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Comparison of the effect of non-surgical treatment modalities on sexual functioning and quality of life of patients with carcinoma of the cervix: a pilot study. SEXOLOGIES 2007. [DOI: 10.1016/j.sexol.2006.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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102
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103
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Fosså SD, Johannesen TB, Lehne G. Long-term outcome after adult-onset cancer. Ann Oncol 2006; 17 Suppl 10:x293-8. [PMID: 17018741 DOI: 10.1093/annonc/mdl276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S D Fosså
- Rikshospitalet-Radiumhospitalet, Department of Clinical Cancer Research, Oslo, Norway
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104
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Wutzl A, Eisenmenger G, Hoffmann M, Czerny C, Moser D, Pietschmann P, Ewers R, Baumann A. Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients. Wien Klin Wochenschr 2006; 118:473-8. [PMID: 16957978 DOI: 10.1007/s00508-006-0644-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Accepted: 05/15/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Osteonecrosis of the jaws is described as an intraoral complication after administration of intravenous nitrogen-containing bisphosphonates. In a retrospective study, patients with osteonecrosis of the jaws after bisphosphonate treatment were evaluated with regard to diagnostic investigations and therapeutic management. PATIENTS AND METHODS Seventeen patients with osteonecrosis of the jaws after bisphosphonate treatment who were referred to our department between July 2004 and June 2005 were included in this study. Computer tomography, magnetic resonance imaging, scintigraphy, bacteriology and biopsy were used in diagnostic evaluation. All patients were treated surgically. RESULTS The reasons for bisphosphonate treatment were multiple myeloma in 12 patients, breast cancer with bone metastasis in four patients and histiocytosis X in one patient. Five patients had received intravenous pamidronate and 12 patients zoledronic acid. The median number of treatment cycles for pamidronate was 36 times (range 4-100) in 38 months (range 4-100). Zolendric acid was given 23.5 times (range 5-39) in 26 months (range 5-39). Nine patients had a lesion in the mandible, eight in the maxilla. Clinical symptoms were exposed bone, pain and local inflammation of the mucosa. Computer tomography showed sclerotic areas in the osteonecrosis zone. The biopsy did not show a metastatic lesion. Sequestrectomy and decortication was adequate in the follow-up. CONCLUSION Nitrogen-containing bisphosphonates appear to be associated with the risk of developing osteonecrosis of the jaws. To reduce this risk, patients should be evaluated by a dentist before beginning treatment with intravenous bisphosphonates.
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Affiliation(s)
- Arno Wutzl
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
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105
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Classe JM, Rauch P, Rodier JF, Morice P, Stoeckle E, Lasry S, Houvenaeghel G. Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer). Gynecol Oncol 2006; 102:523-9. [PMID: 16504274 DOI: 10.1016/j.ygyno.2006.01.022] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 01/03/2006] [Accepted: 01/12/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the morbidity and therapeutic value of surgery after concurrent chemoradiotherapy and brachytherapy in a multicentric series of patients with advanced cervical cancer. METHODS Patients with stage IB2 to IVA cervical cancer treated with concurrent chemoradiotherapy and pelvic radiotherapy followed by brachytherapy and surgery from seven participating French comprehensive cancer centers were enrolled. The surgical treatment consisted of a hysterectomy, which ranged from radical hysterectomy to anterior pelvic exenteration, and lymph node resection. Acute toxicity, pathological response, overall, and disease-free survival were assessed for each pathological response to therapy. RESULTS One hundred seventy-five patients were enrolled from September 1987 to June 2002. The median age was 44 years [27;75]. Patients distribution according to clinical classification was as follows: 41 stage IB2, 18 IIA, 77 IIB, 12 IIIA, 14 IIIB, and 13 IVA. Forty-six patients experienced 51 postoperative complications. Thirty-three patients experienced grade 2 morbidity (18.9%, 33/175), among whom 19 experienced urinary complications (57.5%, 19/175). No post treatment mortality was observed. Grade 3 toxicity rate was 6.9% (12/175). Pathological complete response rate was 38% (67/175). After a median follow-up of 36 months, overall survival and disease-free survival were significantly better in patients who had a pathological complete response to therapy than those who achieved a partial pathological response (P < 0.0001). CONCLUSION Surgery after concurrent chemoradiotherapy and brachytherapy for advanced cervical cancer leads to an acceptable morbidity. Furthermore, surgery allows evaluation of the pathological response to therapy and improves local control in the case of partial pathological response.
