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  • 1
    Keywords: CANCER ; SURVIVAL ; THERAPY ; BREAST-CANCER ; TRIALS ; colorectal cancer ; chemotherapy ; COLON-CANCER ; QUESTIONNAIRE ; MANAGEMENT ; UPDATE ; quality of life ; SURVIVORS ; ADJUVANT CHEMOTHERAPY ; OLDER ; CANCER SURVIVORS ; Long term
    Abstract: Purpose. To investigate the age-specific pattern of administration of chemotherapy and its association with long-term survival and quality of life (QoL) in stage II and III colorectal cancer patients. Methods. Chemotherapy allocation according to disease and patient characteristics was investigated in a population-based cohort of 562 stage II and III colorectal cancer patients. Five years after diagnosis, survival was determined and QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and a tumor specific module. The association among chemotherapy, survival, and QoL was examined while controlling for potential confounders. Results. Chemotherapy was administered in 71% of patients aged 〈60 years and in only 20% of patients aged 〉/=80 years. A significant association between chemotherapy and longer survival time was found for stage III cancer only. Chemotherapy was associated with higher symptom levels for trouble with taste, anxiety, and hair loss. In age-specific analyses, younger survivors (〈70 years at time of follow-up) with a history of chemotherapy reported significantly lower physical, role, and cognitive functioning and higher pain, appetite loss, hair loss, and trouble with taste symptom levels. In contrast, for older survivors (〉/=70 years), only two (hair loss and dry mouth) out of 38 QoL scores were significantly associated with chemotherapy. Discussion. Chemotherapy is associated with lower long-term QoL, especially in younger survivors. In cases of uncertain survival benefits of chemotherapy, consideration of its long-term effects on QoL should be incorporated into final decisions on treatment.
    Type of Publication: Journal article published
    PubMed ID: 22101506
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  • 2
    Keywords: MORTALITY ; BREAST-CANCER ; statistics ; UNITED-STATES ; SURVIVAL RATES ; SEER program ; RECORD LINKAGE ERRORS ; INCOMPLETE REGISTRATION ; EARLY 21ST-CENTURY ; TRACE-BACK
    Abstract: Background: The proportion of cases notified by death certificate only (DCO) is a commonly used criterion to judge completeness of cancer registration even though it is affected by additional factors, particularly during initial years of newly established registries. Methods: Based on cancer registry data from the United States, we provide model calculations to demonstrate the magnitude and time course of the impact of the following mechanisms on DCO proportions of "young" registries: registration of cancer deaths from patients diagnosed prior to the registration period and delayed registration by death certificate of patients diagnosed but not reported after initiation of registration. Results: DCO proportions of up to 〉= 30% can be expected from deaths of previously diagnosed patients during the first year of registration. Although this proportion is expected to gradually diminish over subsequent years, DCO proportions may be dominated for several years by this source, which may still be relevant after 10 or more years of cancer registration for cancers with relatively large proportions of late deaths. Otherwise, however, underreporting during patients' lifetime is expected to become the predominant source of DCO proportions in the long run. Conclusions: Our results may guide interpretation of DCO proportions of relatively "young" cancer registries.
