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Background The increasing colorectal cancer (CRC) survivor population highlights the need for dietary recommendations in order to enhance health-related quality of life (HRQoL) and alleviate symptoms of fatigue, chemotherapy-induced peripheral neuropathy (CIPN), and gastrointestinal problems. Objectives Because of the therapeutic potential of dietary fiber on the gut, we aim to assess longitudinal associations of postdiagnostic dietary fiber, fruit, and vegetable intake, a major source of dietary fiber, with HRQoL, fatigue, CIPN, and gastrointestinal symptoms in CRC survivors from 6 wk to 24 mo posttreatment. Methods In a prospective cohort among stage I–III CRC survivors (n = 459), 5 repeated study measurements between diagnosis and 24 mo posttreatment were executed. Dietary fiber intake and fruit and vegetable intake were measured by 7-d dietary records. HRQoL, fatigue, CIPN, and gastrointestinal symptoms were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 mo posttreatment and used hybrid models to disentangle the overall association into intraindividual changes and interindividual differences over time. Results Higher dietary fiber intake and fruit and vegetable intake were longitudinally associated with statistically significant better physical functioning and less fatigue. Intraindividual analyses showed that an increase of 10 g/d in dietary fiber within individuals over time was associated with better physical functioning (β: 2.3; 95% CI: 0.1, 4.4), role functioning (ability to perform daily activities; 5.9; 1.5, 10.3), and less fatigue (−4.1; −7.7, −0.5). An average increase in fruit and vegetable intake of 100 g/d between individuals over time was predominantly associated with less fatigue (−2.2; −4.2, −0.3). No associations were found with CIPN and gastrointestinal symptoms. Conclusions Our results suggest that increasing dietary fiber, fruit, and vegetable intake is related to better physical and role functioning and less fatigue in the first 2 y after the end of treatment for CRC. [ABSTRACT FROM AUTHOR]

Purpose: This study has aimed to evaluate the effects of surgery on physical activity (PA), quality of life (QoL), and disease-specific health status, by analyzing the differences between sphincter-preserving surgery (low anterior resection (LAR)) and abdominoperineal resection (APR) among rectal cancer survivors.Methods: Individuals who were diagnosed with rectal cancer and who underwent an APR or a LAR between 2000 and 2009 were included. The different questionnaires on QoL, disease-specific health status, and physical activity began their surveys in 2010. Differences in QoL, health status, and physical activity were analyzed between the APR group and the LAR group.Results: The study included 905 rectal cancer survivors (LAR, 632; APR, 273). Besides a higher rate of radiotherapy treatment in the APR group (94% vs. 75%, p < 0.001), there were no differences in clinical characteristics or in comorbid conditions between the LAR group and APR group. No significant differences were found in PA level between the patients who had undergone an APR vs. a LAR. Regarding QoL, APR patients did report a worse physical (p = 0.009) and role functioning (p = 0.03), as well as a worse body image (p = 0.001), compared to patients who had undergone a LAR. However, they reported fewer constipation (p = 0.02) and gastrointestinal problems (p = 0.009). Finally, compared to patients who had undergone a LAR with a permanent ostomy, APR patients reported a better body image (p = 0.048) and less stoma-related problems (p = 0.001).Conclusions: This study showed no differences in PA level among the patients who had undergone an APR versus a LAR. With respect to their QoL, their physical and role functioning seemed to be worse in the APR patients. However, these differences in outcomes resolved when comparing the APR group with patients after a LAR with a permanent ostomy. [ABSTRACT FROM AUTHOR]

