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  • 1
    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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  • 2
    Keywords: PROSTATE ; DIAGNOSIS ; COHORT ; SURGERY ; HEALTH ; NATIONWIDE ; EUROPEAN-ORGANIZATION ; PERSISTENCE ; EORTC QLQ-C30 ; Mastectomy
    Abstract: Abstract Background. Breast cancer survivors may experience adverse effects of cancer and/or treatment years after completion of therapy, which can considerably decrease quality of life (QoL). Little is known about the time course of QoL in breast cancer survivors beyond the fifth year post-diagnosis, when routine follow-up care has usually terminated. We therefore explored in detail whether and to what extent restrictions in breast cancer survivors persist and whether changes or aggravations in QoL occurred over time. Material and methods. QoL was assessed 1, 3, 5, and 10 years post-diagnosis in a population-based cohort of initially 387 female breast cancer patients from Saarland (Germany), using the EORTC QLQ-C30 and QLQ-BR23. Time course of QoL over 10 years post-diagnosis was assessed for survivors and survivors' QoL was compared cross-sectionally to the German general population after adjustment for age. Results. A total of 182 out of 238 patients alive (76.5%) responded in the 10-year, 160 patients (67.2%) participated in all follow-ups. Although breast cancer survivors and controls reported comparable general health and overall QoL, survivors reported significantly more restrictions on most functioning and symptom scales at each follow-up. Detriments in various QoL dimensions (e.g. physical and social functioning; pain, financial difficulties) aggravated from year 5 to 10. Generally, restrictions were largest for the youngest survivors. Conclusion. Relevant restrictions in QoL persist over years in breast cancer survivors and affect predominantly younger women. The aggravation of restrictions in QoL beyond the fifth year may indicate deficits in health care and psychosocial support of breast cancer patients after completion of routine follow-up care.
    Type of Publication: Journal article published
    PubMed ID: 23514583
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  • 3
    Keywords: SURGERY ; RISK-FACTORS ; HEALTH ; CIGARETTE-SMOKING ; COMPLICATIONS ; LIFE-STYLE FACTORS ; ASSOCIATIONS ; INHIBITS APOPTOSIS ; PUBLICATION BIAS ; POSTOPERATIVE OUTCOMES
    Abstract: Smoking is a risk factor for colorectal cancer (CRC) incidence and mortality. However, little is known on smoking and its association with survival after CRC diagnosis. We conducted a systematic review and meta-analysis to summarize current evidence. A systematic literature search was carried out in MEDLINE and ISI Web of Science. We included studies that analyzed recurrence-free survival, disease-free survival, all-cause, and CRC-specific mortality according to smoking status. Data were extracted in duplicate. Standard methods of meta-analysis were applied. Sixteen studies from 11 countries were identified, comprising a total sample size of 62 278 CRC patients. Overall, in the 16 included studies, current smoking and, to a lesser extent, former smoking were rather consistently associated with a poorer prognosis compared with never smokers. Meta-analyses yielded random-effects hazard ratio estimates (95% confidence intervals) for all-cause mortality of 1.26 (1.15-1.37) and 1.11 (0.93-1.33) for current and former smokers, compared with never smokers, respectively. In particular, 30-day mortality was found to be increased by between 49% and 100% among current compared with never smokers. Our results support the existence of detrimental effects of smoking on survival also after CRC diagnosis. Perspectives for enhancing prognosis of CRC patients by smoking abstinence deserve increased attention in further research and clinical practice.
