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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: CANCER ; SURVIVAL ; DIAGNOSIS ; DISEASE ; POPULATION ; AGE ; colorectal cancer ; COLON-CANCER ; MORPHOLOGY ; SUBSITE ; EUROPE ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; colonoscopy ; EMPIRICAL-EVALUATION ; colorectal ; UP-TO-DATE ; EUROCARE-4
    Abstract: BACKGROUND: Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis. METHODS: We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002-2006. RESULTS: The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002-2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon. CONCLUSION: Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.
    Type of Publication: Journal article published
    PubMed ID: 22555397
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  • 3
    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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  • 4
    Keywords: CANCER ; ASSOCIATION ; LONG-TERM SURVIVAL ; UNITED-STATES ; B-CELL LYMPHOMA ; OLDER PATIENTS ; ACUTE MYELOID-LEUKEMIA ; SOCIOECONOMIC-STATUS ; PLUS RITUXIMAB ; EARLY 21ST-CENTURY
    Abstract: Background. New treatment options and supportive care measures have greatly improved survival of patients with non-Hodgkin lymphoma (NHL) but may not be affordable for those with no insurance or inadequate insurance. Methods. Using data from the Surveillance, Epidemiology, and End Results database, we estimated overall and cause-specific survival according to insurance status within 3 years after diagnosis of patients diagnosed with NHL in the U.S. in the period 2007-2011. Because NHL is a heterogeneous condition, we also examined survival in diffuse large B-cell lymphoma (DLBCL). Results. Survival was higher for patients with non-Medicaid insurance compared with either uninsured patients or patients with Medicaid. For patients with any NHL, the 3-year survival estimates were 68.0% for uninsured patients, 60.7% for patients with Medicaid, and 84.9% for patients with non-Medicaid insurance. Hazard ratios (HRs) for uninsured and Medicaid-only patients compared with insured patients were 1.92 (95% confidence interval [CI]: 1.76-2.10) and 2.51 (95% CI: 2.36-2.68), respectively. Results were similar for patients with DLBCL, with survival estimates of 68.5% for uninsured patients (HR: 1.78; 95% CI: 1.57-2.02), 58%, for patients with Medicaid (HR: 2.42; 95% CI: 2.22-2.64), and 83.3% for patients with non-Medicaid insurance. Cause-specific analysis showed survival estimates of 80.3% for uninsured patients (HR: 1.83; 95% CI: 1.62-2.05), 77.7% for patients with Medicaid (HR: 2.23; 95% CI: 2.05-2.42), and 90.5% for patients with non-Medicaid insurance. Conclusion. Lack of insurance and Medicaid only were associated with significantly lower survival for patients with NHL. Further evaluation of the reasons for this disparity and implementation of comprehensive coverage for medical care are urgently needed.
    Type of Publication: Journal article published
    PubMed ID: 25876991
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  • 5
    Keywords: CANCER ; SURVIVAL ; POPULATION ; ACCURACY ; epidemiologic methods ; REGISTRIES ; RATIOS
    Abstract: Background:Relative survival estimates cancer survival in the absence of other causes of death. Previous work has shown that standard errors of non-standardised relative survival may be substantially overestimated by the conventionally used method. However, evidence was restricted to non-standardised relative survival estimates using Hakulinen's method. Here, we provide a more comprehensive evaluation of the accuracy of standard errors including age-standardised survival and estimation by the Ederer II method.Methods:Five- and ten-year non-standardised and age-standardised relative survival was estimated for patients diagnosed with 25 common forms of cancer in Finland in 1989-1993, using data from the nationwide Finnish Cancer Registry. Standard errors of mutually comparable non-standardised and age-standardised relative survival were computed by the conventionally used method and compared with bootstrap standard errors.Results:When using Hakulinen's method, standard errors of non-standardised relative survival were overestimated by up to 28%. In contrast, standard errors of age-standardised relative survival were accurately estimated. When using the Ederer II method, deviations of the standard errors of non-standardised and age-standardised relative survival were generally small to negligible.Conclusion:In most cases, overestimations of standard errors are effectively overcome by age standardisation and by using Ederer II rather than Hakulinen's method.