    Type of Publication: Journal article published
    PubMed ID: 23084081
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  • 3
    Keywords: BREAST-CANCER ; HEALTH ; UNCERTAINTY ; QUESTIONNAIRE ; SCALE ; QUALITY-OF-LIFE ; AFRICAN-AMERICAN ; COMMUNICATION ; OLDER-ADULT ; SUPPORTIVE CARE NEEDS
    Abstract: Background Increasing proportions of patients diagnosed with cancer will become long-term survivors (=5?years post-diagnosis). However, survivors may continue to experience negative effects of cancer and/or treatment, including fear of recurrence (FoR). This review aims to provide an overview of current knowledge on FoR, including determinants and consequences in long-term cancer survivors, and to outline methodological and conceptual challenges that should be addressed in future research. Methods Multiple databases including PUBMED, EMBASE, and PsycINFO were searched to identify relevant articles. Seventeen articles were included. Data were extracted by two reviewers and summarized following a systematic scheme. Results Even years after initial diagnosis, cancer survivors suffer from FoR. Most studies report low or moderate mean FoR scores, suggesting that FoR is experienced in modest intensity by most survivors. Studies including long-term and short-term survivors indicate no significant change of FoR over time. Lower level of education, lower level of optimism, and being Hispanic or White/Caucasian were found to be associated with higher levels of FoR. Significant negative associations were reported between FoR and quality of life as well as psychosocial well-being. All but three studies were conducted in the USA. General cut-offs for severity/clinical significance have not been defined yet. Conclusions FoR at modest intensity is experienced by most long-term cancer survivors. Future studies should address determinants and consequences of FoR in more detail. Validated instruments providing cut-offs for severity/clinical significance of FoR should be developed and utilized. Efficient interventions should be implemented to reduce detrimental effects of FoR.
    Type of Publication: Journal article published
    PubMed ID: 22232030
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  • 4
    Keywords: DIAGNOSIS ; POPULATION ; BREAST-CANCER ; STAGE ; CARE ; DISTANCE ; RELATIVE SURVIVAL ; ACCESS ; imputation
    Abstract: Background: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. Material and methods: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. Results: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. Conclusion: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
    Type of Publication: Journal article published
    PubMed ID: 24680643
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  • 5
    Keywords: CANCER ; Germany ; POPULATION ; BREAST-CANCER ; HEALTH ; colorectal cancer ; chemotherapy ; COLON-CANCER ; COMORBIDITY ; STATES ; exercise ; ASSOCIATIONS ; quality of life ; SURVIVORS ; RANDOMIZED CONTROLLED-TRIAL ; Long term effects ; LOW RECTAL-CANCER ; OLDER-ADULT ; Systematic review
    Abstract: Background Due to the growing number of long term (〉= 5 years) colorectal cancer survivors investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients needs Method To summarise current research results multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long term QoL of colorectal cancer survivors The content of 10 included studies was independently extracted by two reviewers Results Colorectal cancer survivors indicated a good overall QoL but may have slightly lower physical QoL than the general population Furthermore survivors had worse depression scores and reported to suffer from long term symptoms such as bowel problems and distress regarding cancer Apart from stoma and recurrence of the disease mainly general and health related factors such as age social network size income education BMI and number of comorbidities were associated with QoL Studies were mainly conducted in the United States (US) (n = 7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates QoL assessment was cross sectional in all studies Conclusion Despite an overall good QoL colorectal cancer survivors have specific physical and psychological problems The reported determinants of QoL may serve to identify survivors with special needs But further studies are needed that focus on problems like distress depression and bowel problems of long term colorectal cancer survivors
    Type of Publication: Journal article published
    PubMed ID: 20605090
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  • 6
    Keywords: CELLS ; SURVIVAL ; THERAPY ; COHORT ; BREAST-CANCER ; MELANOMA ; QUALITY-OF-LIFE ; NOREPINEPHRINE
    Abstract: Recent observational studies have suggested that the use of beta blockers might be associated with better prognosis after cancer. Because evidence is limited for colorectal cancer (CRC), the association of beta blocker use and prognosis was investigated in a large population-based cohort of patients with CRC. METHODS Between 2003 and 2007, information on beta blocker use at diagnosis and potential confounders was collected by personal interviews for 1975 patients with CRC. Vital status, cause of death, and recurrence status were assessed during a median follow-up time of 5.0 years. The associations of beta blocker use and overall, CRC-specific, and recurrence-free survival were estimated by Cox proportional hazard regression. In addition, beta blocker subgroup, site, and stage-specific analyses were performed. RESULTS After adjustment for covariates including sociodemographic, cancer-related, and lifestyle factors and comorbidity and medications, no significant association between beta blocker use at diagnosis and prognosis was observed for all stages combined. However, in stage-specific analyses, beta blocker use was associated with longer overall survival (hazard ratio = 0.50; 95% confidence interval = 0.33-0.78) and CRC-specific survival (hazard ratio = 0.47; 95% confidence interval = 0.30-0.75) in stage IV patients. For these patients, median overall survival was 18 months longer and CRC-specific survival was 17 months longer for beta blocker users than for nonusers (38 versus 20 months and 37 versus 20 months, respectively). CONCLUSIONS These results suggest that beta blocker use might be associated with longer survival in patients with stage IV CRC.