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Affiliation(s)
- J M Classe
- Department of Oncological Surgery, Centre R. Gauducheau, Site Hôpital nord, Bd. J. Monod, 44805 Saint-Herblain Nantes, France.
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106
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Cetina L, Rivera L, Hinojosa J, Poitevin A, Uribe J, López-Graniel C, Cantú D, Candelaria M, de la Garza J, Dueñas-González A. Routine management of locally advanced cervical cancer with concurrent radiation and cisplatin. Five-year results. BMC WOMENS HEALTH 2006; 6:3. [PMID: 16464243 PMCID: PMC1420274 DOI: 10.1186/1472-6874-6-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 02/07/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Globally, cervical cancer primarily affects socially disadvantaged women. Five randomized trials were the foundation for adopting cisplatin-based chemotherapy during radiation as the standard of care for high-risk patients after primary radical hysterectomy who require adjuvant radiation and for locally advanced patients treated with definitive radiation. These results were obtained in clinical trials performed in carefully prepared academic centers; hence, we sought to determine whether these results could be reproduced when patients were treated on an out-of-protocol basis. METHODS We reviewed the files of 294 patients with locally advanced cervical cancer who received radiation plus weekly cisplatin as routine management between 1999 to 2003, and analyzed treatment compliance, response rate, toxicity, and survival. RESULTS A total of 294 patients who received radiation and cisplatin were analyzed. Mean age was 43.8 years (range, 26-68 years). The majority of cases were squamous cell carcinoma (87.8%), and distribution according to International Federation of Gynecology and Obstetrics (FIGO) stage was as follows: IB2-IIA, 23%; IIB, 53.3%, and IIIB, 23%; there were only two IVA cases. Overall, 96% of patients completed external beam, and intracavitary therapy. The majority of patients (67%) received the planned six courses of weekly cisplatin. Complete responses were achieved in 243 (83%) patients, whereas 51 (17%) had either persistent (32 patients, 10.8%) or progressive (19 patients, 6.4%) disease. At median follow-up (28 months; range, 2-68 months), 36 patients (12.2%) have relapsed (locally 30.5, and systemically, 69.5%). The most common toxicities were hematologic and gastrointestinal, in the majority of cases considered mild-moderate. At median follow-up (28 months; range, 2-68 months), overall and progression-free survival are 76.5 and 67%, respectively. CONCLUSION Our results support use of chemoradiation with six weekly applications of cisplatin at 40 mg/m2 during external radiation for routine management of locally advanced cervical cancer.