    Type of Publication: Journal article published
    PubMed ID: 24692581
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  • 4
    Keywords: MORTALITY ; SURGERY ; RISK-FACTORS ; HEALTH ; CIGARETTE-SMOKING ; COLON-CANCER ; LIFE-STYLE ; METAANALYSIS ; CHEMOTHERAPEUTIC DRUGS ; INHIBITS APOPTOSIS
    Abstract: Current evidence on the association between smoking and colorectal cancer (CRC) prognosis after diagnosis is heterogeneous and few have investigated dose-response effects or outcomes other than overall survival. Therefore, the association of smoking status and intensity with several prognostic outcomes was evaluated in a large population-based cohort of CRC patients; 3,130 patients with incident CRC, diagnosed between 2003 and 2010, were interviewed on sociodemographic factors, smoking behavior, medication and comorbidities. Tumor characteristics were collected from medical records. Vital status, recurrence and cause of death were documented for a median follow-up time of 4.9 years. Using Cox proportional hazards regression, associations between smoking characteristics and overall, CRC-specific, non-CRC related, recurrence-free and disease-free survival were evaluated. Among stage I-III patients, being a smoker at diagnosis and smoking 15 cigarettes/day were associated with lower recurrence-free (adjusted hazard ratios (aHR): 1.29; 95% confidence interval (CI): 0.93-1.79 and aHR: 1.31; 95%-CI: 0.92-1.87) and disease-free survival (aHR: 1.26; 95%-CI: 0.95-1.67 and aHR: 1.29; 95%-CI: 0.94-1.77). Smoking was associated with decreased survival in stage I-III smokers with pack years 20 (Overall survival: aHR: 1.40; 95%-CI: 1.01-1.95), in colon cancer cases (Overall survival: aHR: 1.51; 95%-CI: 1.05-2.17) and men (Recurrence-free survival: aHR: 1.51; 95%-CI: 1.09-2.10; disease-free survival: aHR: 1.49; 95%-CI: 1.12-1.97), whereas no associations were seen among women, stage IV or rectal cancer patients. The observed patterns support the existence of adverse effects of smoking on CRC prognosis among nonmetastatic CRC patients. The potential to enhance prognosis of CRC patients by promotion of smoking cessation, embedded in tertiary prevention programs warrants careful evaluation in future investigations. What's new? Smoking is an established risk factor for a variety of cancers, including colorectal cancer, but evidence regarding its impact on the prognosis of colorectal cancer patients remains sparse. In this population-based study of 3,130 colorectal cancer patients, smoking was associated with reduced survival among patients with nonmetastatic colon cancer. The analyses suggested that the association may be more pronounced in men than women. Future studies should take into account relationships between smoking and other lifestyle factors and should explore the potential role of using the teachable moment of cancer diagnosis in the promotion of smoking cessation.
    Type of Publication: Journal article published
    PubMed ID: 25758762
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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: 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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  • 7
    Keywords: POPULATION ; ASSOCIATION ; HEALTH ; CIGARETTE-SMOKING ; microsatellite instability ; colonoscopy ; pooled analysis ; AVERAGE-RISK ; SERVICES TASK-FORCE ; FATTY-ACID SYNTHASE
    Abstract: Background: Lower gastrointestinal endoscopy can decrease colorectal cancer risk strongly through detection and removal of adenomas. Thus, we aimed to investigate whether utilization of lower gastrointestinal endoscopy modifies the effect of lifetime smoking exposure on colorectal cancer risk in a population-based case-control study. Methods: In this study from Southern Germany including 2,916 patients with colorectal cancer and 3,044 controls, information about lifetime smoking and other risk factors was obtained from standardized interviews. Self-reported endoscopies were validated by medical records. Multivariate logistic regression was performed to investigate associations of smoking with colorectal cancer risk after stratification by utilization of lower gastrointestinal endoscopy in the preceding 10 years. Results: Median age of patients and controls was 69 and 70 years, respectively. Former regular smoking was associated with increased colorectal cancer risk in the group with no previous endoscopy [adjusted OR, 1.50; 95% confidence interval (CI), 1.28-1.75], whereas no association was found in the group with preceding endoscopy (OR, 1.05; CI, 0.83-1.33; P for interaction 〈0.01). Lower gastrointestinal endoscopy did not modify the association of smoking and colorectal cancer risk among current smokers and among the more recent quitters. Conclusions: Our results suggest that the increased risk of colorectal cancer among former regular smokers is essentially overcome by detection and removal of adenomas at lower gastrointestinal endoscopy. However, risk of colorectal cancer was increased if smoking was continued into higher adult age. Impact: The strong protective effect of lower gastrointestinal endoscopy may be compromised by continued smoking. Smoking cessation may increase the efficacy of lower gastrointestinal endoscopy.
    Type of Publication: Journal article published
    PubMed ID: 24403529
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