Publications by authors named "Pernille Envold Bidstrup"

53 Publications

The development and initial validation of the Breast Cancer Recurrence instrument (BreastCaRe)-a patient-reported outcome measure for detecting symptoms of recurrence after breast cancer.

Qual Life Res 2021 Apr 16. Epub 2021 Apr 16.

Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.

Purpose: Patient-reported outomes (PRO) may facilitate prompt treatment. We describe the development and psychometric properties of the first instrument to monitor for symptoms of breast cancer (BC) recurrence.

Methods: This study is nested in the MyHealth randomized trial of nurse-led follow-up based on electronically-collected PROs. We constructed items assessing symptoms of potential recurrence through expert interviews with six BC specialists in Denmark. Semi-structured cognitive interviews were carried out with a patient panel to assess acceptability and comprehensibility. Items were subsequently tested in a population of 1170 women 1-10 years after completing BC treatment. We carried out multiple-groups confirmatory factor analysis (CFA) and Rasch analysis to test dimensionality, local dependence (LD) and differential item functioning (DIF) according to sociodemographic and treatment-related factors. Clinical data was obtained from the Danish Breast Cancer Group registry.

Results: Twenty-two items were generated for the Breast Cancer Recurrence instrument (BreastCaRe). Cognitive testing resulted in clearer items. Seven subscales based on general, bone, liver, lung, brain, locoregional and contralateral recurrence symptoms were proposed. Both CFA and Rasch models confirmed the factor structure. No DIF was identified. Five item pairs showed LD but all items were retained to avoid loss of clinical information. Rasch models taking LD into account were used to generate a standardized scoring table for each subscale.

Conclusions: The BreastCaRe has good content and structural validity, patient acceptability and measurement invariance. We are preparing to examine the predictive validity of this new instrument.
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http://dx.doi.org/10.1007/s11136-021-02841-1DOI Listing
April 2021

Exploring Functional Impairment in Light of Prolonged Grief Disorder: A Prospective, Population-Based Cohort Study.

Front Psychiatry 2020 9;11:537674. Epub 2020 Dec 9.

Research Unit for General Practice, Aarhus, Denmark.

Functional impairment is essential in the diagnostic criteria for prolonged grief disorder (PGD) in the ICD-11. It refers to the negative impact on everyday life, including inability to maintain the usual level of functioning. We aimed to assess the extent of functional impairment, emotion-related role limitation, and impaired social functioning before and after bereavement, and to explore associations with PGD, as measured by the 13-item Prolonged Grief Scale (PGD). Relatives of terminally ill patients ( = 1,622) completed a questionnaire before and after bereavement. The questionnaire assessed "overall functional impairment" (PG-13 item) and "aspects of functional impairment" measured by mean scores of the 36-item Short Form Survey (SF-36) subscales and (0: worst; 100: best). We analyzed associations between PGD and functional impairment prior to bereavement using logistic regression models adjusted for age, gender, personal relation, education, time interval to patient's death, and pre-loss grief. In total, 51% reported overall functional impairment before bereavement, 27% reported functional impairment at 6 months after bereavement, and 19% reported functional impairment at 3 years after bereavement. The mean score was 47.5 (95%CI: 45.4-49.7) before bereavement, increasing to 77.4 (95%CI: 75.7-79.0) at 3 years after bereavement, compared to 85.1 (95%CI: 77.6-92.6) in a reference sample. Mean score increased gradually reaching the mean of the reference sample at 3 years after bereavement. PGD was present in 26% of those with overall functional impairment at 6 months after bereavement, decreasing to 11% at 3 years after bereavement. Pre-bereavement measures of and were associated with PGDat 6 months and 3 years after bereavement. Overall functional impairment was prevalent as reflected in low scores on daily activities and social functioning compared to a reference sample. Functioning may be an important factor during caregiving and bereavement and pre-bereavement functional impairment was associated with PGD. Future studies should investigate if maintaining daily activities and social functioning before bereavement could be key in early supportive care. Moreover, the role of functional impairment in bereavement interventions should be explored.
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http://dx.doi.org/10.3389/fpsyt.2020.537674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755858PMC
December 2020

Is the health literacy of informal caregivers associated with the psychological outcomes of breast cancer survivors?

