiology Branch, Lyon, France; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucian Le Cornet
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Cancer Research Center, Heidelberg, Germany
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Magda Bosch de Basea
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlo Maccia
- CAATS, Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Arvid Nordenskjold
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Richard W Harbron
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environmental and Lifestyle Epidemiology Branch, Lyon, France
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC/WHO), Environmental and Lifestyle Epidemiology Branch, Lyon, France
| |
Collapse
|
39
|
Pedersen S, Holmstroem RB, von Heymann A, Tolstrup LK, Madsen K, Petersen MA, Haslund CA, Ruhlmann CH, Schmidt H, Johansen C, Svane IM, Ellebaek E. Quality of life and mental health in real-world patients with resected stage III/IV melanoma receiving adjuvant immunotherapy. Acta Oncol 2023; 62:62-69. [PMID: 36645166 DOI: 10.1080/0284186x.2023.2165449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Treatment with immune checkpoint inhibitors (ICI) has expanded into the adjuvant setting enhancing the importance of knowledge on the immune-related toxicities and their impact on health-related quality of life (HRQoL). Large phase 3 trials of patients with resected Stage III/IV melanoma found no effect on HRQoL during adjuvant immunotherapy. This study investigates how HRQoL was affected during and after adjuvant immunotherapy in a real-world setting. METHODS Patients with resected melanoma treated with adjuvant nivolumab from 2018 to 2021 in Denmark were identified using the Danish Metastatic Melanoma Database (DAMMED). The study was performed as a nationwide cross-sectional analysis as a questionnaire consisting of six different validated questionnaires on HRQoL, cognitive function, fatigue, depression, fear of recurrence, and decision regret was sent to all patients in March 2021. To evaluate HRQoL during and after adjuvant treatment, patients were divided into groups depending on their treatment status when answering the questionnaire; patients in active treatment for 0-6 months, patients in active treatment for >6 months, patients who ended treatment 0-6 months ago, and patients who ended treatment >6 months ago. RESULTS A total of 271/412 (66%) patients completed the questionnaire. Patients who ended therapy 0-6 months ago had the lowest HRQoL and had more fatigue. Patients in active treatment for >6 months had lower HRQoL and more fatigue than patients who started treatment 0-6 months ago. Patients ending therapy >6 months ago had higher HRQoL and less fatigue compared to patients who ended therapy 0-6 months ago. Multivariable analysis showed an association between HRQoL and treatment status, comorbidity, civil status, and employment status. CONCLUSIONS Adjuvant nivolumab may affect some aspects of QoL, but the influence seems temporary. Patient characteristics, such as civil status, employment status, and comorbidity were associated with HRQoL.
Collapse
Affiliation(s)
- Sidsel Pedersen
- Department of Oncology, National Center for Cancer Immune Therapy (CCIT-DK), Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Rikke B Holmstroem
- Department of Oncology, National Center for Cancer Immune Therapy (CCIT-DK), Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Annika von Heymann
- Department of Oncology, Cancer Survivorship and Late Effects Research Center (CASTLE), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Kasper Madsen
- Department of Oncology, National Center for Cancer Immune Therapy (CCIT-DK), Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Department of Geriatrics and Palliative Medicine GP, Palliative Care Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Christina H Ruhlmann
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Department of Oncology, Cancer Survivorship and Late Effects Research Center (CASTLE), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Inge Marie Svane
- Department of Oncology, National Center for Cancer Immune Therapy (CCIT-DK), Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Eva Ellebaek
- Department of Oncology, National Center for Cancer Immune Therapy (CCIT-DK), Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
40
|
Ben Abdallah H, Seeler S, Bregnhøj A, Ghatnekar G, Kristensen L, Iversen L, Johansen C. 354 Heat Shock Protein 90 Inhibitor Attenuates Inflammation Induced by 12-O-tetradecanoylphorbol-13-acetate in Primary Human Keratinocytes and Mice. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Emmanuel T, Litman T, Ignatov B, Bertelsen T, Steiniche T, Lybæk D, Bregnhøj A, Eidsmo L, Iversen L, Johansen C. 056 Highly Multiplexed Digital Spatial Profiling of Resolved Psoriasis Skin From Dead Sea Climatotherapy or Secukinumab Treated Patients. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
