1
|
Halgren Olsen M, Maltesen T, Lassen P, Kjaer TK, Johansen J, Primdahl H, Andersen E, Kristensen CA, Andersen M, Farhadi M, Overgaard J, Dalton SO. Socioeconomic position and the pre-diagnostic interval among patients diagnosed with head and neck squamous cell carcinoma - a population-based study from DAHANCA. Acta Oncol 2023; 62:1394-1402. [PMID: 37672036 DOI: 10.1080/0284186x.2023.2254478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The socioeconomic differences in survival are pronounced for patients diagnosed with head and neck cancer; disease stage at diagnosis is suggested to be a main driver of this association. This nationwide, population-based study investigates socioeconomic differences in the pre-diagnostic interval and disease stage at diagnosis. MATERIAL AND METHODS Information on patient-reported symptoms, symptom onset and disease-specific factors was obtained from the nationwide population-based Danish Head and Neck Cancer Group (DAHANCA) database for patients diagnosed with head and neck squamous cell carcinoma between 2008 and 2019 in Denmark. Socioeconomic position (SEP) was measured by individual-level education, income and cohabitation status obtained from administrative registers. Socioeconomic differences in the interval from symptom onset to diagnosis were investigated in general linear models with 95% confidence intervals (CIs); overall and by subsite, symptom and comorbidity score. Consultation patterns prior to diagnosis were examined using methods for change-point detection. Associations with advanced-stage disease were estimated in logistic regression models. RESULTS Patients with low, medium and high SEP had a similar interval from patient-reported symptom onset to diagnosis of 10 weeks. Although this interval varied according to primary symptom and anatomical subsite, no apparent socioeconomic differences were observed within these subgroups. Aligned with the patient-reported symptom onset, a distinct increase in consultation rates was observed at 9 weeks (95% CI [7.3; 10.7]) for patients with low SEP and 7 weeks (95% CI [4.8; 9.2]) for patients with high SEP, with overlapping CIs. Patients with low compared to high SEP had increased odds for advanced-stage glottic and oral cavity squamous cell carcinoma. For the remaining subsites the association varied according to SEP-indicator and TNM-edition. CONCLUSION The interval from symptom onset to diagnosis and consultation patterns were similar across SEP groups. Still, socioeconomic differences in stage at diagnosis were observed for some - but not all - subsites.
Collapse
Affiliation(s)
- Maja Halgren Olsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Elo Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev, Herlev, Denmark
| | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mohammad Farhadi
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| |
Collapse
|
2
|
Hultstrand C, Hörnsten C, Lilja M, Coe A, Fjällström P, Hajdarevic S. The association between sociodemographic factors and time to diagnosis for colorectal cancer in northern Sweden. Eur J Cancer Care (Engl) 2022; 31:e13687. [PMID: 35970596 PMCID: PMC9787547 DOI: 10.1111/ecc.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.
Collapse
Affiliation(s)
- Cecilia Hultstrand
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and DevelopmentÖstersund Hospital, Umeå UniversityUmeåSweden
| | | | | | - Senada Hajdarevic
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| |
Collapse
|
3
|
Salz T, Zabor EC, Brown PDN, Dalton SO, Raghunathan NJ, Matasar MJ, Steingart R, Hjalgrim H, Specht L, Vickers AJ, Oeffinger KC, Johansen C. Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors. Acta Oncol 2022; 61:1064-1068. [PMID: 36256902 PMCID: PMC9888465 DOI: 10.1080/0284186x.2022.2107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors. OBJECTIVE To evaluate how preexisting cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs. MATERIAL AND METHODS Using Danish registries, we identified adults diagnosed with lymphoma 2000-2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between preexisting CVRFs and receipt of mediastinal radiation on subsequent MI. RESULTS Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR = 1.96; 95% CI = 1.09-3.52), and presence of ≥1 CVRF (HR = 2.71; 95% CI = 1.77-4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p = 0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation. CONCLUSION Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of preexisting cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.
Collapse
Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Nirupa J Raghunathan
- Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Lymphoma Survivorship Clinic, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christoffer Johansen
- CASTLE - Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Copenhagen, Denmark
| |
Collapse
|
4
|
Zhang H, Fu Y, Chen M, Si L. Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:942911. [PMID: 35983352 PMCID: PMC9379281 DOI: 10.3389/fpubh.2022.942911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer is a major public health problem worldwide and the leading cause of death in China, with increasing incidence and mortality rates. This study sought to assess socioeconomic-related inequalities in health care use among cancer patients in China and to analyze factors associated with this disparity.MethodsThis study used data collected for the China Health and Retirement Longitudinal Study in 2018. Patients who reported having cancer were included. The annual per capita household expenditure was classified into five groups by the quintile method. We calculated the distribution of actual, need-predicted, and need-standardized health care use across different socioeconomic groups among patients with cancer. The concentration index (CI) was used to evaluate inequalities in health care use. Influencing factors of inequalities were measured with the decomposition method.ResultsA total of 392 people diagnosed with cancer were included in this study. The proportion of cancer patients who utilized outpatient and inpatient services was 23.47% and 40.82%, respectively, and the CIs for actual outpatient and inpatient service use were 0.1419 and 0.1960. The standardized CIs (CI for outpatient visits = 0.1549; CI for inpatient services = 0.1802) were also both positive, indicating that affluent cancer patients used more health services. The annual per capita household expenditure was the greatest factor favoring the better-off, which contributed as much as 78.99% and 83.92% to the inequality in outpatient and inpatient services use, followed by high school education (26.49% for outpatient services) and living in a rural village (34.53% for inpatient services). Urban Employee Basic Medical Insurance exacerbated the inequality in inpatient services (21.97%) while having a negative impact on outpatient visits (−22.19%).ConclusionsThere is a pro-rich inequality in outpatient and inpatient services use among cancer patients in China. A lower socioeconomic status is negatively associated with cancer care use. Hence, more targeted financial protection for poor people would relieve cancer patients of the burden caused by the high cost of cancer care.
Collapse
Affiliation(s)
- Huiru Zhang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Mingsheng Chen
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, NSW, Australia
| |
Collapse
|
5
|
Mensah KB, Mensah ABB, Bangalee V, Oosthuizen F. Awareness is the first step: What Ghanaian community pharmacists know about cancer. J Oncol Pharm Pract 2020; 27:1333-1342. [PMID: 32915683 DOI: 10.1177/1078155220955211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goal of this study was to access the knowledge of a representative sample of community pharmacists in Ghana on general cancer, risk factors, signs and symptom and most common cancer counseling points known to community pharmacists. METHODS A structured online questionnaire was administered to 435 registered community pharmacists in the sixteen regions of Ghana.Key findings: Mean score for knowledge of cancer among community pharmacists was 6.8 ± 1.61 points out of a maximum score of 15 points, categorizing the overall knowledge as inadequate. The overall assessment of pharmacists' knowledge revealed that 74.6% of the participants had inadequate level of knowledge on cancer. Mean score for knowledge of cancer signs and symptoms among community pharmacists was 3.55 ± 1.85 out of a maximum score of 7 points, categorizing the overall knowledge as inadequate. The overall evaluation indicated that 79.03% of pharmacists had inadequate knowledge of signs and symptoms cancer. Mean score for knowledge of risk factors of cancer among community pharmacists was 5.25 ± 1.15 out of a maximum score of 12 points, categorizing the overall knowledge as inadequate. The overall assessment of the knowledge score indicates that 70.34% of pharmacists had inadequate knowledge about causes and risk factors of cancer. Almost all participating pharmacists (96.5%) recommended counselling point was avoidance of smoking as a cancer preventive measure. An inverse significant correlation was found between age and knowledge scores of signs and symptoms of cancer (r = -0.077, P = 0.038). There was a statistically significant relationship between pharmacists' level of knowledge on cancer (whether adequate or inadequate) and the cancer items. CONCLUSIONS Knowledge of cancer, its signs and symptoms and its risk factors were inadequate among community pharmacists in Ghana. Efforts should be made to improve knowledge of community pharmacists on cancer through continuous education. Also, undergraduate pharmacy training in oncology should encourage to close knowledge gap of community pharmacists on cancer.
Collapse
Affiliation(s)
- Kofi B Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
6
|
Social Inequality by Income in Short- and Long-Term Cause-Specific Mortality after Stroke. J Stroke Cerebrovasc Dis 2019; 28:1529-1536. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/18/2019] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
|
7
|
Hajdú SF, Christensen MB, Kristensen MØ, Wessel I, Johansen C, Dalton S. Adherence to preventive swallowing exercises for head and neck cancer patients undergoing (chemo)radiotherapy treatment. Acta Oncol 2019; 58:658-664. [PMID: 30698049 DOI: 10.1080/0284186x.2018.1563715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: In recent years, preventive swallowing exercises have been investigated as a means to limit dysphagia in head and neck cancer patients. However, adherence to exercise regimes has been poorly documented limiting the conclusions drawn on the effects of the interventions. We investigated adherence to a preventive swallowing exercise program and identified possible associations between adherence and four selected baseline factors: HPV status, partner status, concomitant chemotherapy and tumor site and between adherence to swallowing exercises and attendance to supervised training sessions. Material and methods: Forming part of an ongoing RCT (clinicaltrials.gov NCT02385929) adherence to intervention was based on participant provided training-logs. The exercise program consisted of 3 weekly supervised sessions of 30 min each and a home-based exercise program to be performed three times daily. Adherence was calculated as percentage of prescribed exercises completed and dichotomously as high (≥80%∼median) and low (<80%∼median) adherence. Associations between adherence and clinical/demographic factors (HPV, partner status, chemotherapy, tumor site or attendance level) were explored by logistic regression analyses. Results: Full adherence data were available from 45 (76%) participants. The total cohort median adherence to exercises was 78%. No association was found between any of the tested factors and adherence. Discussion: The study found a high adherence to preventive swallowing exercises in HNC patients undergoing (chemo)radiotherapy, both in home-based exercises and in supervised sessions, when compared to other studies, although median adherence to home-based exercises was below the defined 80% threshold. We acknowledge, that adherence in an RCT may be higher than in the everyday clinical situation due to surveillance bias. However, we find it reassuring that HNC patients comply with a preventive swallowing program, which requires some time investment from the patients.