Objective Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side-effect of chemotherapy. However, CIPN symptoms are also reported by patients not receiving chemotherapy. Normative data could help interpret CIPN among cancer patients. Our aim was to generate normative data for the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 Questionnaire designed to assess CIPN from the patients' perspective. The normative CIPN data have also been generated for stratified subgroups formed on the basis of sex, age and comorbidity. Methods The QLQ-CIPN20 and the Self-administered Comorbidity Questionnaire were administered to a representative panel of the Dutch-speaking population in the Netherlands. Results Two thousand one hundred and two (78%) of those invited completed the questionnaires. The majority reported no CIPN symptoms (83–97%). Cronbach's alpha coefficients for the sum score, and sensory, motor and autonomic subscales were 0.87, 0.76, 0.82 and 0.49, respectively. Compared with men, women scored significantly worse on the sum score (men, 3.0 versus women, 4.3; p < 0.001), motor scale (2.7 versus 5.1; p < 0.001) and autonomic scale (3.8 versus 5.2; p < 0.01), but this difference was not clinically relevant. CIPN symptoms increased significantly with age among both men (for the sum score and all scales) and women (for the sum score, sensory and motor scale). Those with self-reported comorbidities reported significantly more CIPN symptoms, both statistically and clinically, than those without. For instance, they had a lower mean sum score (1.5) compared to those with asthma/chronic obstructive pulmonary disease (COPD; 6.9), diabetes (5.9), heart disease (8.0), hypertension (6.2), osteoarthritis (9.6) and rheumatoid arthritis (13.8). Conclusions A low prevalence of neuropathy was observed in the normative population without cancer, although neuropathy did increase with age and the presence of comorbidities. These data (which is freely available) can aid in the interpretation of QLQ-CIPN20 scores and can help increase our understanding of the influence of age, sex and comorbid conditions on CIPN among cancer patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few studies specifically focus on fatigue of (long-term) colorectal cancer (CRC) survivors or compare fatigue levels with a normative population. Association between surviving multiple primary cancers and fatigue is also explored. Methods: Survivors diagnosed from 1998 to 2009 were identified from the Eindhoven Cancer Registry. In total, 3739 (79%) respondents and an age- and gender-matched normative population (n =338) completed questionnaires on fatigue and psychological distress. Results: More survivors reported feeling fatigued than the normative population (39% versus 22%, p <0.0001). Short-term survivors (<5 years post-diagnosis) had the highest mean fatigue scores compared with long-term survivors (⩾5 years post-diagnosis) or the normative population (21±7 versus 20±7 versus 18±5, p <0.0001, respectively). Having primary cancers prior to CRC was associated with more fatigue. Surgery+chemoradiation was independently associated with fatigue (odds ratio (OR): 1.63, 95% confidence interval (CI): 1.17–2.29, p =0.004) as were anxiety (OR: 1.16, 95% CI: 1.12–1.19, p <0.0001) and depressive symptoms (OR: 1.38, 95% CI: 1.33–1.43, p <0.0001). Conclusions: Fatigue is a significant problem, especially for short-term CRC survivors. The association between chemoradiation and fatigue suggests that patients could benefit from better information on treatment side-effects. When treating fatigue, clinical care should also focus on survivors’ psychological needs, especially survivors of multiple primary cancers. [Copyright &y& Elsevier]

Abstract: Objective: To examine the association between Type D personality and illness perceptions among colorectal cancer survivors 1–10years post-diagnosis. Methods: Data from two population-based surveys on colorectal cancer survivors was used. Patients diagnosed between 1998 and 2009, as registered in the Eindhoven Cancer Registry, received a questionnaire on Type D personality (DS14) and illness perceptions (B-IPQ); 81% (n =3977) responded. Results: 750 (19%) patients had a Type D personality. They believe their illness has significantly more serious consequences, will last significantly longer, and experience significantly more symptoms that they attribute to their illness. Also, they are more concerned about their illness, and their disease more often influences them emotionally. Differences regarding ‘consequences’, ‘concern’ and ‘emotional response’ were also clinically relevant. The majority of patients stated that the cause of their disease was unknown (23.3%), hereditary (20.3%), lifestyle (15.1%), psychological distress (11.9%) or other (11.6%). Significant differences in perceptions on cause of disease between Type Ds and non-Type Ds were found for psychological distress (16.2 vs. 10.9%; p <0.01), randomness (1.7 vs. 5.3%; p <0.01) and unknown (18.8 vs. 24.4%; p <0.01). Multivariate analyses showed that Type D was negatively associated with ‘coherence’ and positively with ‘consequences’, ‘timeline’, ‘identity’, ‘concern’, and ‘emotional representation’. Conclusions: These results elucidate the associations between personality and illness perceptions, demonstrating their close interrelatedness. Our study may be helpful in further developing theoretical models regarding giving meaning to illness and the illness perceptions that the illness elicits. Future studies should investigate whether interventions can positively impact illness perceptions of Type D cancer patients. [Copyright &y& Elsevier]

Abstract: Introduction: The goal of this large population-based study was to examine the socio-economic implications of cancer survivorship. Methods: Individuals alive and diagnosed with colorectal cancer and melanoma between 1998 and 2007 or Hodgkin lymphoma, non-Hodgkin lymphoma or multiple myeloma between 1999 and 2008 as registered in the Eindhoven Cancer Registry received a questionnaire on work changes and problems with obtaining a new (or extended) health care insurance, life insurance or a home loan; 70% (n =2892) responded. Results: Results showed that 28% of all cancer patients experienced changes in their work situation after cancer. Most of them switched to part-time work or stopped working entirely. Patients (3.4%) who tried to obtain a different or upgrade their health care insurance experienced problems and in most cases, these were eventually resolved. Problems with life insurance were somewhat more common with 18% of those who tried to obtain a life insurance experiencing problems. The majority of these patients was rejected by the insurance company (61%) or was accepted at a higher premium (22%). Of the 21% who tried to obtain a home loan, 9% experienced problems. However, 22.2% got accepted eventually, 27.8% got accepted but at a higher mortgage payment and 22.2% got rejected but were eventually accepted by another bank. Conclusions: Almost a third of cancer survivors experienced changes in their work situation after cancer. Problems with obtaining health insurance, life insurance and home loans were also common. [Copyright &y& Elsevier]

