Partner status and survival after cancer: A competing risks analysis

Social Characteristics and Adherence to Adjuvant Endocrine Therapy in Premenopausal Women With Breast Cancer

PURPOSESocial characteristics, including cohabitation/marital status and socioeconomic position (SEP)-education level, employment status, and income-influence breast cancer prognosis. We investigated the impact of these social characteristics on adherence to adjuvant endocrine therapy (AET) from treatment initiation to 5 years after diagnosis.METHODSWe assembled a nationwide, population-based cohort of premenopausal women diagnosed in Denmark with stage I-III, estrogen receptor-positive breast cancer during 2002-2011. We ascertained prediagnostic social characteristics from national registries. AET adherence was based on information from the Danish Breast Cancer Group and operationalized as (1) adherence trajectories (from group-based trajectory modeling) and (2) early discontinuation. We computed odds ratios (ORs) and associated 95% CI to estimate the association of cohabitation and SEP with AET adherence using multinomial and logistic regression models adjusted according to directed acyclic graphs.RESULTSAmong 4,353 patients, we identified three adherence trajectories-high adherence (57%), slow decline (36%), and rapid decline (6.9%). Compared with cohabiting women, those living alone had higher ORs of slow (1.26 [95% CI, 1.08 to 1.46]) or rapid decline (1.66 [95% CI, 1.27 to 2.18]) versus high adherence. The corresponding ORs for women not working versus employed women were 1.22 (95% CI, 1.02 to 1.45) and 1.76 (95% CI, 1.30 to 2.38). For early discontinuation (17%), the ORs were 1.48 (95% CI, 1.23 to 1.78) for living alone and 1.44 (95% CI, 1.17 to 1.78) for women not working.CONCLUSIONAdherence to AET was lower among women living alone or unemployed than cohabiting or employed women, respectively. These women may benefit from support programs to enhance AET adherence.

[Partnership and family aspects of cancer]

Cancer is not only a challenge for the patient, but can also be associated with psychosocial distress for relatives, especially partners and minor children. Although studies on the long-term effects of cancer on partners, the partnership, and child development are still rare, there are indications that the psychological distress on relatives may become chronic, and that parental illness is a risk factor for a child to develop mental disorders. In addition, a deterioration in partnership satisfaction also increases the risk of separation.Psycho-oncology care should therefore not only consider the patient's psychosocial burden but also that of the partner, as well as its effect on the partnership. Appropriate offers, for example to increase partnership and sexual satisfaction, communication, or dyadic coping, should be made. Children should also be treated as relatives in care. Focusing on both the child's distress and on improving the parent-child relationships and parenting behavior can help children to cope with parental illness in the long term. Thus, cancer should be viewed on the individual, dyadic, and family level, and psychosocial care services should be provided at all levels.

Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

BACKGROUND

To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality.

METHODS

We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction.

RESULTS

Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results.

CONCLUSIONS

Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.

Cancer and Relationship Dissolution: Perspective of Partners of Cancer Patients

Purpose

Cancer can be a burden on the relationship and even lead to relationship dissolution. Previous studies about the impact of cancer on close relationships almost exclusively involve cancer patients. So far, little is known about the views of spouses. Therefore, this study focuses on partners or ex-partners of cancer patients.

Methods

In this cross-sectional study, N = 265 partners or ex-partners of cancer patients are examined regarding a possible separation, the reasons for separation and the influence of the cancer on the relationship. In addition, predictors of separation and the positive or negative perception of the impact of cancer on the relationship were investigated.

Results

The separation rate (23.4%) was marginally lower than in the general population in Germany (35.79%). The most frequent reason for separation was the death of the cancer patient (59.6%), followed by relationship problems (26.9%), and the cancer disease itself (9.6%). Among those who were separated, 57.4% reported that cancer contributed to the separation. On average, the influence of cancer on relationship dissolution is indicated with 82.9%. Also, for those who stayed together, 83.7% reported an impact of the cancer on the relationship, of which 55.9% reported a negative impact. Logistic regressions indicated that higher levels of depression were associated with greater odds of a more negative perception of the influence of cancer on the relationship, whereas a more satisfied relationship tended to be associated with a more positive perception. Those who had no psychological treatment in the past, lower anxiety levels and lower relationship satisfaction had an increased risk of separation. Overall, relationship satisfaction was significantly lower than in the general population in Germany.