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Affiliation(s)
- Lucely Cetina
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Lesbia Rivera
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - José Hinojosa
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - Adela Poitevin
- Division of Radiation Oncology, INCan, Mexico City, Mexico
| | - Jesús Uribe
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - David Cantú
- Division of Surgical Oncology, INCan, Mexico City, Mexico
| | - Myrna Candelaria
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Jaime de la Garza
- Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Alfonso Dueñas-González
- Unit of Biomedical Research on Cancer, Instituto de Investigaciones Biomédicas (IIB), Universidad Nacional Autónoma de México (UNAM)/INCan, Mexico City, México
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107
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Le LP, Le HN, Dmitriev IP, Davydova JG, Gavrikova T, Yamamoto S, Curiel DT, Yamamoto M. Dynamic monitoring of oncolytic adenovirus in vivo by genetic capsid labeling. J Natl Cancer Inst 2006; 98:203-14. [PMID: 16449680 DOI: 10.1093/jnci/djj022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Conditionally replicative adenoviruses represent a promising strategy to address the limited efficacy and safety issues associated with conventional cancer treatment. Despite rapid translation into human clinical trials and demonstrated safety, the fundamental properties of oncolytic adenovirus replication and spread and host-vector interactions in vivo have not been completely evaluated. METHODS We developed a noninvasive dynamic monitoring system to detect adenovirus replication. We constructed capsid-labeled E1/E3-deleted and wild-type adenoviruses (Ad-wt) by fusing the minor capsid protein IX with red fluorescent proteins mRFP1 and tdimer2(12), resulting in Ad-IX-mRFP1, Ad-IX-tdimer2(12), and Ad-wt-IX-mRFP1. Virus DNA replication, encapsidation, cytopathic effect, thermostability, and binding to primary receptor (coxsackie adenovirus receptor) were analyzed using real-time quantitative polymerase chain reaction, cell viability (MTS) assay, and fluorescence microscopy. Athymic mice (n = 4) carrying xenograft tumors that were derived from A549 lung adenocarcinoma cells were intratumorally inoculated with Ad-wt-IX-mRFP1, and adenovirus replication was dynamically monitored with a fluorescence noninvasive imaging system. Correlations between fluorescence signal intensity and viral DNA synthesis and replication were calculated using Pearson's correlation coefficient (r). RESULTS The red fluorescence label had little effect on viral DNA replication, encapsidation, cytopathic effect, thermostability, and coxsackie adenovirus receptor binding. The fluorescent signal correlated with viral DNA synthesis and infectious progeny production both in vitro and in vivo (in A549 cells, r = .99 and r = .65; in tumors, r = .93 and r = .92, respectively). The replication efficiency of Ad-wt-IX-mRFP1 in vivo was variable, and replication and viral spreading and persistence were limited, consistent with clinical observations. CONCLUSIONS Genetic capsid labeling provides a promising approach for the dynamic assessment of oncolytic adenovirus function in vivo.
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Affiliation(s)
- Long P Le
- Division of Human Gene Therapy, Department of Medicine, University of Alabama, Birmingham, AL, USA
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108
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Abstract
In 2005, an estimated 79,480 new cases of gynecologic malignancies will be diagnosed, and almost 29,000 women will die. Treatment of gynecologic malignancies involves a combination of surgery, chemotherapy, and/or radiotherapy, all of which may affect a woman's physical, social, and emotional well-being. Although specific effects on quality of life (QOL) depend on disease site, treatment-, and patient-specific factors, common QOL issues include changes in physical functioning due to side effects of treatment, psychological distress due to fear and anxiety of recurrence, sexual dysfunction associated with anatomic and physiologic changes of treatment, and, for younger women, loss of childbearing potential. As new diagnostic and treatment strategies for gynecologic malignancies are developed, research efforts should include QOL consequences. Further studies are needed to develop strategies for identifying women at risk for serious QOL disruption so that effective interventions to assist these women can be designed.
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Affiliation(s)
- Charlotte C Sun
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, PO Box 301437, Unit 1362, Houston, TX 77230-1439, USA.
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Lenz JH, Steiner-Krammer B, Schmidt W, Fietkau R, Mueller PC, Gundlach KKH. Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates? J Craniomaxillofac Surg 2005; 33:395-403. [PMID: 16253510 DOI: 10.1016/j.jcms.2005.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 07/04/2005] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION In the last decade, bisphosphonates were regularly used to treat osteoporosis and bone pain from diseases such as metastatic breast cancer, multiple myeloma and Paget's disease. Currently, the influence of bisphosphonates in development of avascular osteonecrosis of the jaws has been recognized by various authors. In many cancer patients chemotherapy and medications like steroids have also to be applied. Agreement exists that these drugs can initiate vascular endothelial cell damage and accelerate disturbances in the microcirculation of the jaws possibly resulting in thrombosis of nutrient end arteries. The role of bisphosphonates in cancer patients with previously treated jaws has yet to be elucidated. PATIENTS Four case reports of 'cancer' patients are described in whom osteonecrosis of the jaws was found. In two patients, the nitrogen-containing bisphosphonate zoledronic acid was prescribed for additional therapy of malignancy for a period of 45 up to 70 months. In another case, supportive treatment of breast cancer was offered using ibandronate. The fourth patient suffered avascular necrosis of the mandible without ever having taken bisphosphonates. In any case, revisional, as well as extended surgery has to be performed for osteonecrosis because neither conservative debridement nor antibiotic therapy have shown long term success, with or without bisphosphonates. No withdrawal of bisphosphonates was performed in view of the information on the direct correlation of total dosage and duration of drug intake to systemic incorporation and the long time for drug release. CONCLUSION According to our observations, withdrawal of bisphosphonates is not recommended when necrosis of the jaws has occurred.