Abstract: Objective: Cancer survivors often report comorbid diseases, but there are individual differences in risk. Type D personality is a general propensity to psychological distress that is related to poor cardiovascular outcomes. In this study, we examined whether type D was also related to comorbidity burden and health care utilization among cancer survivors. Methods: Individuals diagnosed with endometrial cancer or colorectal cancer between 1998 and 2007, or with lymphoma or multiple myeloma between 1999 and 2008 as registered in the Eindhoven Cancer Registry, received the Self-Administered Comorbidity Questionnaire, questions on health care utilization and the Type D personality scale; 69% (n=3080) responded. Results: Nineteen percent of survivors had a type D personality. Over a 12-month period, type D survivors significantly more often reported osteoarthritis, back pain, and depression than non–type D survivors. Also, type D survivors more often reported to feel bothered by high blood pressure, osteoarthritis, heart disease, depression, diabetes and lung disease during daily activities. Type D survivors more often visited their general practitioner than non–type D survivors (P<.001), also in relation to cancer (0 visits: 54% vs. 60%; 1–5: 28% vs. 22%; >5: 9% vs. 5%; P<.001), as well as their specialist (0 visits: 6% vs. 7%; 1–5 visits: 59% vs. 64%; >5 visits: 30% vs. 23%; P<.01). Conclusion: Type D personality is a vulnerability factor that may help to identify subgroups of cancer survivors who are at an increased risk for comorbidity burden and increased health care utilization. [Copyright &y& Elsevier]

Abstract: Background: This population-based study assessed the impact of chemotherapy on general and disease-specific health status of resected colon cancer survivors up to 10years post-diagnosis. Patients and methods: Colon cancer survivors diagnosed between 1998 and 2007 were selected from the Eindhoven Cancer Registry. Survivors completed the SF-36 and the EORTC colorectal module (EORTC-QLQ-CR38). Comparisons to a normative population were conducted. Multiple linear regression analyses investigated the association between treatment and health status. Results: Eight hundred and forty eight survivors were evaluated: 29% had chemotherapy (CT); 71% without chemotherapy (nCT). Survivors had similar SF-36 scores and scored better than the normative population on several domains. On the EORTC-QLQ-CR38, male nCT survivors had more sexual problems than CT survivors (p =0.01). Among the sexually active respondents, the survivors reported sex to be less enjoyable than the normative population (p =0.02). In multivariate analyses, CT predicted better physical function, and less male sexual dysfunction and weight loss problems than nCT. Conclusions: Overall, CT survivors have general health status scores comparable to nCT survivors and the normative population up to 10years since initial diagnosis. Sex-related problems among survivors suggest more attention on this often sensitive issue is required in clinical management. [Copyright &y& Elsevier]

Abstract: Aim: The aim of the present study was to generate Dutch reference data for the EORTC QLQ-C30 and for five sexuality items from the EORTC QL-item bank. Furthermore, to evaluate the relative impact of self-reported health problems on these outcomes and compare the Dutch normative EORTC QLQ-C30 overall QoL with available Scandinavian and German normative data. Methods: QLQ-C30 and sexual item normative data were obtained from the Health and Health Complaints project from CentERdata. The CentERpanel is an online household panel consisting of more than 2000 Dutch households, representative of the Dutch-speaking population in the Netherlands. Results: The questionnaire was completed by 1731 (78%) CentERpanel members. For both men and women, functional health (except emotional functioning) decreased with age, and the symptoms pain and fatigue increased with age. Men scored statistically but never clinically significantly better on most functional scales than women. Men reported higher levels of sexual interest and activity than women. All subgroups of participants with health problems reported lower physical and role functioning and overall quality of life (QoL). Those with depression (n =79) reported functioning scores 20–30 points lower than participants without any condition. Dutch men and women reported high levels of overall QoL as compared to previously published Scandinavian and German normative data. Conclusion: Age, gender and other health problems are important when comparing QoL and sexuality among different cancer cohorts. Normative data on QoL and sexuality are needed to interpret QoL issues among the growing group of (long-term) cancer survivors. [Copyright &y& Elsevier]

Objective: To explore whether socioeconomic status (SES) was associated with health-related quality of life (HRQL) and health care use among long-term prostate cancer survivors. Patients and Methods: Through urologists in the Comprehensive Cancer Center South, all 5- to 10-year prostate cancer survivors known in the Eindhoven Cancer Registry without disease progression were invited to complete the 36-item Short Form Health Survey (SF-36), the Expanded Prostate Cancer Index, and the Dutch sexual activities module. Multivariate linear regression assessed the effect of SES (based on home value and household income) on HRQL and health care use. Results: Five-hundred eighty-four patients (response rate 81%) were included. Survivors with a low SES exhibited lower mental SF-36 scores (6–16 points on a 0–100 scale), independent of sociodemographic and clinical characteristics (P <.05), and hardly any differences in physical SF-36 subscales, sexual function, and urinary and bowel function and bother. Presence of serious comorbidity had a stronger predictive value for HRQL than SES. Health care use did not seem to be associated with SES. Conclusions: Prostate cancer survivors with a low SES exhibited a worse mental but not physical HRQL than those with a higher SES. Long-term health outcomes of patients with low SES may be maximized by paying extra attention to comorbid conditions. [Copyright &y& Elsevier]