Conclusion

In particular, psychological factors such as depression and anxiety as well as relationship satisfaction appear to be factors influencing separation and the perception of the influence of cancer on the relationship as positive or negative. Therefore, it seems to be reasonable to consider these aspects in the psychosocial support and also to include the partners in order to achieve a stable and satisfied relationship which has a positive effect on health and psychological well-being.

Occupational Class and Cancer Survival in Korean Men: Follow-Up Study of Nation-Wide Working Population

Background: We aimed to describe inequalities in site-specific cancer survival across different occupational classes in Korean men. Methods: Subjects included cancer diagnosed members of the national employment insurance program during 1995-2008. A total of 134,384 male cases were followed by linking their data to the Death registry until 2009. Occupational classes were categorized according to the Korean Standard Occupational Classification (KSOC). Hazard ratio adjusting age and diagnosed year were calculated for each occupation by cancer sites. Results: Men in service/sales and blue-collar occupations had lower survival of all cancer sites combined and esophagus, stomach, colorectal, liver, larynx, lung, prostate, thyroid cancer and non-Hodgkin's lymphoma than men in professional and managerial positions. Cancer sites with good prognosis like prostate cancer showed wider gap across occupational class. Conclusions: Considerable inequalities in cancer survival were found by occupation among Korean men. Cancer control policy should more focus on lower socioeconomic occupational class.

Social connectedness and mortality after prostate cancer diagnosis: A prospective cohort study

Men with prostate cancer experience side effects for which a supportive social environment may be beneficial. We examined the association between four measures of social connectedness and mortality after a prostate cancer diagnosis. Male participants in the Melbourne Collaborative Cohort Study in 1990-1994, who developed incident prostate cancer and attended follow-up in 2003-2007, were eligible for the study. Information on social connectedness, collected at follow-up, included (i) living arrangement; (ii) frequency of visits to friends/relatives and (iii) from friends/relatives; (iv) weekly hours of social activities. A total of 1,421 prostate cancer cases was observed (338 all-cause deaths, 113 from prostate cancer), including 867 after follow-up (150 all-cause deaths, 55 from prostate cancer) and 554 before follow-up (188 all-cause deaths, 58 from prostate cancer). Cox models stratified by tumour Gleason score and stage, and sequentially adjusted for socioeconomic, health- and lifestyle-related confounders, were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between social connectedness and all-cause mortality after prostate cancer. Men who reported living alone before diagnosis had higher overall mortality (HR = 1.6, 95% CI: 1.0-2.5), after adjustment for socioeconomic, health and lifestyle confounders. Lower mortality was observed for men with more social activities (p-trend = 0.07), but not in comprehensively adjusted models. Consistent with these findings, men living alone after prostate cancer diagnosis had higher mortality (HR = 1.3, 95% CI: 0.9-1.9). Lower mortality was observed with increasing socializing hours in the age-adjusted model (p-trend = 0.06) but not after more comprehensive adjustment. Our findings suggest that living with someone, but not other aspects of social connectedness, may be associated with decreased mortality for men with prostate cancer.

Temporal trends in net and crude probability of death from cancer and other causes in the Australian population, 1984-2013

BACKGROUND

While net probabilities of death in the relative survival framework ignore competing causes of death, crude probabilities allow estimation of the real risk of cancer deaths. This study quantifies temporal trends in net and crude probabilities of death.

METHODS

Australian population-based cohort of 2,015,903 people aged 15-89 years, diagnosed with a single primary invasive cancer from 1984 to 2013 with mortality follow-up to 31 December 2014. Survival was analyzed with the cohort method. Flexible parametric relative survival models were used to estimate both probability measures by diagnosis year for all cancers and selected leading sites.

RESULTS

For each site, excess mortality rates reduced over time, especially for prostate cancer. While both the 10-year net and crude probability of cancer deaths decreased over time, specific patterns varied. For example, the crude probability of lung cancer deaths for males aged 50 years decreased from 0.90 (1984) to 0.79 (2013); whereas the corresponding probabilities for kidney cancer were 0.64 and 0.18 respectively. Patterns for crude probabilities of competing deaths were relatively constant. Although for younger patients, both net and crude measures were similar, crude probability of competing deaths increased with age, hence for older ages net and crude measures were different except for lung and pancreas cancers.

CONCLUSIONS

The observed reductions in probabilities of death over three decades for Australian cancer patients are encouraging. However, this study also highlights the ongoing mortality burden following a cancer diagnosis, and the need for continuing efforts to improve cancer prevention, diagnosis and treatment.