42
|
Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
Collapse
Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| |
Collapse
|
43
|
Johansen C, von Heymann A, Rafn BS, Borgquist S, Christiansen P, Christensen P, Zachariae R, Pappot H, Lassen U. Late effects – the new focus of follow-up. Acta Oncol 2022; 61:1163-1164. [DOI: 10.1080/0284186x.2022.2137845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Christoffer Johansen
- Department of Oncology, Cancer late effect research unit CASTLE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika von Heymann
- Department of Oncology, Cancer late effect research unit CASTLE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette S. Rafn
- Department of Oncology, Cancer late effect research unit CASTLE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
44
|
Deltour I, Poulsen AH, Johansen C, Feychting M, Johannesen TB, Auvinen A, Schüz J. Time trends in mobile phone use and glioma incidence among males in the Nordic Countries, 1979-2016. Environ Int 2022; 168:107487. [PMID: 36041243 PMCID: PMC9463632 DOI: 10.1016/j.envint.2022.107487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In the Nordic countries, the use of mobile phones increased sharply in the mid-1990s especially among middle-aged men. We investigated time trends in glioma incidence rates (IR) with the perspective to inform about the plausibility of brain tumour risks from mobile phone use reported in some case-control studies. METHODS We analysed IR of glioma in Denmark, Finland, Norway, and Sweden among men aged 40-69 years, using data from national cancer registries and population statistics during 1979-2016, using log-linear joinpoint analysis. Information on regular mobile phone use and amount of call-time was obtained from major studies of mobile phones in these countries. We compared annual observed incidence with that expected under various risk scenarios to assess which of the reported effect sizes are compatible with the observed IR. The expected numbers of cases were computed accounting for an impact of other factors besides mobile phone use, such as improved cancer registration. RESULTS Based on 18,232 glioma cases, IR increased slightly but steadily with a change of 0.1% (95 %CI 0.0%; 0.3%) per year during 1979-2016 among 40-59-year-old men and for ages 60-69, by 0.6 % (95 %CI 0.4; 0.9) annually. The observed IR trends among men aged 40-59 years were incompatible with risk ratios (RR) 1.08 or higher with a 10-year lag, RR ≥ 1.2 with 15-year lag and RR ≥ 1.5 with 20-year lag. For the age group 60-69 years, corresponding effect sizes RR ≥ 1.4, ≥2 and ≥ 2.5 could be rejected for lag times 10, 15 and 20 years. DISCUSSION This study confirms and reinforces the conclusions that no changes in glioma incidence in the Nordic countries have occurred that are consistent with a substantial risk attributable to mobile phone use. This particularly applies to virtually all reported risk increases reported by previous case-control studies with positive findings.
Collapse
Affiliation(s)
- Isabelle Deltour
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | | | | | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Tampere, Finland; STUK - Radiation and Nuclear Safety Authority, Vantaa, Finland
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
45
|
Salz T, Zabor EC, Brown PDN, Dalton SO, Raghunathan NJ, Matasar MJ, Steingart R, Hjalgrim H, Specht L, Vickers AJ, Oeffinger KC, Johansen C. Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors. Acta Oncol 2022; 61:1064-1068. [PMID: 36256902 PMCID: PMC9888465 DOI: 10.1080/0284186x.2022.2107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors. OBJECTIVE To evaluate how preexisting cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs. MATERIAL AND METHODS Using Danish registries, we identified adults diagnosed with lymphoma 2000-2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between preexisting CVRFs and receipt of mediastinal radiation on subsequent MI. RESULTS Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR = 1.96; 95% CI = 1.09-3.52), and presence of ≥1 CVRF (HR = 2.71; 95% CI = 1.77-4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p = 0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation. CONCLUSION Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of preexisting cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.