J Cancer Surviv 2020 Nov 9. Epub 2020 Nov 9.

Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.

Purpose: To investigate whether health literacy (HL) among informal caregivers of breast cancer (BC) survivors is associated with patient psychological outcomes.

Methods: We used data (n = 340 pairs) from baseline questionnaires administered in the MyHealth trial investigating nurse-led BC follow-up. All BC survivors and their invited caregivers were included immediately after completion of primary treatment. We performed multivariate regression analyses to examine the association between caregiver HL (nine dimensions as measured by the Health Literacy Questionnaire) as exposure and patient depression, anxiety, and health-related quality of life (HQoL) as outcomes. We further examined whether any association differed according to type of caregiver, patient HL, and patient activation (skill in managing one's health).

Results: Three dimensions, "ability to engage with providers" (β = - 0.2), "navigating the system" (β = - 0.2), and "understand health information" (β = - 0.2), were significantly associated with lower patient depression (p < 0.05), while four dimensions, "having sufficient information" (β = 0.3), "navigating the system" (β = 0.2), "find health information" (β = 0.2), and "understand health information" (β = 0.2), were significantly associated with better patient HQoL (p < 0.05). No significant associations were found for anxiety. Patient HL and activation did not significantly modify the associations, while certain associations for depression were stronger in patients with non-partner caregivers.

Conclusions: The HL of informal caregivers may play an important role in optimizing psychological outcomes in cancer survivors.

Implications For Cancer Survivors: Involving informal caregivers, who can provide support related to health information and services, may be beneficial for the psychological well-being of cancer survivors.
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http://dx.doi.org/10.1007/s11764-020-00964-xDOI Listing
November 2020

Prevalence of cognitive impairment and its relation to mental health in Danish lymphoma survivors.

Support Care Cancer 2021 Jun 28;29(6):3319-3328. Epub 2020 Oct 28.

Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.

Purpose: This study sought to investigate the prevalence of self-reported cognitive impairment and its relation to illness and treatment characteristics and mental health in Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) survivors as cancer-related cognitive impairment has not been extensively studied in lymphoma survivors.

Methods: One hundred fifteen HL and DLBCL survivors (mean age = 40.3 years, mean months since completed treatment = 29.6) completed questionnaires on executive function and mental health. We examined the prevalence of executive impairment and compared illness and treatment characteristics and mental health across survivors reporting impaired and non-impaired executive functioning using chi-square, Cochran-Armitage, and Mann-Whitney U tests.

Results: We found that 39% reported executive impairment. Survivors reporting impaired executive functioning reported worse mental health (ps < .001) than survivors reporting non-impaired executive functioning. A larger proportion of the impaired group had received a high chemo dose compared to the non-impaired group although this result fell short of significance after adjustment for multiple comparisons (p = .017).

Conclusions: Self-reported cognitive impairment is prevalent in HL and DLBCL survivors and is associated with worse mental health and possibly high chemo dose. Future studies should investigate objective impairment and the possible dose-response relationship between chemo dose and cognitive impairment in lymphoma survivors.
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http://dx.doi.org/10.1007/s00520-020-05857-4DOI Listing
June 2021

Patterns in detection of recurrence among patients treated for breast cancer.

Breast Cancer Res Treat 2020 Nov 6;184(2):365-373. Epub 2020 Aug 6.

Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.

Purpose: The Danish follow-up program for breast cancer (BC) patients has recently been changed. Today most patients are offered open access to an outpatient clinic, whereas the scheduled visits are phased out. This strategy has been studied in regards to psychological and health-related quality of life outcomes, but not in regards to detection of recurrence and survival. The aim of this study was to quantify the recurrences detected at scheduled outpatient visits in Denmark before the implementation of revised follow-up guidelines.