Collapse
Affiliation(s)
- Sara Fredslund Hajdú
- Department of Occupational Therapy & Physiotherapy, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Malene Bæk Christensen
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy & Physiotherapy, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Centre for Cancer and Health, Copenhagen, Denmark
| | | | - Irene Wessel
- Department of Otorhinolaryngology Head and Neck Surgery & Audiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, University Hospital of Copenhagen, Rigshospitalet Copenhagen, Denmark
- Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Dalton
- Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| |
Collapse
|
8
|
Wright JM, Hodges TR, Wright CH, Gittleman H, Zhou X, Duncan K, Kruchko C, Sloan A, Barnholtz-Sloan JS. Racial/ethnic differences in survival for patients with gliosarcoma: an analysis of the National cancer database. J Neurooncol 2019; 143:349-357. [PMID: 30989622 DOI: 10.1007/s11060-019-03170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/09/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Gliosarcoma is characterized by the World Health Organization as a Grade IV malignant neoplasm and a variant of glioblastoma. The association of race and ethnicity with survival has been established for numerous CNS malignancies, however, no epidemiological studies have reported these findings for patients with gliosarcoma. The aim of this study was to examine differences by race and ethnicity in overall survival, 30-day mortality, 90-day mortality, and 30-day readmission. METHODS Data were obtained by query of the National Cancer Database (NCDB) for years 2004-2014. Patients with gliosarcoma were identified by International Classification of Diseases for Oncology, Third Edition (ICD-O-3)-Oncology morphologic code 9442/3 and topographical codes C71.0-C71.9. Differences in survival by race/ethnicity were examined using univariable and multivariable Cox proportional hazards models. Readmission and mortality outcomes were examined with univariable and multivariable logistic regression. RESULTS A total of 1988 patients diagnosed with gliosarcoma were identified (White Non-Hispanic n = 1,682, Black Non-Hispanic n = 165, Asian n = 40, Hispanic n = 101). There were no differences in overall survival, 30- and 90-day mortality, or 30-day readmission between the races and ethnicities examined. Median survival was 10.4 months for White Non-Hispanics (95% CI 9.8, 11.2), 10.2 months for Black Non-Hispanics (95% CI 8.6, 13.1), 9.0 months for Asian Non-Hispanics (95% CI 5.1, 18.2), and 10.6 months for Hispanics (95% CI 8.3,16.2). 7.3% of all patients examined had an unplanned readmission within 30 days. CONCLUSION Race/ethnicity are not associated with differences in overall survival, 30-day mortality, 90-day mortality, or 30-day readmission following surgical intervention for gliosarcoma.
Collapse
Affiliation(s)
- James M Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Tiffany R Hodges
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Seidman Cancer Center & Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Christina Huang Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Haley Gittleman
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Xiaofei Zhou
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Kelsey Duncan
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Andrew Sloan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
- Seidman Cancer Center & Case Comprehensive Cancer Center, Cleveland, OH, USA.
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA.
- Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, 11100 Euclid Ave, Wearn 152, Cleveland, OH, 44106-5065, USA.
| |
Collapse
|
9
|
Andersen KK, Olsen TS. Stroke case-fatality and marital status. Acta Neurol Scand 2018; 138:377-383. [PMID: 29920647 DOI: 10.1111/ane.12975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Most studies show that marriage conveys a survival advantage. Whether this is valid also for stroke patients is unclear. Results of studies have been inconsistent and conflicting. MATERIAL & METHODS We studied 1-week and 1-month stroke case-fatality in relation to marital status (married, unmarried, divorced, and widowed) in all patients admitted to hospital for incident stroke in Denmark during 2003-2012. We used information from Danish registries on stroke merged to information on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, cardiovascular risk profile, and causes of death. We studied deaths due to the index stroke within the first week and month after stroke. Multivariate Cox regression models were applied to estimate cause-specific hazards and relative risks. RESULTS We included 60507 patients with an incident stroke of which 51.19% were married, 9.47% were unmarried, 13.29% were divorced, and 26.05% were widowers. Death within the first week and first month was caused by stroke in 2110 (3.5%) and 3423 (5.7%) patients, respectively. Compared to married stroke patients, 1-week/1-month case-fatality (by stroke) was lower for the unmarried (HR (hazard ratio):0.69/0.74), divorced (HR:0.69/0.72), and widowed (HR:0.80/0.74) men and the unmarried (HR:0.84/0.86), divorced (HR:0.82/0.80), and widowed (HR:0.87/0.88) women with stroke. CONCLUSIONS One-week and one-month case-fatality by stroke was lower among the unmarried, divorced, and widowed than among the married stroke patients. Selection by so-called mortality displacement linked to shorter life expectancy among divorced, widowed, and singles may explain our findings.
Collapse
Affiliation(s)
- K. K. Andersen
- Statistics and Pharmacoepidemiology; Danish Cancer Society Research Center; Copenhagen Denmark
| | - T. S. Olsen
- Dept. of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
| |
Collapse
|
10
|
Joergensen AC, Kjaer Urhoj S, Nybo Andersen AM. Primary school achievement and socioeconomic attainment in individuals affected by parental cancer in childhood or adolescence: a Danish nationwide register-based study. J Epidemiol Community Health 2018; 72:982-989. [PMID: 30126977 DOI: 10.1136/jech-2018-210472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/14/2018] [Accepted: 06/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children who experience parental cancer are at increased risk of developing emotional, social, cognitive and behavioural problems. Our aim was to investigate how experience of parental cancer in childhood or adolescence is associated with primary school achievement, educational attainment and income in early adult life. METHODS This is a register-linkage, prospective study of children born in Denmark from 1978 through 1999 and their parents. Parental cancer experience before the ages of 15 and 18 was identified in the Danish National Patient Registry. Final grade point average (GPA) in ninth grade, educational attainment and disposable personal income at the age of 30 were identified in Statistics Denmark registers. General linear models and multinomial logistic regression were used to estimate beta estimates of GPA, and relative risk ratios (RRR) for lower educational and income levels compared with children without parental cancer, taking parental educational status into account. RESULTS Children who had experienced parental cancer achieved a slightly lower final GPA in ninth grade and had a higher risk of low educational attainment (RRR: 1.20; 95% CI 1.14 to 1.25) and attenuated income at the age of 30 (RRR: 1.11; 95% CI 1.06 to 1.16). For all outcomes, analyses suggested substantial deterioration in achievements in subgroups of children whose parent had a severe cancer type (RRRLow education: 1.52; 95% CI 1.39 to 1.66) or if the parent died of cancer (RRRLow education: 1.61; 95% CI 1.49 to 1.75). CONCLUSION Educational and socioeconomic attainments in early adulthood were affected negatively in individuals who had experienced parental cancer as children or adolescents. The associations appeared stronger the more severe the cancer was.
Collapse
Affiliation(s)
- Anne Cathrine Joergensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Stine Kjaer Urhoj
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Andersen KK, Olsen TS. Married, unmarried, divorced, and widowed and the risk of stroke. Acta Neurol Scand 2018; 138:41-46. [PMID: 29492956 DOI: 10.1111/ane.12914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Most studies report that marriage carries a lower risk of stroke than single living. Whether the marriage advantage is applicable with respect to all other marital status categories (unmarried, divorced, widow) remains unclear. We studied marital status and its association with incident stroke. MATERIAL AND METHODS We included all patients > 40 years of age admitted to hospital for stroke in Denmark during 2003-2012 and compared marital status to the general Danish population (5.5 millions). Relative risks (RR) for stroke were estimated in log-linear Poisson regression models adjusting for age, sex, calendar year, income, and length of education. RESULTS A total of 58 847 patients with incident stroke were included. Crude incidence rates of stroke (per 1000 per year) among the four marital status categories were as follows: 1.96 (married), 1.52 (unmarried), 2.36 (divorced), and 5.43 (widowed). Compared to married persons, adjusted risk of stroke was significantly increased for divorced (RR 1.23; CI 1.19-1.27) and unmarried men (RR 1.07; CI 1.03-1.11) but not for widowed men (RR 1.02; CI 0.98-1.06); risk was slightly increased for divorced women (RR 1.10; CI 1.06-1.15) while not for widowed (RR 1.0; CI 0.97-1.03) and unmarried women (RR 0.97; CI 0.97-1.03). CONCLUSIONS Divorce was associated with higher risk of stroke, especially in men. Living in marriage or as unmarried or widower had only little or no impact on the risk of stroke.
Collapse
Affiliation(s)
- K. K. Andersen
- Danish Cancer Society Research Center; Copenhagen Denmark
| | - T. S. Olsen
- Department of Neurology; Bispebjerg University Hospital; Copenhagen Denmark
| |
Collapse
|
12
|
Andersen KK, Olsen TS. Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers. Stroke 2018; 49:1585-1592. [PMID: 29866752 DOI: 10.1161/strokeaha.118.021373] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Manifest cancer is associated with increased risk of stroke. The risk of stroke in people with occult cancer in comparison to the risk in the background population without cancer has not been investigated. Smoking is a risk factor for both cancer and stroke, but the role of smoking for the risk of stroke in cancer has not been investigated. METHODS We identified all incident cases of cancer in Denmark 2003 to 2012 (n=264.376) from the Danish Cancer Registry. Each person with cancer was matched by age, sex, and income with 10 randomly selected persons without cancer at index date (n=2.571.260). Linking data to the Danish Stroke Registry, we studied risk of ischemic/hemorrhagic stroke the year before (occult cancer) and after cancer diagnosis was established in the Danish Stroke Registry (manifest cancer) and stratified into the 15 most common cancer types related (lung, colon, bladder, rectum, pancreas, kidney, stomach, and head and neck cancer) and unrelated (non-Hodgkin lymphoma, breast, prostate, melanoma, central nervous system, ovary and endometrial) to smoking. RESULTS Risk of ischemic/hemorrhagic stroke was increased for both occult (relative risk, 1.75/2.00) and manifest cancers (relative risk, 1.30/1.41). For occult cancer, risk of ischemic stroke was increased for all of the smoking-related cancers, but among cancers unrelated to smoking, only lymphoma, central nervous system, and endometrial cancer were associated with increased risk of stroke; breast, prostate, melanoma, and ovarian cancers were not. For occult cancer, risk of hemorrhagic stroke was generally increased for smoking-related cancers while not for cancers unrelated to smoking. For manifest cancer, risk of ischemic and hemorrhagic stroke was generally increased for cancers related to smoking while not for cancers unrelated to smoking. CONCLUSIONS Cancer, occult and manifest, is associated with increased risks for stroke. The increased risk is linked mainly to cancers related to smoking.