Collapse
Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Nirupa J Raghunathan
- Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Lymphoma Survivorship Clinic, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christoffer Johansen
- CASTLE - Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Copenhagen, Denmark
| |
Collapse
|
46
|
Sylow L, Grand MK, von Heymann A, Persson F, Siersma V, Kriegbaum M, Lykkegaard Andersen C, Johansen C. Incidence of New-Onset Type 2 Diabetes After Cancer: A Danish Cohort Study. Diabetes Care 2022; 45:e105-e106. [PMID: 35653597 DOI: 10.2337/dc22-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Lykke Sylow
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mia K Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Center for Cancer and Organ Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Center for Cancer and Organ Disease, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
47
|
Horsbøl TA, Kjaer SK, Andersen EW, Ammitzbøll G, Thygesen LC, Johansen C, Jensen PT, Frøding LP, Lajer H, Dalton SO. Use of hypnotics among women diagnosed with cervical cancer – A population-based cohort study. Gynecol Oncol 2022; 166:300-307. [DOI: 10.1016/j.ygyno.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
|
48
|
Bousquet PA, Meltzer S, Fuglestad AJ, Lüders T, Esbensen Y, Juul HV, Johansen C, Lyckander LG, Bjørnetrø T, Inderberg EM, Kersten C, Redalen KR, Ree AH. The mitochondrial DNA constitution shaping T-cell immunity in patients with rectal cancer at high risk of metastatic progression. Clin Transl Oncol 2022; 24:1157-1167. [PMID: 34961902 PMCID: PMC9107448 DOI: 10.1007/s12094-021-02756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/09/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE A significant percentage of colorectal cancer patients proceeds to metastatic disease. We hypothesised that mitochondrial DNA (mtDNA) polymorphisms, generated by the high mtDNA mutation rate of energy-demanding clonal immune cell expansions and assessable in peripheral blood, reflect how efficiently systemic immunity impedes metastasis. PATIENTS AND METHODS We studied 44 rectal cancer patients from a population-based prospective biomarker study, given curative-intent neoadjuvant radiation and radical surgery for high-risk tumour stage and followed for metastatic failure. Blood specimens were sampled at the time of diagnosis and analysed for the full-length mtDNA sequence, composition of immune cell subpopulations and damaged serum mtDNA. RESULTS Whole blood total mtDNA variant number above the median value for the study cohort, coexisting with an mtDNA non-H haplogroup, was representative for the mtDNA of circulating immune cells and associated with low risk of a metastatic event. Abundant mtDNA variants correlated with proliferating helper T cells and cytotoxic effector T cells in the circulation. Patients without metastatic progression had high relative levels of circulating tumour-targeting effector T cells and, of note, the naïve (LAG-3+) helper T-cell population, with the proportion of LAG-3+ cells inversely correlating with cell-free damaged mtDNA in serum known to cause antagonising inflammation. CONCLUSION Numerous mtDNA polymorphisms in peripheral blood reflected clonal expansion of circulating helper and cytotoxic T-cell populations in patients without metastatic failure. The statistical associations suggested that patient's constitutional mtDNA manifests the helper T-cell capacity to mount immunity that controls metastatic susceptibility. TRIAL REGISTRATION ClinicalTrials.gov NCT01816607; registration date: 22 March 2013.
Collapse
Affiliation(s)
- P A Bousquet
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - S Meltzer
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - A J Fuglestad
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Cancer Treatment, Sørlandet Hospital, Kristiansand, Norway
| | - T Lüders
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology, Akershus University Hospital, Lorenskog, Norway
| | - Y Esbensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology, Akershus University Hospital, Lorenskog, Norway
| | - H V Juul
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - C Johansen
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - L G Lyckander
- Department of Pathology, Akershus University Hospital, Lorenskog, Norway
| | - T Bjørnetrø
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - E M Inderberg
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - C Kersten
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
- Centre for Cancer Treatment, Sørlandet Hospital, Kristiansand, Norway
| | - K R Redalen
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - A H Ree
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
49
|
Auvinen A, Cardis E, Blettner M, Moissonnier M, Sadetzki S, Giles G, Johansen C, Swerdlow A, Cook A, Fleming S, Berg-Beckhoff G, Iavarone I, Parent ME, Woodward A, Tynes T, McBride M, Krewski D, Feychting M, Takebayashi T, Armstrong B, Hours M, Siemiatycki J, Lagorio S, Larsen SB, Schoemaker M, Klaeboe L, Lönn S, Schüz J. Diagnostic radiological examinations and risk of intracranial tumours in adults-findings from the Interphone Study. Int J Epidemiol 2022; 51:537-546. [PMID: 34648614 PMCID: PMC9082802 DOI: 10.1093/ije/dyab140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk. METHODS Brain tumour cases (2644 gliomas, 2236 meningiomas, 1083 neuromas) diagnosed in 2000-02 were identified through hospitals in 13 countries, and 6068 controls (population-based controls in most centres) were included in the analysis. Participation across all centres was 64% for glioma cases, 78% for meningioma cases, 82% for acoustic neuroma cases and 53% for controls. Information on previous diagnostic radiological examinations was obtained by interviews, including the frequency, timing and indication for the examinations. Typical brain doses per type of examination were estimated based on the literature. Examinations within the 5 years before the index date were excluded from the dose estimation. Adjusted odds ratios were estimated using conditional logistic regression. RESULTS No materially or consistently increased odds ratios for glioma, meningioma or acoustic neuroma were found for any specific type of examination, including computed tomography of the head and cerebral angiography. The only indication of an elevated risk was an increasing trend in risk of meningioma with the number of isotope scans, but no such trends for other examinations were observed. No gradient was found in risk with estimated brain dose. Age at exposure did not substantially modify the findings. Sensitivity analyses gave results consistent with the main analysis. CONCLUSIONS There was no consistent evidence for increased risks of brain tumours with X-ray examinations, although error from selection and recall bias cannot be completely excluded. A cautious interpretation is warranted for the observed association between isotope scans and meningioma.