    Type of Publication: Journal article published
    PubMed ID: 22173672
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  • 6
    Keywords: QUALITY ; LONG-TERM ; CANCER ; COLORECTAL-CANCER ; colorectal cancer ; ONCOLOGY ; review ; DETERMINANTS ; LIFE
    Type of Publication: Meeting abstract published
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  • 7
    Keywords: CANCER ; EXPRESSION ; IN-VITRO ; proliferation ; tumor ; carcinoma ; human ; IN-VIVO ; MODEL ; VITRO ; EXPOSURE ; GENE ; GENES ; PROTEIN ; PROTEINS ; TUMORS ; LINES ; MICE ; CARCINOGENESIS ; CONTRAST ; KERATINOCYTES ; SKIN ; cell cycle ; CELL-CYCLE ; CYCLE ; E7 ; papillomavirus ; SUSCEPTIBILITY ; TRANSGENIC MICE ; PROGRESSION ; PROMOTER ; LINE ; human papillomavirus ; LIFE-SPAN ; E6 ; HUMAN KERATINOCYTES ; keratin ; SQUAMOUS-CELL CARCINOMA ; CARCINOMAS ; REPLICATION ; squamous cell carcinoma ; HUMAN-PAPILLOMAVIRUS TYPE-16 ; SQUAMOUS-CELL CARCINOMAS ; epidermis ; immunosuppression ; RE ; immortalization ; keratinocyte ; CARCINOGEN ; ONCOGENESIS ; CHECKPOINT ; EPIDERMODYSPLASIA-VERRUCIFORMIS ; LIFE ; HYPERPLASIA ; LEVEL ; EVENTS ; BOVINE ; chemical carcinogenesis ; CYCLE ARREST ; DYSPLASIA
    Abstract: The oncoproteins E6 and E7 of human papillomavirus type 38 (HPV38) display several transforming activities in vitro, including immortalization of primary human keratinocytes. To evaluate the oncogenic activities of the viral proteins in an in vivo model, we generated transgenic mice expressing HPV38 E6 and E7 under the control of the bovine homologue of the human keratin 10 (K10) promoter. Two distinct lines of HPV38 E6/E7-expressing transgenic mice that express the viral genes at different levels were obtained. In both lines, HPV38 E6 and E7 induced cellular proliferation, hyperplasia, and dysplasia, in the epidermis. The rate of occurrence of these events was proportional to the levels of HPV38 E6 and E7 expression in the two transgenic lines. Exposure of the epidermis of nontransgenic mice to UV led to p21(WAF1) accumulation and cell cycle arrest. In contrast, keratinocytes from transgenic mice continued to proliferate and were not positive for p21(WAF1), indicating that cell cycle checkpoints are altered in keratinocytes expressing the viral genes. Although the HPV38 E6/E7-expressing transgenic mice did not develop spontaneous tumors during their life span, two-stage carcinogen treatment led to a high incidence of papillomas, keratoacanthomas, and squamous-cell carcinomas in HPV38 mice compared with nontransgenic animals. Together, these data show that HPV38 E6 and E7 display transforming properties in vivo, providing further support for the role of HPV38 in carcinogenesis
    Type of Publication: Journal article published
    PubMed ID: 16282489
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  • 8
    Keywords: PEPTIDE ; RECEPTOR ; CANCER ; CELLS ; EXPRESSION ; IN-VITRO ; tumor ; TUMOR-CELLS ; carcinoma ; CELL ; Germany ; human ; VITRO ; MOLECULES ; TISSUE ; ACCUMULATION ; LINES ; ACTIVATION ; LIGAND ; CONTRAST ; T-CELLS ; CELL-LINES ; DOWN-REGULATION ; MOLECULE ; TARGET ; IN-SITU ; NEOPLASIA ; PROGRESSION ; NUMBER ; cervical cancer ; cervical intraepithelial neoplasia ; CERVICAL-CANCER ; CELL-LINE ; LYMPHOCYTES ; PEPTIDES ; LIGANDS ; CLASS-I ; HUMAN-PAPILLOMAVIRUS ; NATURAL-KILLER-CELLS ; NK cells ; EPITHELIAL-CELLS ; CERVICAL-CARCINOMA ; CARCINOMAS ; PROGNOSTIC-SIGNIFICANCE ; IMMUNOTHERAPY ; intraepithelial neoplasia ; T-LYMPHOCYTES ; T lymphocyte ; BIOPSY ; T lymphocytes ; ONCOLOGY ; RE ; USA ; LOSSES ; NKG2D RECEPTOR ; viral ; NOV ; NK-CELLS ; NKG2D ligands ; DNAM-1 ligands ; I-RELATED CHAIN ; PARTICLE VACCINE ; QUADRIVALENT VACCINE
    Abstract: Human papillomavirus-induced cervical carcinomas often show impaired expression of MHC class I molecules resulting in the inability of tumor cells to directly present viral peptides to cytotoxic T lymphocytes. Loss of MHC class I expression combined with the expression of activating NK cell receptor ligands renders tumor cells potentially susceptible to NK cell attack. Thus, in this study, we analyzed the expression of activating NK cell receptor ligands, NK cell accumulation and activation status in situ in normal ectocervical tissue (NCT), cervical intraepithelial neoplasia (CIN) and squamous cervical carcinoma (CxCa). We observed that expression of the DNAM-I ligand CD155 was frequently upregulated in CxCa, but not in CIN. The NKG2D ligand MICA was upregulated in fewer CxCa biopsies. In contrast, another NKG2D ligand ULBP2 was preferentially expressed in differentiated epithelial cells of NCT. Increased numbers of NK cells were detected in CIN as compared to NCT and CxCa. Expression of activating NK cell receptor ligands combined with loss of MHC class I was not correlated with enhanced NK cell accumulation or activation status. Furthermore, we demonstrate that cervical cancer cell lines are killed by the NK cell line, NKL, in a NKG2D- and DNAM-1-dependent manner in vitro. Since a significant number of CxCa biopsies showed low MHC class I expression combined with high expression of one or more of the tested activating NK cell receptor ligands, we conclude that CxCa might be a promising target for NK cell-based adoptive immunotherapy. (C) 2008 Wiley-Liss, Inc