Collapse
Affiliation(s)
- Klaus Kaae Andersen
- From the Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A.)
| | - Tom Skyhøj Olsen
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark (T.S.O.).
| |
Collapse
|
13
|
Erdmann F, Winther JF, Dalton SO, Zeeb H, Krøyer A, Bautz A, Schmiegelow K, Schüz J. Survival from tumours of the central nervous system in Danish children: Is survival related to family circumstances? Int J Cancer 2018; 142:671-680. [PMID: 28971474 DOI: 10.1002/ijc.31082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/07/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022]
Abstract
Little is known about social inequalities in childhood cancer survival. We investigated the impact of family circumstances on survival from paediatric central nervous system (CNS) tumours in a nationwide, register-based cohort of Danish children. All children born between 1973 and 2006 and diagnosed with a CNS tumour before the age of 20 years (N = 1,261) were followed until 10 years from diagnosis. Using Cox proportional hazards models, the impact of various family characteristics on overall survival was estimated. Hazard ratios (HRs) for all CNS tumours combined did not show strong associations between survival and any family characteristic. Analyses by CNS tumour subtypes showed reduced survival for children with glioma when living outside of Copenhagen (HR 1.55; CI 1.03; 2.35). For embryonal CNS tumours, the number of full siblings was associated with worse survival (HR for having 3+ siblings 3.60; CI 1.52; 8.53) and a trend of better survival was observed for children with parents of younger age at child's diagnosis and poorer survival of children with parents of older age. Despite free and uniform access to health care services, some family circumstances appear to affect survival from specific CNS tumour types in Danish children. Further research is warranted to gain a more comprehensive understanding of the impact of family factors on childhood cancer survival in other populations and to elaborate underlying mechanisms and pathways of those survival inequalities observed.
Collapse
Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, 69372, France
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, 2100, Denmark
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, Bremen, 28359, Germany
- University of Bremen, Faculty of Human and Health Science, Bremen, 28359, Germany
| | - Anja Krøyer
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, 2100, Denmark
| | - Andrea Bautz
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, 2100, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics & Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, 2100, Denmark
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, 69372, France
| |
Collapse
|
14
|
Salz T, Zabor EC, de Nully Brown P, Dalton SO, Raghunathan NJ, Matasar MJ, Steingart R, Vickers AJ, Svenssen Munksgaard P, Oeffinger KC, Johansen C. Preexisting Cardiovascular Risk and Subsequent Heart Failure Among Non-Hodgkin Lymphoma Survivors. J Clin Oncol 2017; 35:3837-3843. [PMID: 28922087 DOI: 10.1200/jco.2017.72.4211] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The use of anthracycline chemotherapy is associated with heart failure (HF) among survivors of non-Hodgkin lymphoma (NHL). We aimed to understand the contribution of preexisting cardiovascular risk factors to HF risk among NHL survivors. Methods Using Danish registries, we identified adults diagnosed with aggressive NHL from 2000 to 2010 and sex- and age-matched general-population controls. We assessed HF from 9 months after diagnosis through 2012. We used Cox regression analysis to assess differences in risk for HF between survivors and general population controls. Among survivors only, preexisting cardiovascular factors (hypertension, dyslipidemia, and diabetes) and preexisting cardiovascular disease were ascertained. We used multivariable Cox regression to model the association of preexisting cardiovascular conditions on subsequent HF. Results Among 2,508 survivors of NHL and 7,399 controls, there was a 42% increased risk of HF among survivors compared with general population controls (hazard ratio [HR], 1.42; 95% CI, 1.07 to 1.88). Among survivors (median age at diagnosis, 62 years; 56% male), 115 were diagnosed with HF during follow-up (median years of follow-up, 2.5). Before NHL diagnosis, 39% had ≥ 1 cardiovascular risk factor; 92% of survivors were treated with anthracycline-containing regimens. In multivariable analysis, intrinsic heart disease diagnosed before lymphoma was associated with increased risk of HF (HR, 2.71; 95% CI, 1.15 to 6.36), whereas preexisting vascular disease had no association with HF ( P > .05). Survivors with cardiovascular risk factors had an increased risk of HF compared with those with none (for 1 v 0 cardiovascular risk factors: HR, 1.63; 95% CI, 1.07 to 2.47; for ≥ 2 v 0 cardiovascular risk factors: HR, 2.86; 95% CI, 1.56 to 5.23; joint P < .01). Conclusion In a large, population-based cohort of NHL survivors, preexisting cardiovascular conditions were associated with increased risk of HF. Preventive approaches should take baseline cardiovascular health into account.
Collapse
Affiliation(s)
- Talya Salz
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Emily C Zabor
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Peter de Nully Brown
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Susanne Oksberg Dalton
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Nirupa J Raghunathan
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Matthew J Matasar
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Richard Steingart
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Andrew J Vickers
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Peter Svenssen Munksgaard
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Kevin C Oeffinger
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Christoffer Johansen
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| |
Collapse
|
15
|
Suppli NP, Bukh JD, Moffitt TE, Caspi A, Johansen C, Tjønneland A, Kessing LV, Dalton SO. Genetic variants in 5-HTTLPR, BDNF, HTR1A, COMT, and FKBP5 and risk for treated depression after cancer diagnosis. Depress Anxiety 2017; 34:845-855. [PMID: 28590587 PMCID: PMC5933050 DOI: 10.1002/da.22660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The role of gene-environment interactions in the pathogenesis of depression is unclear. Previous studies addressed vulnerability for depression after childhood adversity and stressful life events among carriers of numerous specific genetic variants; however, the importance of individual genetic variants, the environmental exposures with which they interact, and the magnitude of the risk conveyed by these interactions remain elusive. METHODS We included 7,320 people with a first primary cancer identified in the prospective Diet, Cancer and Health study in an exposed-only cohort study. The mean age of the individuals was 68 years (5th, 95th percentiles: 58, 78) at cancer diagnosis. Using Cox regression models and cumulative incidence plots, we analyzed the associations between genetic variants in 5-HTTLPR, BDNF, HTR1A, COMT, and FKBP5 and use of antidepressants as well as hospital contact for depression after diagnosis of cancer. RESULTS Overall, we observed no statistically significant associations, with nonsignificant hazard ratio estimates for use of antidepressants of 0.95-1.07. CONCLUSIONS This study of elderly people indicates that it is unlikely that the investigated genetic variants are clinically relevantly associated with depression after diagnosis of cancer. The mechanisms for gene-environment interactions in younger individuals are probably different, and we advise caution in extrapolating our results to early life stress. However, conclusion from the present study might be generalizable to elderly persons exposed to other stressful life events.
Collapse
Affiliation(s)
- Nis P. Suppli
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark,Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Jens D. Bukh
- Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, NC, USA,Center for Genomic and Computational Biology, Duke University, NC, USA,Social, Genetic, and Developmental Psychiatry Research Center, Institute of Psychiatry, King’s College London, London, UK
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, NC, USA,Center for Genomic and Computational Biology, Duke University, NC, USA,Social, Genetic, and Developmental Psychiatry Research Center, Institute of Psychiatry, King’s College London, London, UK
| | - Christoffer Johansen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark,Department of Oncology, Finsencentret, Rigshospitalet, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lars V. Kessing
- Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Susanne O. Dalton
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| |
Collapse
|
16
|
Cromhout PF, Latocha KM, Olsen MH, Suppli NP, Christensen J, Johansen C, Dalton SO. First use of antidepressant medication in male partners of women with breast cancer in Denmark from 1998 to 2011. Psychooncology 2017; 26:2269-2275. [PMID: 28511290 DOI: 10.1002/pon.4459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/31/2017] [Accepted: 05/12/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A diagnosis of breast cancer disrupts the life of the patient, but also the partner may experience adverse psychological effects. We examined partners' risk for first use of antidepressant medication, as a proxy for pharmacologically treated depression. METHODS By linkage of national registers, we identified 1 420 592 depression-free men living with a cancer-free female partner in 1998 to 2011. During follow-up, breast cancer was diagnosed in female partners of 26 256 men. In Poisson regression models, we estimated the rate ratios for first use of antidepressant medication compared to partners of breast cancer-free women. Cox regression analyses examined associations between exposed partners' sociodemographic characteristics, somatic comorbidity, death of female partner, and first use of antidepressant medication. RESULTS Male partners of women with breast cancer had an increased rate ratio of 1.08 (95% CI, 1.03-1.13) for first use of antidepressant medication compared to the background population, corresponding to excess absolute risk of 12 cases per 10 000 person-years. This increased risk persisted throughout 14 years of follow-up. Higher age, shorter education, somatic comorbidity, and death of female partner were associated with increased risk among men whose partner had breast cancer. CONCLUSION The modest, but long term, increased risk for first use of antidepressant medication calls for attention by health care professionals to symptoms of depression among partners of breast cancer patients.
Collapse
Affiliation(s)
- Pernille F Cromhout
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark
| | - Kristine M Latocha
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark
| | - Maja H Olsen
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark
| | - Nis P Suppli
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark
| | - Jane Christensen
- Danish Cancer Society Research Center, Statistics and Pharmaco-epidemiology, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark.,Clinic of Oncology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne O Dalton
- Danish Cancer Society Research Center, Unit of Survivorship, Copenhagen, Denmark
| |
Collapse
|
17
|
Jeppesen MM, Mogensen O, Hansen DG, Iachina M, Korsholm M, Jensen PT. Detection of recurrence in early stage endometrial cancer - the role of symptoms and routine follow-up. Acta Oncol 2017; 56:262-269. [PMID: 28080157 DOI: 10.1080/0284186x.2016.1267396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Considerable controversy remains as to the optimal organization of endometrial cancer follow-up. AIM To evaluate the relationship between the way recurrence was detected and survival after treatment for endometrial cancer. Further, to identify characteristics associated with a pre-scheduled examination in women with symptomatic recurrence. MATERIAL AND METHODS All women with early stage endometrial cancer during 2005-2009 were included in a population-based historical cohort derived from the Danish Gynecological Cancer Database. Women diagnosed with recurrence within three years after primary surgery and the mode of recurrence detection were identified from hospital charts: asymptomatic recurrence detected at regular follow-up, symptomatic recurrence detected at regular follow-up or symptomatic recurrence detected in between follow-up. Survival of women with symptomatic and asymptomatic disease was compared. Furthermore, characteristics associated with self-referral as compared to presenting symptoms at regular follow-ups were identified using univariate analyses. RESULTS In total, 183 cases of recurrence (7%) were identified in the cohort of 2612 women. Of these, 65.5% were symptomatic with vaginal bleeding as the most prevalent symptom. Asymptomatic women had a significantly better three-year survival rate compared to symptomatic women (80.3% vs. 54.3%, p < 0.01). A total of 2.3% of the entire population had an asymptomatic recurrence. Women diagnosed at a pre-scheduled visit due to symptoms had a higher educational level (p = 0.03) and more often high-risk disease (p = 0.02) than symptomatic women diagnosed at regular follow-up. CONCLUSION Early stage endometrial cancer carries a low risk of recurrence. Survival appears to be superior in asymptomatic patients, but length-time bias, i.e. the effect of aggressive tumor biology in symptomatic recurrences, may bias results in non-randomized controlled trials. Well educated patients with symptoms of recurrence more often sought medical attendance compared to less educated counterparts. This should be considered if patient-initiated follow-up is the standard care.