Collapse
Affiliation(s)
- Anssi Auvinen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere
University, Tampere, Finland
- STUK—Radiation and Nuclear Safety Authority, Helsinki,
Finland
| | - Elisabeth Cardis
- Barcelona Institute of Global Health (ISGlobal), Centre for Research in
Environmental Epidemiology, Universitat Pompeu Funebra, Barcelona,
Spain
- CIBER Epidemiologia y Salud Publica, Madrid, Spain
| | | | | | | | - Graham Giles
- Cancer Council Victoria, Melbourne, VIC, Australia
| | | | - Anthony Swerdlow
- Division of Genetics and Epidemiology, Institute of Cancer
Research, London, UK
- Division of Breast Cancer Research, Institute of Cancer
Research, London, UK
| | - Angus Cook
- School of Population and Global Health, University of Western
Australia, Crawley, WA, Australia
| | | | | | | | - Marie-Elise Parent
- INRS Centre Armand-Frappier Santé Biotechnologie, Institut National de la
Recherche Scientifique, Université du Québec, Laval, QC, Canada
| | - Alistair Woodward
- School of Population Health, University of Auckland,
Auckland, New Zealand
| | - Tore Tynes
- National Institute of Occupational Health, Oslo, Norway
| | - Mary McBride
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Dan Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of
Ottawa, ON, Canada
| | | | | | - Bruce Armstrong
- School of Public Health, University of Sydney, Sydney, NSW,
Australia
| | | | | | | | | | - Minouk Schoemaker
- Division of Genetics and Epidemiology, Institute of Cancer
Research, London, UK
| | - Lars Klaeboe
- Norwegian Radiation Protection Authority, Østerås, Norway
| | - Stefan Lönn
- Karolinska Institutet, Stockholm, Sweden
- Region Halland, Research and Development, Sweden
| | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
50
|
Schlehofer B, Blettner M, Moissonnier M, Deltour I, Giles GG, Armstrong B, Siemiatycki J, Parent ME, Krewski D, Johansen C, Auvinen A, Lahkola A, Hours M, Berg-Beckhoff G, Sadetzki S, Lagorio S, Takebayashi T, Yamaguchi N, Woodward A, Cook A, Tynes T, Klaboe L, Feychting M, Feltbower R, Swerdlow A, Schoemaker M, Cardis E, Schüz J. Association of allergic diseases and epilepsy with risk of glioma, meningioma and acoustic neuroma: results from the INTERPHONE international case-control study. Eur J Epidemiol 2022; 37:503-512. [PMID: 35118581 DOI: 10.1007/s10654-022-00843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Abstract
We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case-control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58-0.92), hay fever (OR 0.72; CI 0.61-0.86), and eczema (OR 0.78, CI 0.64-0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87-4.63) and for meningioma (2.12; CI 1.27-3.56), but not for acoustic neuroma. This large-scale case-control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma.
Collapse
Affiliation(s)
- Brigitte Schlehofer
- Leimen, Germany (retired); formerly: Unit of Environmental Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - Monika Moissonnier
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Isabelle Deltour
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Bruce Armstrong
- School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | | | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- STUK Radiation and Nuclear Safety Authority, Environmental Radiation Surveillance, Helsinki, Finland
| | - Anna Lahkola
- STUK Radiation and Nuclear Safety Authority, Environmental Radiation Surveillance, Helsinki, Finland
| | | | - Gabriele Berg-Beckhoff
- Unit for Health Promotion Research, Department of Public Health, and Hospital South West Jutland Esbjerg, University of Southern Denmark, Odense, Denmark
| | - Siegal Sadetzki
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Jerusalem, Israel
| | - Susanna Lagorio
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Alistair Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angus Cook
- Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tore Tynes
- National Institute of Occupational Health, Oslo, Norway
| | - Lars Klaboe
- Norwegian Radiation Protection Authority, Østerås; The Cancer Registry of Norway, Oslo, Norway
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Elisabeth Cardis
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiologia Y Salud Pública, Madrid, Spain
| | - Joachim Schüz
- International Agency for Research On Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France.
| |
Collapse
|