    Type of Publication: Journal article published
    PubMed ID: 18712710
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  • 9
    Keywords: CANCER ; GROWTH ; LONG-TERM ; validation ; ASSOCIATION ; HEALTH ; WOMEN ; colorectal cancer ; PREDICTORS ; SCALE ; quality of life ; depression ; VARIABLES ; CANCER SURVIVORS ; benefit finding ; INVENTORY ; post-traumatic growth ; STAGE BREAST-CANCER ; VERSION
    Abstract: Background:As research on quality of life of colorectal cancer (CRC) survivors has mainly focused on downsides of cancer survivorship, the aim of this study is to investigate benefit finding (BF) and post-traumatic growth (PTG) in long-term CRC survivors.Methods:Benefit finding, PTG, and quality of life were assessed 5 years after diagnosis in a population-based cohort of 483 CRC patients using the benefit finding scale, the post-traumatic growth inventory, and the EORTC QLQ-C30. Prevalence of BF and PTG, determinants of moderate-to-high BF and PTG, and the association between BF, PTG, and quality of life were investigated.Results:Moderate to high levels of BF and PTG were experienced by 64% and 46% of the survivors, respectively. Survivors with the highest level of education and with higher depression scores reported less BF and PTG. The PTG increased with increasing stage and self-reported burden of diagnosis. Quality of life only correlated weakly with PTG (Pearson's r=0.1180, P=0.0112) and not with BF (r=0.0537, P=0.2456).Conclusion:Many long-term CRC survivors experience BF and PTG. As these constructs were not strongly correlated with quality of life, focusing solely on quality of life after cancer misses an important aspect of survivorship.
    Type of Publication: Journal article published
    PubMed ID: 21878935
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  • 10
    Keywords: CANCER ; SURVIVAL ; Germany ; STAGE ; LONG-TERM SURVIVAL ; PROGNOSTIC-SIGNIFICANCE ; ENDOMETRIAL CANCER ; POSTMENOPAUSAL WOMEN ; cancer registries ; PERIOD ANALYSIS ; EMPIRICAL-EVALUATION ; ENDOGENOUS HORMONES ; UP-TO-DATE ; ESTROGEN-RECEPTOR-ALPHA ; ER-ALPHA ; SOCIETY GUIDELINES ; Population based ; UTERINE SARCOMAS
    Abstract: Background: Population-based studies on endometrial cancer providing survival estimates by age, histology, and stage have been sparse. We aimed to derive most up-to-date and detailed survival estimates for endometrial cancer patients in Germany. Methods: We used a pooled German national dataset including data from 11 cancer registries covering a population of 33 million people. 30,906 patients diagnosed with endometrial cancer in 1997-2006 were included. Period analysis was performed to calculate 5-year relative survival (RS) in 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age-adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Results: Overall, age-adjusted 5-year relative survival in 2002-2006 was 81%. A moderate age gradient was observed, with 5-year RS decreasing from 90% in the age group 15-49 years to 75% in the age group 70+ years. Furthermore prognosis varied strongly by histologic subtypes and stage, with age-adjusted 5-year RS ranging from 43% (for sarcoma) to 94% (for squamous metaplasia), and reaching 91% for localized, 51% for regional, and 20% for distant stage. Except for age group 65-74 years, no significant improvement in survival was seen during the recent 5-year period under investigation. Conclusion: In this comprehensive population-based survival analysis of patients with endometrial cancer from Germany, prognosis of endometrial cancer moderately varied by age, and strongly varied by histology and stage. While prognosis is rather good overall, further improvement in 5-year relative survival of endometrial cancer patients has been stagnating in the early 21st century
    Type of Publication: Journal article published
    PubMed ID: 22459016
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