Collapse
Affiliation(s)
- Mette Moustgaard Jeppesen
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ole Mogensen
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Sweden and Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Dorte Gilså Hansen
- The National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- The Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Korsholm
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
18
|
Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: A population-based study (2009-2014). Medicine (Baltimore) 2017; 96:e5941. [PMID: 28178134 PMCID: PMC5312991 DOI: 10.1097/md.0000000000005941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) survival varies at individual and geographically level. This population-based study aimed to evaluating various factors affecting the survival rate of CRC patients in Kurdistan province.In a retrospective cohort study, patients diagnosed as CRC were collected through a population-based study from March 1, 2009 to 2014. The data were collected from Kurdistan's Cancer Registry database. Additional information and missing data were collected reference to patients' homes, medical records, and pathology reports. The CRC survival was calculated from the date of diagnosis to the date of cancer-specific death or the end of follow-up (cutoff date: October 2015). Kaplan-Meier method and log-rank test were used for the univariate analysis of survival in various subgroups. The proportional-hazard model Cox was also used in order to consider the effects of different factors on survival including age at diagnosis, place of residence, marital status, occupation, level of education, smoking, economic status, comorbidity, tumor stage, and tumor grade.A total number of 335 patients affected by CRC were assessed and the results showed that 1- and 5-year survival rate were 87% and 33%, respectively. According to the results of Cox's multivariate analysis, the following factors were significantly related to CRC survival: age at diagnosis (≥65 years old) (HR 2.08, 95% CI: 1.17-3.71), single patients (HR 1.62, 95% CI: 1.10-2.40), job (worker) (HR 2.09, 95% CI: 1.22-3.58), educational level: diploma or below (HR 0.61, 95% CI: 0.39-0.92), wealthy economic status (HR 0.51, 95% CI: 0.31-0.82), tumor grade in poorly differentiated (HR 2.25, 95% CI: 1.37-3.69), and undifferentiated/anaplastic grade (HR 2.90, 95% CI: 1.67-4.98).We found that factors such as low education, inappropriate socioeconomic status, and high tumor grade at the time of disease diagnosis were effective in the poor survival of CRC patients in Kurdistan province; this, which need more attention.
Collapse
Affiliation(s)
- Mohammad Aziz Rasouli
- Student Research Committee
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Ghobad Moradi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Daem Roshani
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | | |
Collapse
|
19
|
The nature of early-stage endometrial cancer recurrence—A national cohort study. Eur J Cancer 2016; 69:51-60. [DOI: 10.1016/j.ejca.2016.09.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/18/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022]
|
20
|
Erdmann F, Winther JF, Dalton SO, Lightfoot T, Zeeb H, Simony SB, Deltour I, Ferro G, Bautz A, Schmiegelow K, Schüz J. Survival From Childhood Hematological Malignancies in Denmark: Is Survival Related to Family Characteristics? Pediatr Blood Cancer 2016; 63:1096-104. [PMID: 26937602 DOI: 10.1002/pbc.25950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/27/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Due to diverse findings as to the role of family factors for childhood cancer survival even within Europe, we explored a nationwide, register-based cohort of Danish children with hematological malignancies. METHODS All children born between 1973 and 2006 and diagnosed with a hematological malignancy before the age of 20 years (N = 1,819) were followed until 10 years from diagnosis. Kaplan-Meier curves and Cox proportional hazards models estimating hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the impact of family characteristics on overall survival in children with hematological malignancies. RESULTS Having siblings and increasing birth order were associated with reduced survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Associations with AML were strongest and statistically significant. HRs of 1.62 (CI 0.85; 3.09) and 5.76 (CI 2.01; 16.51) were observed for the fourth or later born children with ALL (N = 41) and AML (N = 9), respectively. Children with older parents showed a tendency toward inferior ALL survival, while for AML young maternal age was related to poorer survival. Based on small numbers, a trend toward poorer survival from non-Hodgkin lymphoma was observed for children having siblings and for children of younger parents. CONCLUSIONS Further research is warranted to gain further knowledge on the impact of family factors on childhood cancer survival in other populations and to elaborate potential underlying mechanisms and pathways of those survival inequalities.
Collapse
Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | | | | | - Tracy Lightfoot
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH, Bremen, Germany
| | - Sofie Bay Simony
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Isabelle Deltour
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andrea Bautz
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics & Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Division of Pediatric Hematology/Oncology, Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| |
Collapse
|
21
|
Karlsen RV, Frederiksen K, Larsen MB, von Heymann-Horan AB, Appel CW, Christensen J, Tjønneland A, Ross L, Johansen C, Bidstrup PE. The impact of a breast cancer diagnosis on health-related quality of life. A prospective comparison among middle-aged to elderly women with and without breast cancer. Acta Oncol 2016; 55:720-7. [PMID: 26942569 DOI: 10.3109/0284186x.2015.1127415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The improved survival after breast cancer has prompted knowledge on the effect of a breast cancer diagnosis on health-related quality of life (HQoL). This study compared changes in HQoL among women from before to after breast cancer diagnosis with longitudinal changes among women who remained breast cancer-free. Material and methods The Danish Diet, Cancer and Health study included 57 053 cancer-free persons aged 50-64 years at baseline (1993-1997). We used data from first follow-up (1999-2002) and second follow-up (2010-2012) on HQoL [Medical Outcomes Survey, short form (SF-36)] obtained from 542 women aged 64-82 years with primary breast cancer (stages I-III) and a randomly matched sample of 729 women who remained breast cancer-free. Linear regression models were used to estimate the differences in changes in HQoL between women with and without breast cancer; the analyses were repeated with stratification according to age, comorbidity, partner support and time since diagnosis. Results Women with breast cancer reported significantly larger decreases in HQoL from before to after diagnosis than those who remained breast cancer-free (physical component summary, -2.0; 95% CI -2.8; -1.2, mental component summary, -1.5, 95% CI -2.3; -0.6). This association was significantly modified by comorbidity and time since diagnosis. Conclusions Women with breast cancer reported significantly larger HQoL declines than breast cancer-free women. Breast cancer diagnosis seems to have the greatest impact on HQoL closest to diagnosis and in women with comorbidity indicating that this group should be offered timely and appropriate follow-up care to prevent HQoL declines.
Collapse
Affiliation(s)
- Randi V. Karlsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Matilde B. Larsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Charlotte W. Appel
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jane Christensen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Lone Ross
- Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Christoffer Johansen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Finsen Centre, Rigshospitalet, Copenhagen, Denmark
| | | |
Collapse
|
22
|
Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study. J Cancer Surviv 2016; 10:915-26. [PMID: 27084710 DOI: 10.1007/s11764-016-0538-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/21/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories. METHODS A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories. RESULTS The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated. CONCLUSIONS A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories. IMPLICATIONS FOR CANCER SURVIVORS In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.
Collapse
|
23
|
Albieri V, Olsen TS, Andersen KK. Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype. EBioMedicine 2016; 6:199-205. [PMID: 27211561 PMCID: PMC4856739 DOI: 10.1016/j.ebiom.2016.02.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Identifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. METHODS A cohort study including all citizens 25-80years of age in Denmark 2003-2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FINDINGS Of the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01-1.14) and ischemic strokes (RR 1.07; CI 1.00-1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11-1.79). Risk was for mild strokes (RR 1.31; CI 1.16-1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65-0.91). Risk was age-related; highest among women 25-45years (RR≈1.7). Risk was unrelated to numbers of dispensations. INTERPRETATION Migraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.
Collapse
Affiliation(s)
- Vanna Albieri
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Tom Skyhøj Olsen
- Department of Neurology, Bispebjerg University Hospital, 2400 Copenhagen, Denmark.
| | - Klaus Kaae Andersen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
| |
Collapse
|
24
|
Merrild CH, Risør MB, Vedsted P, Andersen RS. Class, Social Suffering, and Health Consumerism. Med Anthropol 2015; 35:517-528. [DOI: 10.1080/01459740.2015.1102248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Sun Y, Vedsted P, Fenger-Grøn M, Wu CS, Bech BH, Olsen J, Benros ME, Vestergaard M. Cancer Mortality in People Treated with Antidepressants before Cancer Diagnosis: A Population Based Cohort Study. PLoS One 2015; 10:e0138134. [PMID: 26367120 PMCID: PMC4569483 DOI: 10.1371/journal.pone.0138134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/25/2015] [Indexed: 01/06/2023] Open
Abstract
Background Depression is common after a cancer diagnosis and is associated with an increased mortality, but it is unclear whether depression occurring before the cancer diagnosis affects cancer mortality. We aimed to study cancer mortality of people treated with antidepressants before cancer diagnosis. Methods and Findings We conducted a population based cohort study of all adults diagnosed with cancer between January 2003 and December 2010 in Denmark (N = 201,662). We obtained information on cancer from the Danish Cancer Registry, on the day of death from the Danish Civil Registry, and on redeemed antidepressants from the Danish National Prescription Registry. Current users of antidepressants were defined as those who redeemed the latest prescription of antidepressant 0–4 months before cancer diagnosis (irrespective of earlier prescriptions), and former users as those who redeemed the latest prescription five or more months before cancer diagnosis. We estimated an all-cause one-year mortality rate ratio (MRR) and a conditional five-year MRR for patients who survived the first year after cancer diagnosis and confidence interval (CI) using a Cox proportional hazards regression model. Overall, 33,111 (16.4%) patients redeemed at least one antidepressant prescription in the three years before cancer diagnosis of whom 21,851 (10.8%) were current users at the time of cancer diagnosis. Current antidepressant users had a 32% higher one-year mortality (MRR = 1.32, 95% CI: 1.29–1.35) and a 22% higher conditional five-year mortality (MRR = 1.22, 95% CI: 1.17–1.26) if patients survived the first year after the cancer diagnosis than patients not redeeming antidepressants. The one-year mortality was particularly high for patients who initiated antidepressant treatment within four months before cancer diagnosis (MRR = 1.54, 95% CI: 1.47–1.61). Former users had no increased cancer mortality. Conclusions Initiation of antidepressive treatment prior to cancer diagnosis is common and is associated with an increased mortality.