Abstract: Objective: We aimed to investigate the prevalence of Type D personality (the conjoint effects of negative affectivity and social inhibition) among melanoma survivors and to obtain insight into its effects on health status, impact of cancer and health care utilisation. Methods: We selected all patients diagnosed with melanoma between 1998 and 2007 from three large regional hospitals in the Netherlands. In total, 699 survivors, alive in January 2008, received a questionnaire including Type D personality scale (DS14), impact of cancer questionnaire (IOC) and SF-36 and 80% responded (n =562). Results: Twenty-two percent of survivors (n =125) were classified as Type D. They reported a clinically and statistically significant worse general health (57.8 versus 75.6), social functioning (73.1 versus 88.7), mental health (61.7 versus 80.6), more emotional role limitations (67.8 versus 89.4) and less vitality (54.5 versus 72.8) than non-Type D patients. Additionally, they reported a statistically and clinically relevant higher impact of cancer on body changes, negative self-evaluation, negative outlook on life, life interferences and health worry. Furthermore, they were more worried about the influence of the sun on their skin and acted accordingly. No differences were found in health care utilisation. Conclusions: Type D personality has a distinct negative impact on health status in melanoma survivors and is an important factor to screen for in clinical practice. Giving special attention to these patients is important while they are more likely to experience a strong impact of cancer which cannot be explained by socio-demographical or clinical characteristics. [Copyright &y& Elsevier]

Abstract: Objective: This article reviews all available literature concerning the implications of Type D personality (the conjoint effects of negative affectivity and social inhibition) among patients with noncardiovascular conditions. Methods: Published papers were included if they studied Type D personality among noncardiovascular patient populations. Twelve articles met our inclusion criteria and were subjected to a methodological quality checklist (e.g., sample size, response rate, Type D measurement). Results: The methodological quality of the selected studies was quite good. The noncardiovascular patient populations included chronic pain, asthma, tinnitus, sleep apnea, primary care patients, vulvovaginal candidiasis, mild traumatic brain injury, vertigo, melanoma and diabetic foot syndrome. Type D personality was associated with an increased number or severity of reported health complaints, heightened the perception of negative emotions (e.g., depression and anxiety), had an adverse effect on health-related behaviors, was associated with poor adherence to treatment and significantly reduced effort to perform during diagnostic testing. Conclusion: Type D is a vulnerability factor that not only affects people with cardiovascular conditions but also those with other medical conditions. Type D was associated with poor physical and mental health status and poor self-management of the disease. Consequently, including Type D in future studies seems warranted. [Copyright &y& Elsevier]

Objective: To further document the experienced burden in patients with peripheral arterial disease (PAD), we compared the health status of patients with PAD and chronic heart failure (CHF). As a secondary aim, we studied clinical and socio-demographic correlates of health status in both conditions. Methods: We conducted a cross-sectional observational study in four outpatient clinics in the Southern part of The Netherlands, with subjects consisting of ambulatory (346 PAD and 188 CHF) patients. All patients completed the Short-Form 12 to assess their physical and mental health status. Information about socio-demographic, clinical risk factors, and disease severity indices was obtained from patients'' medical records. Propensity methodology was applied to enhance comparability between both medical conditions. Results: Type of medical condition explained differences in health status (F = 33.1, P < .0001, Effect Size = 0.27). Impaired physical health status was more often reported in PAD patients (48.4%) compared with CHF patients (17.4%, Odds Ratio [OR] = 4.4, 95% Confidence Interval [CI] 2.3-8.8, P < .0001); impaired mental health status was more noted in CHF patients (43.5% vs. 22.0%, OR = 1.7, 95% CI 1.2-2.6, P = .002). In PAD, younger age (P = .002), low education (P = .02), cardiac history (P = .02), diabetes mellitus (P = .03), and a lower ankle brachial index (P = .003) were associated with worse physical health status; younger age (P = .01) and living without partner (P = .01) were associated with lower mental health status scores. In CHF, patients with comorbid diabetes mellitus (P < .001) and females (P = .001) reported worse physical health, whereas no clinical or socio-demographics were associated with mental health status. Conclusions: By contrasting PAD patients'' health status with another chronic disabling condition, the impact of PAD on patients'' physical health status became evident; whereas mental health status was more affected in CHF, patients with PAD reported a greater physical burden as compared with CHF patients. PAD patients who were younger, lower-educated, without a partner or had a cardiac history especially reported a higher disease burden. Clinicians need to be aware of these differences in order to develop tailor-made disease management programs for different groups of cardiovascular patients. [Copyright &y& Elsevier]