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Affiliation(s)
- Jan-Hendrik Lenz
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University, Germany.
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Hougardy BMT, Maduro JH, van der Zee AGJ, Willemse PHB, de Jong S, de Vries EGE. Clinical potential of inhibitors of survival pathways and activators of apoptotic pathways in treatment of cervical cancer: changing the apoptotic balance. Lancet Oncol 2005; 6:589-98. [PMID: 16054570 DOI: 10.1016/s1470-2045(05)70281-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical cancer is the most common gynaecological malignant disorder worldwide. The best possible treatment of locally advanced cervical cancer is a combination of radiation and cisplatin-based chemotherapy. However, 5-year overall survival is still only 52%. To improve treatment results, research should focus on the discovery of innovative drug strategies. Drugs directed at inducing tumour-cell apoptosis are regarded as important treatment modalities. Here, we present an overview of the molecular options that can change the apoptotic balance in cervical cancer, through increasing death-receptor-mediated apoptosis, the use of proteasome inhibitors, short interfering RNAs, or non-steroidal anti-inflammatory drugs (NSAIDs). Furthermore, the potential of attacking prosurvival signalling through the epidermal-growth-factor receptor and insulin-like-growth-factor receptor to support the apoptotic process is discussed. Additional research is needed to elucidate the clinical potential of these compounds in the treatment of cervical cancer.
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Affiliation(s)
- Brigitte M T Hougardy
- Department of Gynaecological Oncology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
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111
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Denschlag D, Gabriel B, Mueller-Lantzsch C, Tempfer C, Henne K, Gitsch G, Hasenburg A. Evaluation of patients after extraperitoneal lymph node dissection for cervical cancer. Gynecol Oncol 2005; 96:658-64. [PMID: 15721408 DOI: 10.1016/j.ygyno.2004.08.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The presence of nodal metastases is an important prognostic factor in patients with cervical cancer. To adjust our therapy to the anatomic extent of the disease, we performed a surgical staging with extraperitoneal lymph node dissection (EPLND). The goal of our study was to evaluate the clinical outcome and side effects of the combined treatment approach of EPLND and either radical hysterectomy in case of early stage cervical cancer (FIGO Ia/b and IIa) and negative nodes, or pelvic radiotherapy/extended field radiotherapy with concomitant chemotherapy in case of positive nodes or advanced stage cervical cancer (FIGO IIb, III, and IVa). PATIENTS AND METHODS Fifty-nine patients with primarily diagnosed invasive cervical cancer underwent EPLND. The value of this procedure as a diagnostic tool for evaluating the extent of disease was determined. Additionally, treatment-related complications and clinical outcomes were monitored. RESULTS A total of 983 lymph nodes were removed during EPLND (mean 16.7). According to the results of EPLND, radical hysterectomy was abandoned due to histopathologically confirmed lymph node involvement by frozen section in 11 out of 36 patients with early stage cervical cancer (31%). The most common adverse effects directly related to surgery in general (EPLND or combined EPLND and radical hysterectomy) were lymph cysts in seven patients (12%). Only in the group of patients who received EPLND followed by radical hysterectomy, 2 out of 25 patients (8%) developed a severe ileus postoperatively (WHO Grade 3 toxicity). The treatment approach of combined EPLND followed by radio- and chemotherapy was without major complications (WHO Grade 3 or 4 toxicity). After a mean follow up of 28 months (range 6-60), 44 out of 58 patients (one patient lost to follow up) are without evidence of disease (76%), 2 patients have progressive disease (3%), and 12 patients died of their disease (21%). Using Kaplan-Meier analysis, the estimated 5-year overall survival rate for all patients is 64% (SD +/- 9%). Performing the Cox proportional regression analysis, in contrast to clinical FIGO staging (P = 0.24; ns), lymph node involvement was the only significant independent predictor for overall survival (P = 0.04). CONCLUSION Our data support the approach of pretherapeutic surgical staging by performing EPLND as a diagnostic tool with a low complication rate. This allows an individualized treatment for cervical cancer patients.