Collapse
Affiliation(s)
- Yuelian Sun
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Sen Wu
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
26
|
Stensen S, Kjaer SK, Jensen SM, Frederiksen K, Junge J, Iftner T, Munk C. Factors associated with type-specific persistence of high-risk human papillomavirus infection: A population-based study. Int J Cancer 2015; 138:361-8. [DOI: 10.1002/ijc.29719] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/30/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Signe Stensen
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Gynaecology; Rigshospitalet, University of Copenhagen; Denmark
| | - Signe M. Jensen
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Kirsten Frederiksen
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Jette Junge
- Department of Pathology; Hvidovre Hospital; Denmark
| | - Thomas Iftner
- Medical Virology, Experimental Virology Section; University Hospital of Tübingen; Germany
| | - Christian Munk
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| |
Collapse
|
27
|
Dehlendorff C, Andersen KK, Olsen TS. Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men. J Am Heart Assoc 2015; 4:e001967. [PMID: 26150479 PMCID: PMC4608080 DOI: 10.1161/jaha.115.001967] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uncertainty remains about whether stroke affects men and women similarly. We studied differences between men and women with regard to stroke severity and survival. METHODS AND RESULTS We used the Danish Stroke Registry, with information on all hospital admissions for stroke in Denmark between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death reported on death certificates as due to stroke was related to the index stroke if death occurred within the first week or month after stroke. Multivariate Cox regression analysis and multiple imputation were applied. Stroke was the cause of death for 4373 and 5512 of the 79 617 patients within 1 week (5.5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women and significantly so (>15%) from the mid-70s (adjusted for age, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk factors). Results were essentially the same when analyzing deaths within 1 week, 1 month and ischemic and hemorrhagic stroke separately. CONCLUSIONS Stroke affects women and men differently. Elderly women were affected more severely than elderly men but were more likely to survive.
Collapse
Affiliation(s)
| | - Klaus Kaae Andersen
- Section of statistics, Danish Cancer Society Research CenterCopenhagen, Denmark
| | - Tom Skyhøj Olsen
- Department of Neurology, Bispebjerg University HospitalCopenhagen, Denmark
| |
Collapse
|
28
|
Møller PK, Tolstrup JS, Olsen MH, Dalton SO, Overgaard J, Johansen J. Predictors of continuous tobacco smoking in a clinical cohort study of Danish laryngeal cancer patients smoking before treated with radiotherapy. Acta Oncol 2015; 54:685-92. [PMID: 25765594 DOI: 10.3109/0284186x.2014.996665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many cancer patients who are smokers when starting cancer therapy continue smoking despite evidence of tobacco smoking as a risk factor for poor treatment response and secondary primary cancers. Small samples and inconsistent results in previous studies warrant further research to identify predictors of being a continuous smoker during and after radiotherapy. MATERIAL AND METHODS In the clinical database of the Danish Head and Neck Cancer Group (DAHANCA), we identified 1455 patients diagnosed with laryngeal cancer between 2000 and 2010, who were all smokers at date of diagnosis and treated with primary radiotherapy. Information on the socio-economic characteristics of the study cohort was obtained from Statistics Denmark the year prior to diagnosis. Logistic regression analyses were applied. RESULTS In the cohort of laryngeal cancer patients smoking before starting radiotherapy, 50% still smoked one year after radiotherapy similar to the percentage of smokers during treatment. Being younger than 60 years (OR 1.39, 95% CI 1.00-1.91), commenced smoking before the age of 15 (OR 1.77, 95% CI 1.32-2.38), having a poor WHO Performance status (OR 3.09, 95% CI 1.71-5.61), low income (OR 2.21, 95% CI 1.23-3.98) and living alone (OR 1.56, 95% CI 1.13-2.14) were associated with increased risk of continuous smoking during treatment. Similar findings were found two months and one year after radiotherapy, however, no association with living alone (OR 1.08, 95% CI 0.73-1.59) at the one-year follow-up. Tumor stage and the average number of cigarettes smoked per day before radiotherapy were not associated with being a continuous smoker. CONCLUSION Younger patients, who had an early smoking initiation, a poor performance status, low income and lived alone, were most likely to continue smoking. Continuous smoking was not related to the extent of disease.
Collapse
|
29
|
Who are the cancer survivors? A nationwide study in Denmark, 1943-2010. Br J Cancer 2015; 112:1549-53. [PMID: 25719832 PMCID: PMC4453680 DOI: 10.1038/bjc.2015.68] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/07/2015] [Accepted: 01/27/2015] [Indexed: 11/11/2022] Open
Abstract
Background: No nationwide studies on social position and prevalence of comorbidity among cancer survivors exist. Methods: We performed a nationwide prevalence study defining persons diagnosed with cancer 1943–2010 and alive on the census date 1 January 2011 as cancer survivors. Comorbidity was compared by social position with the non-cancer population. Results: Cancer survivors composed 4% of the Danish population. Somatic comorbidity was more likely among survivors (OR 1.59, 95% CI 1.57–1.60) and associated with higher age, male sex, short education, and living alone among survivors. Conclusions: Among cancer survivors, comorbidity is common and highly associated with social position.
Collapse
|
30
|
Štefková G, Veselská ZD, Vargová V, Paľo M. The Association of Education, Employment and Living with a Partner with the Treatment among Patients with Head and Neck Cancer. AIMS Public Health 2015; 2:1-9. [PMID: 29546091 PMCID: PMC5690365 DOI: 10.3934/publichealth.2015.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/21/2015] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to explore possible associations between social and socioeconomic status and ongoing treatment among patients with head and neck cancer. MATERIAL AND METHODS Data from 159 examined patients treated with head and neck cancer during the period from 2011 to 2012 were explored. A logistic regression analysis was used to assess association of social status (living with somebody vs. living alone), socioeconomic status (employed vs. unemployed) and education (primary/secondary/university) with treatment. RESULTS The results from logistic regression showed significant association of employment status and education with both interruption in radiochemotherapy and searching for additional help after surgery. Interruption of radiochemotherapy was almost 3 times more likely in a group of unemployed compared to the employed patients. Lack of searching for help after surgery was almost 4 times more likely in a group of unemployed compared to the employed and 5 times more likely in the group with the lowest education compared with the group with the highest education. CONCLUSIONS The study suggests that special attention needs to be paid, not only during but also after treatment, to the patients from low socioeconomic groups.
Collapse
Affiliation(s)
- Gabriela Štefková
- Nursing Department, Medical Faculty, PJ Safarik University in Košice, Slovakia
| | | | - Viola Vargová
- 1st Department of Internal Medicine, Medical Faculty, PJ Safarik University in Košice, Slovakia
| | - Marek Paľo
- Department of Radiology of JA Reiman University hospital in Prešov, Slovakia
| |
Collapse
|
31
|
Terp H, Rottmann N, Larsen PV, Hagedoorn M, Flyger H, Kroman N, Johansen C, Dalton S, Hansen DG. Participation in questionnaire studies among couples affected by breast cancer. Support Care Cancer 2014; 23:1907-16. [PMID: 25487844 DOI: 10.1007/s00520-014-2554-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Participation bias may be a problem in couple-based psychosocial studies. Therefore, it is important to investigate the characteristics associated with participation. The aim of this study was to analyze whether participation in a longitudinal psychosocial questionnaire study among couples affected by breast cancer was associated with socioeconomic, breast cancer-specific, and other health-related characteristics of the patients and partners. METHODS The analyzes are based on 2254 couples who were invited to participate in a nationwide survey on psychosocial adjustment among couples dealing with breast cancer. Participating couples (N = 792) were compared with non-participating couples (N = 1462) with regard to socioeconomic and health-related characteristics obtained from nationwide clinical and administrative registers. RESULTS Associations were seen between various socioeconomic variables and couple participation. The patient characteristics older age (OR = 0.15 [95% CI = 0.07-0.55]), low education (OR = 1.95 [95% CI = 1.46-2.68]), disability pension (OR = 0.59 [95% CI = 0.39-0.55]), or non-western ethnicity (OR = 0.36 [95% CI = 0.15-0.82]) reduced couple participation. The partner characteristics older age (OR = 0.23 [95% CI = 0.15-0.43]), low education (OR = 1.67 [95% CI = 1.25-2.22]), receiving disability pension (OR = 0.46 [95% CI = 0.25-0.82]), non-western ethnicity (OR = 0.17 [95% CI = 0.06-0.49]), or high morbidity (OR = 0.76 [95% CI = 0.60-0.96]) also reduced couple participation. Furthermore, couples with low income (OR = 1.49 [95% CI = 1.16-1.95]) had reduced participation. No associations were found between couple participation and breast cancer-related variables. CONCLUSIONS Socioeconomic characteristics of patients and partners, and morbidity of partners may influence participation in couple-based psychosocial breast cancer research. Breast cancer-related characteristics do not seem to influence participation.
Collapse
Affiliation(s)
- Helene Terp
- National Research Center of Cancer Rehabilitation, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark,
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Andersen KK, Dalton SO, Steding-Jessen M, Olsen TS. Socioeconomic Position and Survival After Stroke in Denmark 2003 to 2012. Stroke 2014; 45:3556-60. [DOI: 10.1161/strokeaha.114.007046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Klaus Kaae Andersen
- From the Section of Statistics, Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A., S.O.D., M.S.-J.); and Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark (T.S.O.)
| | - Susanne Oksbjerg Dalton
- From the Section of Statistics, Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A., S.O.D., M.S.-J.); and Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark (T.S.O.)
| | - Marianne Steding-Jessen
- From the Section of Statistics, Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A., S.O.D., M.S.-J.); and Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark (T.S.O.)
| | - Tom Skyhøj Olsen
- From the Section of Statistics, Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A., S.O.D., M.S.-J.); and Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark (T.S.O.)
| |
Collapse
|
33
|
Norredam M, Hansen OH, Petersen JH, Kunst AE, Kristiansen M, Krasnik A, Agyemang C. Remigration of migrants with severe disease: myth or reality?--a register-based cohort study. Eur J Public Health 2014; 25:84-9. [PMID: 25201902 DOI: 10.1093/eurpub/cku138] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND 'Remigration bias' is often referred to when explaining low mortality outcomes among migrants compared with local-born. The hypothesis suggests that severely ill migrants tend to return to their country of origin, but it has hitherto not been tested in a large-scale epidemiological study. Consequently, we studied whether migrants with severe disease were more likely to emigrate compared with migrants without severe disease. METHODS A historic prospective cohort study was conducted based on all adult refugees and family reunification immigrants (n = 114,331) who obtained residence permission in Denmark between 1 January 1993 and 31 December 2010. Migrants with severe disease were identified through the Danish National Patient Register. Emigrations during follow-up (1 January 1993 to 31 December 2011) were identified using the Danish Civil Registration System. Hazard ratios were calculated for emigration among migrants with different levels of disease severity, adjusting for sex, age and income. RESULTS Results showed progressively fewer emigrations with increasing disease severity. Migrants with low (HR = 0.92; 95% CI: 0.80-1.06), moderate (HR = 0.84; 95% CI: 0.67-1.06) and high (HR = 0.70; 95% CI: 0.55-0.90) disease severity had fewer emigrations to 'country of origin' compared with migrants without disease. For emigration to 'any country', results likewise showed fewer emigrations among migrants with low (HR = 0.86; 95% CI: 0.78-0.95), moderate (HR = 0.73; 95% CI: 0.62-0.87) and high (HR = 0.64; 95% CI: 0.53-0.76) disease severity. This tendency was also observed by nationality and migrant status. On the disease-specific level, no uniform tendencies in emigration patterns were identified. CONCLUSION The results do not generally support the hypothesis of 'remigration bias' but rather suggest the opposite. Accordingly, remigration bias does not appear to explain lower mortality of migrants.