Purpose: To obtain insight into the long-term (5- to 10-year) effects of prostate cancer and treatment on bowel, urinary, and sexual function, we performed a population-based study. Prostate-specific function was compared with an age-matched normative population without prostate cancer. Methods and Materials: Through the population-based Eindhoven Cancer Registry, we selected all men diagnosed with prostate cancer between 1994 and 1998 in the southern Netherlands. In total, 964 patients, alive in November 2004, received questionnaire; 780 (81%) responded. Results: Urinary problems were most common after a prostatectomy; bowel problems were most common after radiotherapy. Compared with an age-matched normative population both urinary and bowel functioning and bother were significantly worse among survivors. Urinary incontinence was reported by 23–48% of survivors compared with 4% of the normative population. Bowel leakage occurred in 5–14% of patients compared with 2% of norms. Erection problems occurred in 40–74% of patients compared with 18% of norms. Conclusions: These results form an important contribution to the limited information available on prostate-specific problems in the growing group of long-term prostate cancer survivors. Bowel, urinary, and sexual problems occur more often among long-term survivors compared with a reference group and cannot be explained merely by age. Because these problems persist for many years, urologists should provide patients with adequate information before treatment. After treatment, there should be an appropriate focus on these problems. [Copyright &y& Elsevier]

Abstract: Background: The consequences of cancer and its treatment on health-related quality of life (HRQL) and health care utilisation among elderly long-term cancer survivors have rarely been studied. However, the impact can be different for older compared to younger patients due to the higher prevalence of comorbid diseases, a higher risk of treatment-related complications and because they often receive different therapies compared to younger patients. Therefore, this study addressed the following questions; do HRQL and health care utilisation differ between younger and elderly cancer survivors, and are those differences age or disease related. Methods: A population-based, cross-sectional survey among 1893 long-term survivors of endometrial cancer, prostate cancer and non-Hodgkin’s lymphoma was conducted using a cancer registry. HRQL was measured by the SF-36 and health care utilisation was measured with a self-reported questionnaire. Results were compared to a normative population. Patients with disease progression were excluded resulting in a total number of 1112 patients to be analysed. Results: Young non-Hodgkin lymphoma survivors (<70 years) reported lower vitality, bodily pain and general health compared to the normative population while older (⩾70 years) survivors did not differ from the norm. Young lymphoma survivors experienced better physical functioning compared to older survivors. Young endometrial cancer survivors experienced less bodily pain compared to the normative population while older survivors did not differ from the norm. Young endometrial cancer survivors experienced better physical and role functioning compared to older survivors. Young prostate cancer survivors reported less bodily pain compared to the norm while older survivors did not. Young prostate cancer survivors reported higher scores on physical functioning compared to older survivors. Age, comorbid diseases, educational level and current occupation influenced HRQL significantly. Both younger and older cancer survivors visited their medical specialist, but not their GP, significantly more often compared to the age-matched general Dutch population. Both younger and older cancer survivors only sporadically used additional care services after cancer treatment. Discussion: HRQL of older and younger survivors is comparable, with the exception of physical functioning which is lower in older survivors. This difference in physical functioning was probably not caused by cancer because physical functioning among cancer survivors did not differ much compared to an age-matched normative population. Both younger and older long-term cancer survivors visited their medical specialist often but only sporadically used additional care services after cancer treatment. [Copyright &y& Elsevier]

Purpose: To compare the health-related quality of life (HRQOL) among 5–10-year survivors of Stage I-II endometrial (adeno-)carcinoma (EC) treated with surgery alone or surgery with external beam adjuvant radiotherapy (EBRT) and an age-matched norm population. Methods and Materials: A population-based, cross-sectional survey was conducted by the Eindhoven Cancer Registry. All patients were included who had been diagnosed with EC between 1994 and 1998 (n = 462). Information from the questionnaires returned was linked to data from the Eindhoven Cancer Registry on patient, tumor, and treatment characteristics. Results: Responses were received from 75% of the patients. The analyses were restricted to women with Stage I-II disease at diagnosis, treated with either surgery alone or surgery with adjuvant EBRT, and without recurrent disease or new primary malignancies (n = 264). The patients who had received adjuvant EBRT (n = 80) had had a significantly higher tumor stage and grade at diagnosis (p < 0.0001) and a longer mean time since diagnosis (p = 0.04). Age, number of comorbid diseases, current marital status, nulliparity, education, and occupation were similar for both treatment groups. On multivariate analyses, adjuvant EBRT was independently and negatively associated with the vitality and physical and social well-being scale scores. The HRQOL scores of both treatment groups, however, were similar to those of an age-matched norm population. Conclusion: In general, the HRQOL of EC survivors is good. EC survivors treated with surgery alone had a better HRQOL than women treated with surgery and adjuvant EBRT, although for both groups, the HRQOL was in the range of the norm population. [Copyright &y& Elsevier]

Abstract: This study describes the quality of life (QoL) of long-term Hodgkin’s lymphoma survivors and compares it to an age-matched normative sample. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with Hodgkin’s lymphoma from 1989 to 1998. Eighty percent of survivors completed the SF-36 and the quality of life-cancer survivors questionnaire. QoL was better among patients diagnosed 10–15 years ago compared to patients diagnosed 5–9 years ago. The patients diagnosed 5–9 years ago experienced lower general health, social functioning, mental health and vitality compared to an age-matched normative sample, while the patients diagnosed 10–15 years earlier reported lower general health but better physical functioning. Most patients reported that their work situation did not change. Problems pertaining to the obtainment of health insurance, life insurance and mortgages were high. QoL among Hodgkin’s lymphoma survivors is lower compared to an age-matched normative sample. Survivors furthermore experience some (financial) problems in the years after diagnosis. [Copyright &y& Elsevier]