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Affiliation(s)
- D Denschlag
- Department of Obstetrics and Gynecology, University of Freiburg School of Medicine, Hugstetter Strasse 55 D-79106 Freiburg, Germany.
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Datta NR, Pasricha R, Singh U, Srivastava A. Predictors of survival end points in patients with cancer of the cervix on long-term follow-up: inferences and implications from an audit of patients treated with a specific radiotherapy protocol. Clin Oncol (R Coll Radiol) 2004; 16:536-42. [PMID: 15630847 DOI: 10.1016/j.clon.2004.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIMS An audit of patients with cancer of the cervix treated with a specified protocol of external beam radiotherapy (EXRT) followed by intracavitary brachytherapy (ICBT) was carried out to determine the prognosticators for major survival end points. MATERIALS AND METHODS Patients treated between 1991 and 2003 with a uniform protocol of EXRT (50 Gy/25 fractions/5 weeks) followed by high-dose-rate ICBT (18 Gy/3 fractions/3 weeks) were selected from the database. Various clinical and treatment parameters were evaluated for extent of locoregional response at completion of EXRT, namely absence or presence of gross residual tumour (AGRT and PGRT, respectively) and survival end points. These included locoregional disease-free survival (LDFS), disease-free survival (DFS) and overall survival (OS). RESULTS Of the 157 evaluable patients, 145 (92%) belonged to FIGO stages II and III. Eighty-three (53%) at completion of EXRT had AGRT, which was influenced by age and gross tumour features. The estimated 10-year LDFS, DFS and OS were 38.6%, 33.1% and 38.5%, respectively. Factors significant on univariate analysis for these survival end points were EXRT duration, ICBT time, overall treatment time (OTT) and EXRT response. On multivariate analysis, AGRT to EXRT, an OTT of < or = 67 days, and patients older than 50 years were the significant favourable determinants for all the above survival end points. CONCLUSION The audit highlights that younger people, especially those with bulky tumours that determine response to EXRT, are poor prognosticators for survival end points. They could perhaps benefit from treatment intensification regimens using chemoradiotherapy, provided that OTT is not unduly prolonged.
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Affiliation(s)
- N R Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Nord C, Mykletun A, Thorsen L, Bjøro T, Fosså SD. Self‐reported health and use of health care services in long‐term cancer survivors. Int J Cancer 2004; 114:307-16. [PMID: 15543613 DOI: 10.1002/ijc.20713] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Owing to an increasing number of long-term cancer survivors, the use of health care services and somatic health problems were compared between cancer survivors and a noncancer population. Data from the Nord-Trondelag Health Survey 2 (HUNT 2, 1995-1997) was merged with the Cancer Registry of Norway. Six cancer subgroups were constructed with diagnosis 5 years prior HUNT 2: testicular cancer (n= 59), colorectal cancer (n= 175), prostate cancer (n= 87), breast cancer (n= 258), gynaecological cancer (n= 153) and lymphoma/leukaemia (n= 83). For each cancer survivor 3 matched noncancer controls were selected from the HUNT 2 survey. The prevalence of common health problems, use of health care services and unfavourably life style parameters were compared between the 2 groups. Cancer survivors used health care services and received social welfare benefits more often than the controls. There was an increased risk of perceiving poor health after a history of cancer. Common health problems and/or unfavourable life style parameters could not explain poor health or the increased use of health care services among cancer survivors. Further studies are needed to investigate the reasons for increased use of health care services and perceived poor health in cancer survivors.
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Affiliation(s)
- Carina Nord
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway.
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