Collapse
Affiliation(s)
- Marie Norredam
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark 2 Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark
| | - Oluf Hoejbjerg Hansen
- 3 Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- 3 Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anton E Kunst
- 4 Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
| | - Maria Kristiansen
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark
| | - Allan Krasnik
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- 4 Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Andersen KK, Steding‐Jessen M, Dalton SO, Olsen TS. Socioeconomic position and incidence of ischemic stroke in Denmark 2003-2012. A nationwide hospital-based study. J Am Heart Assoc 2014; 3:e000762. [PMID: 25030354 PMCID: PMC4310360 DOI: 10.1161/jaha.113.000762] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND A greater burden of stroke risk factors in general is associated with a higher risk for stroke among people of lower than those of higher socioeconomic position. The relative impact of individual stroke risk factors is still unclear. METHODS AND RESULTS We studied the relations between socioeconomic position, measured as household income and length of education, and all hospital admissions for a first ischemic stroke among 54 048 people over the age of 40 years in Denmark in 2003-2012 in comparison with the general Danish population (23.5 million person-years). We also studied the cardiovascular risk factor profile associated with socioeconomic position in stroke patients. Relative risks for stroke were estimated in log-linear Poisson regression models. The risk for hospitalization for a first ischemic stroke was almost doubled for people in the lowest income group, and the risk of those of working age (<65 years) was increased by 36% among people with the shortest education. Diabetes, obesity, smoking, and high alcohol consumption in particular and, to a lesser extent, previous myocardial infarction or intermittent arterial claudication were significantly overrepresented among stroke patients with lower socioeconomic position. Atrial fibrillation and hypertension were not. CONCLUSIONS In Denmark, there is a strong relation between low socioeconomic position and risk for hospitalization for stroke. Lifestyle, as indicated by smoking, obesity, and alcohol consumption, and diabetes appears to increase the risk for stroke in people with lower socioeconomic position.
Collapse
Affiliation(s)
- Klaus Kaae Andersen
- Danish Cancer Society Research Center, Copenhagen, Denmark (K.K.A., M.S.J., S.O.D.)
| | | | | | - Tom Skyhøj Olsen
- Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark (T.S.O.)
| |
Collapse
|
35
|
Aaronson NK, Mattioli V, Minton O, Weis J, Johansen C, Dalton SO, Verdonck-de Leeuw IM, Stein KD, Alfano CM, Mehnert A, de Boer A, van de Poll-Franse LV. Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice. EJC Suppl 2014. [PMID: 26217166 PMCID: PMC4250535 DOI: 10.1016/j.ejcsup.2014.03.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.
Collapse
Affiliation(s)
- Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vittorio Mattioli
- O.U. Anesthesiology, Intensive Care, Pain and Palliative Care, Experimental Unit of Psycho-Oncology, National Cancer Research Center 'Giovanni Paolo II', Bari, Italy
| | - Ollie Minton
- Palliative Medicine, Division of Population Health Sciences and Education, St. George's University of London, London, United Kingdom
| | - Joachim Weis
- Department of Psychosocial Oncology, Clinic for Tumor Biology, University of Freiburg, Freiburg, Germany
| | - Christoffer Johansen
- Cancer Late Effects Research, Oncology, Finsencenteret, RIgshospitalet, University of Copenhagen & Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Susanne O Dalton
- Unit of Survivorship Research, The Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology, Head and Neck Surgery, VU University Medical Center and Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Kevin D Stein
- Behavioral Research Center, Intramural Research Department, American Cancer Society, Atlanta, GA, USA
| | - Catherine M Alfano
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Anja Mehnert
- Section of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Angela de Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Comprehensive Cancer Centre of the Netherlands, Eindhoven, The Netherlands
| |
Collapse
|
36
|
Holm LV, Hansen DG, Kragstrup J, Johansen C, Christensen RD, Vedsted P, Søndergaard J. Influence of comorbidity on cancer patients' rehabilitation needs, participation in rehabilitation activities and unmet needs: a population-based cohort study. Support Care Cancer 2014; 22:2095-105. [PMID: 24643775 DOI: 10.1007/s00520-014-2188-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/02/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to investigate possible associations between cancer survivors' comorbidity status and their (1) need for rehabilitation, (2) participation in rehabilitation activities and (3) unmet needs for rehabilitation in a 14-month period following date of diagnosis. METHODS We performed a population-based cohort study including incident cancer patients diagnosed from 1 October 2007 to 30 September 2008 in two regions in Denmark. Fourteen months after diagnosis, participants completed a questionnaire measuring different aspects and dimensions of rehabilitation. Individual information on comorbidity was based on hospital contacts from 1994 and until diagnosis, subsequently classified according to the Charlson comorbidity index. Logistic regression analyses were used to explore the association between comorbidity and outcomes for rehabilitation. Analyses were conducted overall and stratified for gender, age and cancer type. RESULTS A total of 3,439 patients responded (70%). Comorbidity at all levels was statistically significant associated with a physical rehabilitation need, and moderate to severe comorbidity was statistically significant associated with a need in the emotional, family-oriented and financial areas as well as participation in physical-related rehabilitation activities. Stratified analyses showed that significant results in most cases were related to being older than 65 years or having colorectal or prostate cancer. CONCLUSIONS Comorbidity at all levels was significantly associated with needs for physical rehabilitation. Moderate to severe comorbidity was further associated with other areas of need and participation in physical area activities. This should be taken into account when planning rehabilitation interventions for cancer survivors. Differences among subgroups could help target interventions and should be explored further.
Collapse
Affiliation(s)
- Lise Vilstrup Holm
- Research Centre for Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark,
| | | | | | | | | | | | | |
Collapse
|
37
|
Sharpe KH, McMahon AD, Raab GM, Brewster DH, Conway DI. Association between socioeconomic factors and cancer risk: a population cohort study in Scotland (1991-2006). PLoS One 2014; 9:e89513. [PMID: 24586838 PMCID: PMC3937337 DOI: 10.1371/journal.pone.0089513] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/23/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lung and upper aero-digestive tract (UADT) cancer risk are associated with low socioeconomic circumstances and routinely measured using area socioeconomic indices. We investigated effect of country of birth, marital status, one area deprivation measure and individual socioeconomic variables (economic activity, education, occupational social class, car ownership, household tenure) on risk associated with lung, UADT and all cancer combined (excluding non melanoma skin cancer). METHODS We linked Scottish Longitudinal Study and Scottish Cancer Registry to follow 203,658 cohort members aged 15+ years from 1991-2006. Relative risks (RR) were calculated using Poisson regression models by sex offset for person-years of follow-up. RESULTS 21,832 first primary tumours (including 3,505 lung, 1,206 UADT) were diagnosed. Regardless of cancer, economically inactivity (versus activity) was associated with increased risk (male: RR 1.14, 95% CI 1.10-1.18; female: RR 1.06, 95% CI 1.02-1.11). For lung cancer, area deprivation remained significant after full adjustment suggesting the area deprivation cannot be fully explained by individual variables. No or non degree qualification (versus degree) was associated with increased lung risk; likewise for UADT risk (females only). Occupational social class associations were most pronounced and elevated for UADT risk. No car access (versus ownership) was associated with increased risk (excluding all cancer risk, males). Renting (versus home ownership) was associated with increased lung cancer risk, UADT cancer risk (males only) and all cancer risk (females only). Regardless of cancer group, elevated risk was associated with no education and living in deprived areas. CONCLUSIONS Different and independent socioeconomic variables are inversely associated with different cancer risks in both sexes; no one socioeconomic variable captures all aspects of socioeconomic circumstances or life course. Association of multiple socioeconomic variables is likely to reflect the complexity and multifaceted nature of deprivation as well as the various roles of these dimensions over the life course.