Abstract: The aim of this study was to review the literature on quality of life among long-term survivors of breast cancer and identify the specific aspects of quality of life that were affected in these survivors. We also describe predictors of quality of life. Published research reports were included if they described the quality of life of breast cancer survivors diagnosed at least five years earlier. The methodological quality of the 10 selected studies, conducted between 1997 and 2004, was high according to a list of predefined criteria. Most studies reported that long-term survivors of breast cancer experienced good overall quality of life. However, almost all studies reported that breast cancer survivors experienced some specific problems (e.g., a thick and painful arm and problems with sexual functioning). The current medical condition, amount of social support and current income level were strong positive predictors of quality of life, and the use of adjuvant chemotherapy emerged as a negative predictor. More research on the specific medical and psychosocial needs of survivors is needed in order to be able to design appropriate intervention studies. If anything, this review shows that focusing on the long-term effects of breast cancer is important when evaluating the full extent of cancer treatment. [Copyright &y& Elsevier]

Previous reports highlight the greater number of side effects that women experience during cancer treatment, but little is known about sex differences in symptoms and functioning in long-term survivors. We investigated sex differences in the prevalence of physical (EORTC QLQ-C30) and emotional symptoms (Hospital Anxiety and Depression Scale) and loss of functioning (EORTC QLQ-C30) in 5339 cancer survivors (55% males). General linear models were computed to assess the differences in symptoms and functioning between female and male cancer survivors and between survivors and an age-matched reference population. The direct comparison between female and male cancer survivors identified more symptoms, such as nausea and vomiting (M = 5.0 versus. 3.2), insomnia (M = 26.1 versus. 15.9), anxiety (M = 5.2 versus. 4.2), and lower physical (M = 77.5 versus. 82.5) and emotional functioning (M = 83.4 versus. 86.3), in female survivors. However, comparison with an age-matched reference population demonstrated that several symptoms, such as fatigue, dyspnea, anxiety and depression, appeared to be more frequent in male patients. The investigation of functioning domains — compared with a reference population — highlighted further sex-specific differences. Female survivors experienced a moderate net loss in physical and cognitive functioning (−6.1 [95% CI = −8.1; −4,1] and −5.2 respectively [95% CI = −7; −3.5]), whereas male survivors displayed a significant net loss in role and social functioning compared to the reference population (−9.9 [95% CI = −11.2; −8.6] and −7.7 [95% CI = −9.6; −7.6] respectively). To adequately capture sex differences in symptoms and functioning in long-term cancer survivors, a comparison with a reference population should always be considered. In our study population, this adjustment highlighted a significant and unexpected long-term impact on male patients. Role and social functioning were especially impacted in male patients, emphasizing the need to further investigate these gendered domains. • Long-term cancer survivors report sex-specific symptoms and functional impairments. • Comparison with age-and sex-matched reference group showed more impairment in males. • Loss of role and social functioning in males could represent a loss of gender role. [ABSTRACT FROM AUTHOR]

Abstract Objective Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, feelings, and behaviors associated with physical symptoms. DSM-5 criteria for SSD focus on these psychological features (criterion B) rather than the presence or absence of an identifiable medical disorder. This study examines the role of medical disorder in the assessment of SSD and associations of SSD with health care utilization. Method Participants (N = 448, mean age 46.7 ± 16.9 years, 53.8% women) were recruited from the general community and completed the SSD-12 to quantify DSM-5 Criterion B for SSD. Participants also provided demographic and medical background information. Results The SSD-12 total score was elevated in individuals with a major medical disorder (N = 97: cardiovascular disease, cancer, pulmonary disease or other: SSD-12 = 11.6 ± 8.8), and also among those with medical conditions commonly treated in primary care (N = 46: e.g., migraine, asthma: SSD-12 = 8.3 ± 7.1), compared to those free of these disorders (SSD-12 = 5.8 ± 7.0), which remained significant in age- and sex-adjusted models. Normative values are reported. High SSD-12 scores (≥15) were associated with more health care utilization (adjusted OR primary care visits = 3.35, 95%CI = 1.64–6.87). Conclusions The SSD-12 is a useful tool for the assessment of SSD. Medical comorbidity is associated with higher SSD-12 scores. Future studies are needed to determine whether SSD is more common in medical patients or whether correction of normative values is needed for screening purposes. [ABSTRACT FROM AUTHOR]