    Type of Publication: Journal article published
    PubMed ID: 24415516
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  • 7
    Keywords: SURVIVAL ; THERAPY ; MORTALITY ; BREAST-CANCER ; prevention ; WOMEN ; smoking ; HYPERTENSION ; METAANALYSIS ; bias
    Abstract: BACKGROUND: Recently, it has been postulated that long-term use of beta blockers might decrease the risk of certain types of cancer because of weakening of norepinephrine signaling. Previous studies on colorectal cancer (CRC) yielded inconsistent results, but lacked information on covariates. Thus, the authors investigated the association of beta blocker use and CRC risk in a large population-based case-control study (DACHS study). METHODS: Between 2003 and 2007, information on beta blocker use and potential confounders was collected by personal interviews for 1762 CRC cases and 1708 control individuals from Germany. The association of CRC risk and beta blocker use and subclasses of beta blockers was estimated by multiple logistic regression. In addition, site- and stage-specific analyses were performed. RESULTS: After adjustment for covariates, no association was observed with beta blocker use (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.86-1.29) or with duration of beta blocker use. Also, the analysis by subclasses of beta blockers (cardioselectivity) and active ingredients (metoprolol, bisoprolol, carvedilol, and atenolol) or by CRC subsite showed no associations. In stage-specific analyses, long-term beta blocker use (6+ years) was associated with a significantly higher risk of stage IV CRC (OR, 2.02; 95% CI, 1.25-3.27). CONCLUSIONS: Our adjusted results do not support the hypothesis that beta blocker use is associated with decreased risk of CRC. In contrast, we found a positive association of long-term beta blocker use and risk of stage IV CRC. The latter result should be further evaluated in future studies.
    Type of Publication: Journal article published
    PubMed ID: 22585669
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  • 8
    Keywords: DEATH ; ASSOCIATION ; BREAST-CANCER ; SURVEILLANCE ; UNITED-STATES ; colonoscopy ; ENDOSCOPY ; sigmoidoscopy ; AMERICAN-COLLEGE ; SEER program
    Abstract: OBJECTIVES: A common approach in the evaluation of screening for colorectal cancer (CRC) is comparing observed numbers of CRC deaths in screening participants with expected numbers derived from CRC mortality in the general population. We aimed to illustrate and quantify an often-overlooked bias that may occur in such studies if CRC mortality in the general population is not restricted by the date of diagnosis (whereas screening participants by definition do not have a prior CRC diagnosis). STUDY DESIGN AND SETTING: We illustrate and quantify the expected bias using cancer registry data from the United States. RESULTS: Unless an incidence-based mortality approach is used, expected numbers of CRC deaths in screening cohorts (and hence estimated screening effects) are substantially overestimated. Overestimation of expected CRC deaths is most severe (more than fivefold) during the first year of follow-up and rapidly decreases in the subsequent years. Nevertheless, overestimation of 5- and 10-year cumulative numbers of expected CRC deaths is still as high as 60-70% and 20-30%, respectively. Substantial bias even persists if the initial years of follow-up are excluded from the analyses. CONCLUSION: Careful restriction of expected CRC deaths by an incidence-based mortality approach is indispensable for deriving valid screening effect estimates.
    Type of Publication: Journal article published
    PubMed ID: 24210777
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