Collapse
Affiliation(s)
- Katharine H. Sharpe
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom
- University of Glasgow, College of Medical, Veterinary and Life Sciences: Dental School, Glasgow, Scotland, United Kingdom
| | - Alex D. McMahon
- University of Glasgow, College of Medical, Veterinary and Life Sciences: Dental School, Glasgow, Scotland, United Kingdom
| | - Gillian M. Raab
- University of St Andrews, St Andrews, Fife, Scotland, United Kingdom
| | - David H. Brewster
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, United Kingdom
- Public Health Sciences, Edinburgh University Medical School, Edinburgh, Scotland, United Kingdom
| | - David I. Conway
- University of Glasgow, College of Medical, Veterinary and Life Sciences: Dental School, Glasgow, Scotland, United Kingdom
| |
Collapse
|
38
|
Kjaer T, Albieri V, Jensen A, Kjaer SK, Johansen C, Dalton SO. Divorce or end of cohabitation among Danish women evaluated for fertility problems. Acta Obstet Gynecol Scand 2014; 93:269-76. [DOI: 10.1111/aogs.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 12/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Trille Kjaer
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Vanna Albieri
- Department of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Allan Jensen
- Department of Viruses, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne K. Kjaer
- Department of Viruses, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
- Juliane Marie Center; Clinic of Gynecology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Christoffer Johansen
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne O. Dalton
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| |
Collapse
|
39
|
Bøje CR, Dalton SO, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Overgaard J. Evaluation of comorbidity in 9388 head and neck cancer patients: A national cohort study from the DAHANCA database. Radiother Oncol 2014; 110:91-7. [DOI: 10.1016/j.radonc.2013.11.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/15/2022]
|
40
|
Bøje CR. Impact of comorbidity on treatment outcome in head and neck squamous cell carcinoma – A systematic review. Radiother Oncol 2014; 110:81-90. [DOI: 10.1016/j.radonc.2013.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/14/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
|
41
|
Svendsen RP, Jarbol DE, Larsen PV, Støvring H, Hansen BL, Soendergaard J. Associations between health care seeking and socioeconomic and demographic determinants among people reporting alarm symptoms of cancer: a population-based cross-sectional study. Fam Pract 2013; 30:655-65. [PMID: 23864364 DOI: 10.1093/fampra/cmt036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Late diagnosis of cancer may partly be explained by the fact that some patients do not seek health care promptly when experiencing an alarm symptom. Socioeconomic and demographic differences exist concerning knowledge and awareness of cancer alarm symptoms in the general population and socioeconomic differences are found in cancer incidence and survival. We therefore hypothesise that socioeconomic and demographic differences in health care-seeking behaviour are present among people with alarm symptoms. OBJECTIVES To analyse associations between health care seeking and socioeconomic and demographic factors among people reporting cancer alarm symptoms. METHODS A questionnaire survey comprising 20000 people aged >20 from the Danish population. The questionnaire concerned alarm symptoms of common cancers and subsequent health care seeking. Data on socioeconomic factors were obtained from Statistics Denmark. MAIN OUTCOMES health care seeking and patient interval. RESULTS A total of 26.1% of all subjects reported that they did not seek health care when having experienced an alarm symptom. Women-subjects aged >40, subjects living with a partner and subjects having a cancer diagnosis-were more likely to seek health care, whereas medium educational level was negatively associated with health care seeking. Further, women were more likely to seek health care within 1 month, whereas subjects out of the workforce were less likely to do so. CONCLUSIONS Approximately three out of four subjects sought health care when having experienced an alarm symptom but 50% waited for at least 1 month. Some demographic factors were found to be associated with health care-seeking behaviour and the patient interval, whereas no consistent associations were found with regard to socioeconomics.
Collapse
Affiliation(s)
- Rikke P Svendsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK-5000 Odense C and
| | | | | | | | | | | |
Collapse
|
42
|
Poulsen AH, Friis S, Johansen C, Jensen A, Frei P, Kjaear SK, Dalton SO, Schüz J. Mobile phone use and the risk of skin cancer: a nationwide cohort study in Denmark. Am J Epidemiol 2013; 178:190-7. [PMID: 23788669 DOI: 10.1093/aje/kws426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The International Agency for Research on Cancer has classified radiofrequency radiation as possibly carcinogenic. Previous studies have focused on intracranial tumors, although the skin receives much radiation. In a nationwide cohort study, 355,701 private mobile phone subscribers in Denmark from 1987 to 1995 were followed up through 2007. We calculated incidence rate ratios (IRRs) for melanoma, basal cell carcinoma, and squamous cell carcinoma by using Poisson regression models adjusted for age, calendar period, educational level, and income. Separate IRRs for head/neck tumors and torso/leg tumors were compared (IRR ratios) to further address potential confounders. We observed no overall increased risk for basal cell carcinoma, squamous cell carcinoma, or melanoma of the head and neck. After a follow-up period of at least 13 years, the IRRs for basal cell carcinoma and squamous cell carcinoma remained near unity. Among men, the IRR for melanoma of the head and neck was 1.20 (95% confidence interval: 0.65, 2.22) after a minimum 13-year follow-up, whereas the corresponding IRR for the torso and legs was 1.16 (95% confidence interval: 0.91, 1.47), yielding an IRR ratio of 1.04 (95% confidence interval: 0.54, 2.00). A similar risk pattern was seen among women, though it was based on smaller numbers. In this large, population-based cohort study, little evidence of an increased skin cancer risk was observed among mobile phone users.
Collapse
Affiliation(s)
- Aslak Harbo Poulsen
- Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Koefoed MM, Søndergaard J, Christensen RD, Jarbøl DE. Influence of socioeconomic and demographic status on spirometry testing in patients initiating medication targeting obstructive lung disease: a population-based cohort study. BMC Public Health 2013; 13:580. [PMID: 23768408 PMCID: PMC3729528 DOI: 10.1186/1471-2458-13-580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 06/03/2013] [Indexed: 11/22/2022] Open
Abstract
Background Socioeconomic status is known to influence the prevalence, severity and mortality of obstructive lung diseases, but it is uncertain whether it affects the use of diagnostic spirometry in patients initiating treatment for these conditions. The objective of this paper was to examine a possible association between education, income, labour market affiliation, cohabitation status and having spirometry performed when initiating medication targeting obstructive pulmonary disease. Methods We conducted a population-based cohort study. Danish national registers were linked, retrieving data on prescriptions, spirometry testing, socioeconomic and demographic variables in all first time users of medication targeting obstructive lung disease in 2008. Results A total of 37,734 persons were included and approximately half of the cohort had spirometry performed. Among medication users under 65 years of age, being unemployed was significantly associated with reduced odds of having spirometry performed, the strongest association was seen in men (OR = 0.82, CI = 0.73-0.91). Medium income was associated with increased odds of having spirometry performed in men (OR = 1.18, CI = 1.06-1.30) and high educational level (>12 years) was associated with reduced odds of having spirometry performed in women (OR = 0.86, CI = 0.78-0.94). Cohabitation status was not associated with having spirometry performed. Among medication users over 65 years of age, living alone was associated with reduced odds of having spirometry performed among men (OR = 0.78, CI = 0.69-0.88). Conclusion Social inequity in spirometry testing among patients initiating medication targeting obstructive lung disease was confirmed in this study. Increased focus on spirometry testing among elderly men living alone, among the unemployed and among women with higher education is required when initiating medication.
Collapse
Affiliation(s)
- Mette M Koefoed
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J,B, Winsløws Vej 9A, 1, DK-5000, Odense C, Denmark.
| | | | | | | |
Collapse
|
44
|
Omland LH, Osler M, Jepsen P, Krarup H, Weis N, Christensen PB, Roed C, Sørensen HT, Obel N. Socioeconomic status in HCV infected patients - risk and prognosis. Clin Epidemiol 2013; 5:163-72. [PMID: 23766659 PMCID: PMC3678712 DOI: 10.2147/clep.s43926] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background and aims It is unknown whether socioeconomic status (SES) is a risk factor for hepatitis C virus (HCV) infection or a prognostic factor following infection. Methods From Danish nationwide registries, we obtained information on three markers of SES: employment, income, and education. In a case control design, we examined HCV infected patients and controls; conditional logistic regression was employed to obtain odds ratios (ORs) for HCV infection for each of the three SES markers, adjusting for the other two SES markers, comorbidity, and substance abuse. In a cohort design, we used Cox regression analysis to compute mortality rate ratios (MRRs) for each of the three SES markers, adjusting for the other two SES markers, comorbidity level, age, substance abuse, and gender. Results When compared to employed persons, ORs for HCV infection were 2.71 (95% confidence interval [CI]: 2.24–3.26) for disability pensioners and 2.24 (95% CI: 1.83–2.72) for the unemployed. When compared to persons with a high income, ORs were 1.64 (95% CI: 1.34–2.01) for low income persons and 1.19 (95% CI: 1.02–1.40) for medium income persons. The OR was 1.35 (95% CI: 1.20–1.52) for low education (no more than basic schooling). When compared to employed patients, MRRs were 1.71 (95% CI: 1.22–2.40) for unemployed patients and 2.24 (95% CI: 1.63–3.08) for disability pensioners. When compared to high income patients, MRRs were 1.47 (95% CI: 1.05–2.05) for medium income patients and 1.64 (95% CI: 1.13–2.34) for low income patients. Educational status was not associated with mortality. Conclusion Low SES was associated with an increased risk of HCV infection and with poor prognosis in HCV infected patients.
Collapse
Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kjær T, Bøje CR, Olsen MH, Overgaard J, Johansen J, Ibfelt E, Steding-Jessen M, Johansen C, Dalton SO. Affiliation to the work market after curative treatment of head-and-neck cancer: a population-based study from the DAHANCA database. Acta Oncol 2013; 52:430-9. [PMID: 23282115 DOI: 10.3109/0284186x.2012.746469] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Survivors of squamous cell carcinoma of the head and neck (HNSCC) are more severely affected in regard to affiliation to the work market than other cancer survivors. Few studies have investigated associations between socioeconomic and disease-related factors and work market affiliation after curative treatment of HNSCC. We investigated the factors for early retirement pension due to disability and unemployment in patients who had been available for work one year before diagnosis. METHODS In a nationwide, population-based cohort study, data on 2436 HNSCC patients treated curatively in 1992-2008 were obtained from the Danish Head and Neck Cancer Group database and linked to Danish administrative population-based registries to obtain demographic and socioeconomic variables. We used multivariate logistic regression models to assess associations between socioeconomic factors (education, income and cohabitating status), cancer-specific variables such as tumour site and stage, comorbidity, early retirement pension and unemployment, with adjustment for age, gender and year of diagnosis. RESULTS Short education [odds ratio (OR) 4.8; 95% confidence interval (CI) 2.2-10.4], low income (OR 3.2; 95% CI 1.8-5.8), living alone (OR 3.0; 95% CI 2.1-4.4) and having a Charlson comorbidity index score of 3 or more (OR 5.9; 95% CI 3.1-11) were significantly associated with early retirement overall and in all site groups. For the subgroup of patients who were employed before diagnosis, the risk pattern was similar. Tumour stage was not associated with early retirement or unemployment. CONCLUSIONS Cancer-related factors were less strongly associated with early retirement and unemployment than socioeconomic factors and comorbidity. Clinicians treating HNSCC patients should be aware of the socioeconomic factors related to work market affiliation in order to provide more intensive social support or targeted rehabilitation for this patient group.