Purpose: To date, few studies have evaluated the impact of preoperative radiotherapy (pRT) on long-term health status of rectal cancer survivors. Using a population-based sample, we assessed the impact of pRT on general and disease-specific health status of rectal cancer survivors up to 10 years postdiagnosis. The health status of older (≥75 years old at diagnosis) pRT survivors was also compared with that of younger survivors. Methods and Materials: Survivors identified from the Eindhoven Cancer Registry treated with surgery only (SU) or with pRT between 1998 and 2007 were included. Survivors completed the Short Form-36 (SF-36) health survey questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Colorectal 38 (EORTC QLQ-CR38) questionnaire. The SF-36 and EORTC QLQ-CR38 (sexuality subscale) scores of the survivors were compared to an age- and sex-matched Dutch normal population. Results: A total of 340 survivors (response, 85%; pRT survivors, 71%) were analyzed. Overall, survivors had similar general health status. Both short-term (<5 years) and long-term (≥5 years) pRT survivors had significantly poorer body image and more problems with gastrointestinal function, male sexual dysfunction, and defecation than SU survivors. Survivors had comparable general health status but greater sexual dysfunction than the normal population. Older pRT survivors had general and disease-specific health status comparable to that of younger pRT survivors. Conclusions: For better survivorship care, rectal cancer survivors could benefit from increased clinical and psychological focus on the possible long-term morbidity of treatment and its effects on health status. [ABSTRACT FROM AUTHOR]

Purpose: In a population-based sample of cervical cancer survivors, health-related quality of life (HRQoL) was assessed 2–10 years postdiagnosis. Methods and Materials: All patients given a diagnosis of cervical cancer in 1995–2003 in the Eindhoven region, The Netherlands, and alive after Jan 2006 were identified through the cancer registry. Generic HRQoL (36-Item Short-Form Health Survey, EQ-5D), cervical cancer–specific HRQoL (European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module), and anxiety (6-item State Trait Anxiety Inventory) were assessed and compared with a reference population (n = 349). Data for tumor characteristics at diagnosis and disease progression were available. Results: A total of 291 women responded (69%), with a mean age of 53 ± 13 (SD) years (range, 31–88 years). Treatment had consisted of surgery (n = 195) or a combination of therapies (n = 75); one woman had not been treated. Of all women, 85% were clinically disease free, 2% had a recurrence/metastasis, and in 13%, this was unknown. After controlling for background characteristics (age, education, job and marital status, having children, and country of birth), generic HRQoL scale scores were similar to the reference population, except for worse mental health in survivors. The most frequent symptoms were crampy pain in the abdomen or belly (17%), urinary leakage (15%), menopausal symptoms (18%), and problems with sexual activity. Compared with the 6–10-year survivors, more sexual worry and worse body image were reported by the 2–5-year survivors. Compared with surgery only, especially primary radiotherapy was associated with an increased frequency of treatment-related side effects, also after controlling for age and disease stage at diagnosis and follow-up. Conclusions: Most cervical cancer survivors were coping well, although their mental health was worse than in the reference population. Even after 2–10 years, radiotherapy was associated with an increased frequency of treatment-related side effects. [Copyright &y& Elsevier]

Highlights from the article: Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, feelings, and behaviors associated with physical symptoms. This study examines whether SSD in the general population is associated with health care utilization, independent of the presence of medical disorders. Future longitudinal studies are needed to determine differential predictive value of clinically diagnosed SSD versus elevated SSD questionnaire sores as related to health care utilization and which interventions will be beneficial in reducing individual burden and health care costs.

Objective Our goal was to examine whether Type D personality and its components, negative affectivity (NA) and social inhibition (SI), were associated with all-cause mortality among colorectal cancer (CRC) patients.Methods: CRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received a questionnaire on Type D (DS14) on average 5.3years after diagnosis. Survival status (31-12-2013) was obtained from the Central Bureau for Genealogy. We used a Cox proportional hazard model to relate personality to all-cause mortality, while adjusting for demographics, clinical characteristics and cardiovascular disease (CVD).Results: Fifty percent was categorized as the 'reference group' (n=1281), 17% as 'SI only' (n=421), 12% as 'NA only' (n=309), and 21% as 'Type D' (n=532). After adjustment, CRC patients in the 'NA only' and 'Type D' groups showed an increased risk (HR=2.0, 95% CI=1.4-2.8, p<0.01, and HR=1.7, 95% CI=1.3-2.4, p<0.01) for all-cause mortality. This adverse effect of NA was limited to men aged >70. There was an additional adverse effect of SI on all-cause mortality in older men without CVD (HR=2.3, 95% CI=1.2-4.4, p=0.01). Personality was not related to mortality in women. Entering personality continuously, showed an increased risk for NA among older survivors, men and patients with comorbid CVD. Neither SI nor the interaction term was predictive in both the un- and adjusted Cox models.Conclusion: Our findings suggest that it is the NA component that drives the adverse effect of psychological distress on survival in CRC patients, which is most prominent among older men. [ABSTRACT FROM AUTHOR]

