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Background Many colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL). Prediction models are useful tools for identifying survivors at risk of low HRQoL in the future and for taking preventive action. Therefore, we developed prediction models for CRC survivors to estimate the 1-year risk of low HRQoL in multiple domains. Methods In 1458 CRC survivors, seven HRQoL domains (EORTC QLQ-C30: global QoL; cognitive, emotional, physical, role, social functioning; fatigue) were measured prospectively at study baseline and 1 year later. For each HRQoL domain, scores at 1-year follow-up were dichotomized into low versus normal/high. Separate multivariable logistic prediction models including biopsychosocial predictors measured at baseline were developed for the seven HRQoL domains, and internally validated using bootstrapping. Results Average time since diagnosis was 5 years at study baseline. Prediction models included both non-modifiable predictors (age, sex, socio-economic status, time since diagnosis, tumor stage, chemotherapy, radiotherapy, stoma, micturition, chemotherapy-related, stoma-related and gastrointestinal complaints, comorbidities, social inhibition/negative affectivity, and working status) and modifiable predictors (body mass index, physical activity, smoking, meat consumption, anxiety/depression, pain, and baseline fatigue and HRQoL scores). Internally validated models showed good calibration and discrimination (AUCs: 0.83–0.93). Conclusions The prediction models performed well for estimating 1-year risk of low HRQoL in seven domains. External validation is needed before models can be applied in practice.

Background: Many colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL). Prediction models are useful tools for identifying survivors at risk of low HRQoL in the future and for taking preventive action. Therefore, we developed prediction models for CRC survivors to estimate the 1-year risk of low HRQoL in multiple domains. Methods: In 1458 CRC survivors, seven HRQoL domains (EORTC QLQ-C30: Global QoL; cognitive, emotional, physical, role, social functioning; fatigue) were measured prospectively at study baseline and 1 year later. For each HRQoL domain, scores at 1-year follow-up were dichotomized into low versus normal/high. Separate multivariable logistic prediction models including biopsychosocial predictors measured at baseline were developed for the seven HRQoL domains, and internally validated using bootstrapping. Results: Average time since diagnosis was 5 years at study baseline. Prediction models included both non-modifiable predictors (age, sex, socio-economic status, time since diagnosis, tumor stage, chemotherapy, radiotherapy, stoma, micturition, chemotherapy-related, stoma-related and gastrointestinal complaints, comorbidities, social inhibition/negative affectivity, and working status) and modifiable predictors (body mass index, physical activity, smoking, meat consumption, anxiety/depression, pain, and baseline fatigue and HRQoL scores). Internally validated models showed good calibration and discrimination (AUCs: 0.83-0.93). Conclusions: The prediction models performed well for estimating 1-year risk of low HRQoL in seven domains. External validation is needed before models can be applied in practice.

Oratie uitgesproken bij de aanvaarding van het ambt van bijzonder hoogleraar epidemiologie i.h.b. arbeidsepidemiologie aan Maastricht University, Faculty of Health, Medicine and Life Sciences

PURPOSE: Emerging evidence suggests that light physical activity (LPA), besides moderate-to-vigorous physical activity (MVPA), may beneficially influence physical functioning of colorectal cancer survivors, but its relation with other health-related outcomes is unknown. We applied a biopsychosocial approach to investigate independent associations between self-reported LPA, MVPA and multiple health-related quality of life (HRQoL) outcomes in 2-10y post-diagnosis colorectal cancer survivors. METHODS: Stage I-III colorectal cancer survivors diagnosed between 2002 and 2010 at Maastricht University Medical Center+, the Netherlands, were included in a cross-sectional study (n = 151). Time spent in LPA and MVPA (hours.week), and HRQoL outcome scores (0-100 points) were assessed by validated questionnaires. RESULTS: Median time spent in LPA and MVPA was 10.0 (interquartile range, 2.0-22.0) and 8.7 hours.week (4.5-15.0), respectively. In multivariable linear regression models, both LPA and MVPA were significantly and independently associated with higher physical functioning (mean difference [MD] between highest and lowest quartile, 10.2; 95% CI, 0.2 to 20.3; and 14.5; 5.1 to 23.9, respectively; both P-trend<0.05). Additionally, LPA was significantly associated with higher role functioning (MD, 19.5; 95% CI, 6.9 to 32.1; P-trend<0.01) and lower disability (MD, -9.9; 95% CI, -17.8 to -1.9; P-trend=0.02), independent from MVPA. Subgroup analyses showed that beneficial associations between LPA and HRQoL were mainly observed in women and participants with multiple comorbidities. CONCLUSION: Self-reported LPA, besides MVPA, was beneficially associated with multiple HRQoL outcomes in colorectal cancer survivors, especially in women and survivors with multiple comorbidities. Prospective studies are warranted to establish whether LPA is a suitable target for personalized lifestyle interventions to improve the HRQoL of colorectal cancer survivors.

PURPOSE: Employees experiencing a high need for recovery (NFR) are at risk of long-term adverse effects in both their health and labour participation. So far, the determinants of NFR across age categories remain unknown. The aim of this study is to investigate the determinants of the NFR among employees in three age categories (30-44, 45-54 and 55-65 years), for men and women separately. METHODS: The study was based on data from the prospective Maastricht Cohort Study. Wave T3 (May 1999) was chosen as article baseline (n = 7,900). The follow-up period of 20 months included five follow-up waves. Cox regression analyses were performed to investigate the determinants, which originated from the work environment, health and lifestyle and personal domain of employees, of NFR across age categories over time. RESULTS: Cross-sectional results demonstrated substantial differences in mean scores and proportion of cases of NFR across age categories. Longitudinal analyses demonstrated risk factors in the multifactorial aetiology of NFR that played a role in all age categories, but also showed several age-specific risk factors, e.g. low decision latitude appeared to be a risk factor only in the oldest age category. CONCLUSIONS: Although selection effects may have occurred, this study shows that the risk factors for a high NFR were different among the age categories. To prevent and reduce a high NFR among employees, it is important to develop preventive measures that target age-specific risk factors.

We explored whether overweight and obesity were associated with the physical and social environment at neighborhood level. Data from Maastricht municipality survey (the Netherlands) were used (n = 9771 adults). Multinomial regression models were computed (outcome being normal weight, overweight, or obese). We found inconsistent associations between neighborhood social and physical environment characteristics and overweight and obesity in the total sample. The effects were more consistent and stronger for older residents (> 65) and obesity as an outcome. Better scores on traffic nuisance, green space, social cohesion, nuisance, and safety were associated with lower odds of obesity among elderly (OR ranged between 0.71 [95 % CI 0.44 to 0.93] to 0.85 [95 % CI 0.74 to 0.96] for each point of improvement in neighborhood social and physical environment (scale 0-10)). We showed that there are neighborhood-level factors that are associated with obesity, particularly in elderly residents. These could be targeted in preventive strategies outside health care settings.