Collapse
Affiliation(s)
- Trille Kjær
- Survivorship, Danish Cancer Society Research Center, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Holm LV, Hansen DG, Larsen PV, Johansen C, Vedsted P, Bergholdt SH, Kragstrup J, Søndergaard J. Social inequality in cancer rehabilitation: a population-based cohort study. Acta Oncol 2013; 52:410-22. [PMID: 23320776 DOI: 10.3109/0284186x.2012.745014] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In a healthcare system with equal access we analysed possible associations between cancer survivors' socioeconomic status (SES) and their: 1) need for rehabilitation; 2) participation in rehabilitation activities; and 3) unmet needs for rehabilitation in a 14-month period following date of diagnosis. METHODS A population-based cohort study including incident cancer patients diagnosed from 1 October 2007 to 30 September 2008 in Denmark. Fourteen months after diagnosis participants completed a mailed out questionnaire developed to measure different aspects and dimensions of rehabilitation. Individual information on cohabitation status, education, income and labour market status was retrieved from national registers. Logistic regression analyses were used to explore associations between socioeconomic status and rehabilitation outcomes. RESULTS A total of 3439 patients responded (70%). Significant interactions between SES and sex were demonstrated and further analyses were therefore stratified for gender. In general, women and to a lesser extent men with short education and low income participated less often in activities and had in some areas more unmet needs. Women living alone more often expressed a rehabilitation need in the physical, emotional and financial area and had to a higher extent unmet needs in a number of areas. Men living alone and men outside the workforce had increased odds of unmet needs in the physical area. CONCLUSIONS Despite equal access to care, SES had a significant impact on cancer survivors' rehabilitation. In general, the associations were most pronounced for female cancer patients. We suggest that special attention should be paid to socioeconomically disadvantaged groups by taking into account differences in SES in a clinical setting and when developing targeted rehabilitation programmes.
Collapse
Affiliation(s)
- Lise Vilstrup Holm
- Research Centre for Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense C, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
All-Cause Mortality Among Men Whose Cohabiting Partner Has Been Diagnosed with Cancer. Epidemiology 2013; 24:96-9. [DOI: 10.1097/ede.0b013e318276cced] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Carlsen K, Harling H, Pedersen J, Christensen KB, Osler M. The transition between work, sickness absence and pension in a cohort of Danish colorectal cancer survivors. BMJ Open 2013; 3:bmjopen-2012-002259. [PMID: 23444446 PMCID: PMC3586129 DOI: 10.1136/bmjopen-2012-002259] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of socioeconomic and clinical factors on the transitions between work, sickness absence and retirement in a cohort of Danish colorectal cancer survivors. DESIGN Register-based cohort study with up to 10 years of follow-up. SETTING Population-based study with use of administrative health-related and socioeconomic registers. PARTICIPANTS All persons (N=4343) diagnosed with colorectal cancer in Denmark during the years 2001-2009 while they were in their working age (18-63 years) and who were part of the labour force 1 year postdiagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES By the use of multistate models in Cox proportional hazards models, we analysed the HR for re-employment, sickness absence and retirement in models including clinical as well as health-related variables. RESULTS 1 year after diagnosis, 62% were working and 58% continued until the end of follow-up. Socioeconomic factors were found to be associated with retirement but not with sickness absence and return to work. The risk for transition from work to sickness absence increased if the disease was diagnosed at a later stage (stage III) 1.52 (95% CI 1.21 to 1.91), not operated curatively 1.35 (95% CI 1.11 to 1.63) and with occurrence of postoperative complications 1.25 (95% CI 1.11 to 1.41). The opposite was found for the transition from sickness absence back to work. CONCLUSIONS This nationwide study of colorectal cancer patients who have survived 1 year shows that the stage of disease, general health condition of the individual, postoperative complications and the history of sickness absence and unemployment have an impact on the transition between work, sickness absence and disability pension. This leads to an increased focus on the rehabilitation process for the more vulnerable persons who have a combination of severe disease and a history of work-related problems with episodes outside the working market.
Collapse
Affiliation(s)
- Kathrine Carlsen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Henrik Harling
- Department of Surgery, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jacob Pedersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Merete Osler
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| |
Collapse
|
49
|
Hardell L, Carlberg M, Hansson Mild K. Use of mobile phones and cordless phones is associated with increased risk for glioma and acoustic neuroma. ACTA ACUST UNITED AC 2012; 20:85-110. [PMID: 23261330 DOI: 10.1016/j.pathophys.2012.11.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 12/20/2022]
Abstract
The International Agency for Research on Cancer (IARC) at WHO evaluation of the carcinogenic effect of RF-EMF on humans took place during a 24-31 May 2011 meeting at Lyon in France. The Working Group consisted of 30 scientists and categorised the radiofrequency electromagnetic fields from mobile phones, and from other devices that emit similar non-ionising electromagnetic fields (RF-EMF), as Group 2B, i.e., a 'possible', human carcinogen. The decision on mobile phones was based mainly on the Hardell group of studies from Sweden and the IARC Interphone study. We give an overview of current epidemiological evidence for an increased risk for brain tumours including a meta-analysis of the Hardell group and Interphone results for mobile phone use. Results for cordless phones are lacking in Interphone. The meta-analysis gave for glioma in the most exposed part of the brain, the temporal lobe, odds ratio (OR)=1.71, 95% confidence interval (CI)=1.04-2.81 in the ≥10 years (>10 years in the Hardell group) latency group. Ipsilateral mobile phone use ≥1640h in total gave OR=2.29, 95% CI=1.56-3.37. The results for meningioma were OR=1.25, 95% CI=0.31-4.98 and OR=1.35, 95% CI=0.81-2.23, respectively. Regarding acoustic neuroma ipsilateral mobile phone use in the latency group ≥10 years gave OR=1.81, 95% CI=0.73-4.45. For ipsilateral cumulative use ≥1640h OR=2.55, 95% CI=1.50-4.40 was obtained. Also use of cordless phones increased the risk for glioma and acoustic neuroma in the Hardell group studies. Survival of patients with glioma was analysed in the Hardell group studies yielding in the >10 years latency period hazard ratio (HR)=1.2, 95% CI=1.002-1.5 for use of wireless phones. This increased HR was based on results for astrocytoma WHO grade IV (glioblastoma multiforme). Decreased HR was found for low-grade astrocytoma, WHO grades I-II, which might be caused by RF-EMF exposure leading to tumour-associated symptoms and earlier detection and surgery with better prognosis. Some studies show increasing incidence of brain tumours whereas other studies do not. It is concluded that one should be careful using incidence data to dismiss results in analytical epidemiology. The IARC carcinogenic classification does not seem to have had any significant impact on governments' perceptions of their responsibilities to protect public health from this widespread source of radiation.
Collapse
Affiliation(s)
- Lennart Hardell
- Department of Oncology, University Hospital, SE-701 85 Örebro, Sweden.
| | | | | |
Collapse
|
50
|
Baldur-Felskov B, Kjaer SK, Albieri V, Steding-Jessen M, Kjaer T, Johansen C, Dalton SO, Jensen A. Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study. Hum Reprod 2012; 28:683-90. [PMID: 23223399 DOI: 10.1093/humrep/des422] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do women who don't succeed in giving birth after an infertility evaluation have a higher risk of psychiatric disorders compared with women who do? SUMMARY ANSWER The results indicated that being unsuccessful in giving birth after an infertility evaluation could be an important risk factor for psychiatric disorders. WHAT IS KNOWN ALREADY Several studies have investigated the association between fertility treatment and psychological distress, but the results from these studies show substantial variation and lack of homogeneity that may be due to methodological limitations. STUDY DESIGN, SIZE AND DURATION A retrospective cohort study was designed using data from a cohort of 98 320 Danish women evaluated for fertility problems during 1973-2008 and linked to several Danish population-based registries. All women were followed from the date of first infertility evaluation until date of hospitalization for the psychiatric disorder in question, date of emigration, date of death or 31 December 2008, whichever occurred first. Owing to the precise linkage between the infertility cohort and the Danish population-based registries, using the unique Danish personal identification number, virtually no women were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING AND METHODS Information on reproductive status for all women in the infertility cohort was obtained by linkage to the Danish Medical Birth Registry. A total of 53 547 (54.5%) women gave birth after the initial infertility evaluation, whereas 44 773 (45.5%) women did not gave birth after the evaluation. To determine psychiatric disorders diagnosed in the women after enrolment in the infertility cohort, the cohort was linked to the Danish Psychiatric Central Registry. A total of 4633 women were hospitalized for a psychiatric disorder. The Cox proportional hazard regression model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between parity status after the initial infertility evaluation and risk of hospitalization for various groups of psychiatric disorders, including 'all mental disorders' and six main discharge subgroups labelled: 'alcohol and intoxicant abuse', 'schizophrenia and psychoses', 'affective disorders', 'anxiety, adjustment and obsessive compulsive disorders', 'eating disorder' and 'other mental disorders'. MAIN RESULTS AND THE ROLE OF CHANCE The incidence rate for all mental disorders was 393 cases per 100 000 person-years among women who did not succeed in giving birth after the infertility evaluation but only 353 cases per 100 000 person-years among women who succeeded in giving birth after the infertility evaluation. Women not giving birth after the infertility evaluation had an increased risk of hospitalization for all mental disorders (HR 1.17, 95% CI 1.11; 1.25), alcohol and intoxicant abuse (HR 2.02, 95% CI 1.69; 2.41), schizophrenia and psychoses (HR 1.46, 95% CI 1.17; 1.82) and other mental disorders (HR 1.42, 95% CI 1.27; 1.58) compared with women who gave birth after the infertility evaluation. In contrast, the risk of affective disorders (HR 0.90, 95% CI 0.81; 0.99) was decreased among women not giving birth after the infertility evaluation. Finally, the risk of anxiety, adjustment and obsessive compulsive disorders (HR 1.07, 95% CI 0.97; 1.17) as well as of eating disorders (HR 1.40, 95% CI 0.88; 2.22) was not significantly affected by parity status after the infertility evaluation. LIMITATIONS, REASON FOR CAUTION As only psychiatric conditions warranting hospitalization could be included in the present study, the true incidence of all psychiatric disorders among women with fertility problems is likely to be somewhat underestimated. Furthermore, since detailed information on fertility treatment was not available for all cohort members the association between different modalities of assisted reproductive techniques and risk of psychiatric disorders was not assessed. WIDER IMPLICATIONS OF THE FINDINGS Clinicians and other healthcare personnel involved in diagnosis and treatment of women with fertility problems should be aware of the potential risk modification of psychiatric disorders associated with unsuccessful fertility treatment. Hence, our results may point to new aspects of follow-up of women with fertility problems who are unsuccessful in giving birth in order to prevent or identify and treat these possible psychological side effects. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Danish Cancer Society (award number: 96 222 54). All authors report no conflicts of interest.
Collapse
Affiliation(s)
- B Baldur-Felskov
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark
| | | | | | | | | | | | | | | |
Collapse
|