Background The goal of this study was to compare health related quality of life (HRQoL) and disease-specific symptoms between colon cancer patients treated with surgery only (SU) and surgery and adjuvant chemotherapy (SU + adjCT). Results were stratified for those aged <70 and ⩾70 years. HRQoL of patients was also compared with an age- and sex-matched normative population. Methods Patients diagnosed with colon cancer between January 2000 and June 2009, as registered within the population-based Eindhoven Cancer Registry, received a questionnaire on HRQoL (European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire version 3.0 (QLQ-C30)) and disease-specific symptoms (EORTC QLQ-Colorectal 38 (EORTC QLQ-CR38)) in 2010. The first was also completed by the normative population ( n = 685). Results 1606 (72%) colon cancer survivors responded to our questionnaire. 1542 colon cancer patients treated with SU ( n = 1031) or SU + adjCT ( n = 493) were included in this study. In colon cancer patients aged <70 years and aged ⩾70 no statistical significant differences on the subscales of the EORTC QLQ-C30 or the EORTC QLQ-CR38 were observed between patients treated with SU and SU + adjCT. Colon cancer patients aged <70 years either treated with SU or SU + adjCT reported significantly more insomnia, diarrhoea and financial problems compared with the normative population. No differences in HRQoL were found between colon cancer patients aged ⩾70 years either treated with SU or SU + adjCT and the normative population. Conclusion No differences in HRQoL and disease-specific symptoms were found between patients treated with SU versus SU + adjCT in both younger and elderly colon cancer patients. Withholding patients adjCT, based on concerns for long-term HRQoL or disease-specific symptoms does therefore not seem plausible. [ABSTRACT FROM AUTHOR]

Abstract: ‘Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES)’ is a registry for the study of the physical and psychosocial impact of cancer and its treatment from a dynamic, growing population-based cohort of both short and long-term cancer survivors. PROFILES contains a large web-based component and are linked directly to clinical data from the population-based Eindhoven cancer registry. This paper describes the rationale and design of PROFILES. The primary aims of studies that use the PROFILES registry are: (1) psychosocial risk and outcome assessment to identify patients at high risk for poor physical and mental health outcomes, (2) to analyse mediating mechanisms to better understand the biological and behavioural factors associated with cancer treatment outcomes, and (3) to evaluate physical and psychosocial care needs of cancer survivors. PROFILES is a tool that enables data collection management; from inviting patients to participation in studies, to collecting patient-reported outcomes data via web-based or mailed questionnaires and linking these data with clinical data. The availability of a control cohort of approximately 2000 persons from the general population who complete the same basic questionnaire annually will provide the opportunity to estimate the unique impact of cancer, beyond that of normal ageing and comorbidities. Raw data from the PROFILES registry will be available for non-commercial scientific research, subject to study question, privacy and confidentiality restrictions, and registration (www.profilesregistry.nl). [Copyright &y& Elsevier]

Objectives: To prospectively investigate the influence of 3-month neoadjuvant hormonal therapy (NHT) before brachytherapy (BT) for low-risk prostate cancer (PCa) on urinary function and health-related quality of life (HRQL). Methods: Between 2003 and 2008, 300 patients with PCa were treated with BT using 125I stranded seeds, of whom 86 received 3-month NHT to downsize the prostate before treatment. Urinary complaints were measured on all occasions with the International Prostate Symptom Score (n = 134) and European Organization for Research and Treatment of Cancer—Quality of Life Questionnaire PR25 (EORTC-QLQ-PR25 questionnaire; n = 118) and HRQL with the EORTC-QLQ-C30 (n = 120) questionnaire. Results: Post-BT, urinary function became worse over the first 6 weeks and then improved steadily, but did not return to baseline levels at 1 year. At baseline, the NHT group reported worse urinary function compared with the non-NHT group (P < .01). However, the post-BT improvement of urinary function was better in the NHT group at 3 months (P < .05). Global HRQL, physical, role and social functioning decreased over the first 3 months (P < .05) post-BT but returned to baseline levels within 1 year. Emotional function steadily improved over the 1-year follow-up period (P < .001). The NHT group reported better global HRQL, social and emotional functioning 1 year post-BT compared with baseline (P < 05). All results were adjusted for comorbidity. This is a single-center study with a follow-up of 1 year, thereby potentially limiting the general applicability of the results. Conclusions: Three months of NHT before BT might positively influence urinary function and HRQL up to 1 year post-BT. Therefore, PCa patients should not be dissuaded from considering NHT followed by BT because of prostate size. [Copyright &y& Elsevier]

Abstract: Background: The general introduction of HPV vaccination, as the primary prevention of cervical cancer, is the subject of debate in the Netherlands. Methods: We explored intentions towards HPV vaccinations for pre-adolescents in 1367 women; screen invitees, women with abnormal smears, cervical cancer survivors, and a reference group. Results: 76% (screen invitees) to 81% (women with abnormal smears) said ‘yes’ to vaccinations, often motivated by ‘prevention is better than cure’. Multivariate logistic regression showed that younger women were more positive than older women. Intentions were not related to education, job, marital status or having children. Both women who were pro and anti-HPV vaccinations expressed concerns about long-term effectiveness and side effects. Comments such as ‘cervical cancer runs in the family’ demonstrated confused knowledge. Conclusions: Most respondents had a positive intention towards HPV vaccinations, but intention was lower than actual childhood vaccination uptake in the current National Immunisation Programme (95%). Uncertainties about long-term effectiveness and side effects were the major causes of doubt. [Copyright &y& Elsevier]