Methods: We conducted a cross-sectional study among 310 patients with recurrent BC. Information was retrieved on tumor characteristics, type of visit when recurrence was detected, recurrence localization, symptoms reported, and duration of symptoms from the Danish Breast Cancer Group database and medical records.

Results: The recurrences were locoregional (26%), locoregional and distant (15%), or distant (59%). Among patients still in outpatient follow-up (n = 199), recurrence was detected at a patient-requested extra outpatient visit (15%), by the general practitioner or other specialist (47%), at a scheduled outpatient visit (21%), or on a scheduled mammogram (11%). Among patients with recurrences detected at scheduled outpatient visits, the majority (88%) reported symptoms related to the recurrence. Most frequent symptoms were pain (37%), dyspnoea (15%), and fatigue (12%).

Conclusions: One-fifth of BC recurrences among patients attending outpatient follow-up were detected at scheduled outpatient visits. Very few of these were asymptomatic. Whether there will be a delay in detection of the symptomatic recurrences when the number of visits is reduced is unknown.
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http://dx.doi.org/10.1007/s10549-020-05847-4DOI Listing
November 2020

Total burden of disease in cancer patients at diagnosis-a Danish nationwide study of multimorbidity and redeemed medication.

Br J Cancer 2020 09 7;123(6):1033-1040. Epub 2020 Jul 7.

Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.

Background: Multimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers.

Methods: We conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2-12 months before the cancer diagnosis.

Results: We included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications.

Conclusion: Among patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.
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http://dx.doi.org/10.1038/s41416-020-0950-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493878PMC
September 2020

Grief symptoms and primary care use: a prospective study of family caregivers.

BJGP Open 2020 Aug 25;4(3). Epub 2020 Aug 25.

Research Unit for General Practice, Aarhus, Denmark.

Background: Family caregivers to patients who are severely ill have high use of primary health care and psychotropic medication. However, it remains sparsely investigated whether healthcare services target the most vulnerable caregivers.

Aim: This study aimed to examine associations between family caregivers' grief trajectories of persistent high-grief symptom level (high-grief trajectory) versus persistent low-grief symptom level (low-grief trajectory), as well as early contacts with GPs or psychologists and the use of psychotropic medication.

Design & Setting: A population-based cohort study of family caregivers ( = 1735) in Denmark was undertaken.

Method: The Prolonged Grief-13 (PG-13) scale measured family caregivers' grief symptoms at inclusion (during the patient's terminal illness), 6 months after bereavement, and 3 years after bereavement. Multinomial regression was used to analyse register-based information on GP consultations, psychologist sessions, and psychotropic medication prescriptions in the 6 months before inclusion.

Results: A total of 1447 (83.4%) family caregivers contacted their GP, and 91.6% of participants in the high-grief trajectory had GP contact. Compared with family caregivers in the low-grief trajectory, family caregivers in the high-grief trajectory had ≥4 face-to-face GP consultations (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.3 to 5.0), more GP talk therapy (OR =4.4; 95% CI = 1.9 to 10.0), and more psychotropic medication, but not significantly more psychologist sessions (OR = 1.7; 95% CI = 0.5 to 6.6).

Conclusion: Family caregivers in the high-grief trajectory had more contact with their GP, but their persisting grief symptoms suggest that primary care interventions for family caregivers should be optimised. Future research is warranted in such interventions and in the referral patterns to specialised mental health care.
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http://dx.doi.org/10.3399/bjgpopen20X101063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465574PMC
August 2020

Clinical characteristics and quality of life, depression, and anxiety in adults with neurofibromatosis type 1: A nationwide study.

Am J Med Genet A 2020 07 2;182(7):1704-1715. Epub 2020 Jun 2.

Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.

Neurofibromatosis type 1 (NF1) is a genetic condition characterized by numerous somatic manifestations. The psychosocial burden in adults has rarely been studied. We examined the prevalence of self-reported impairment of quality of life (QoL), symptoms of anxiety and depression and need for support, associated with disease severity and visibility. We conducted a nationwide cross-sectional study of all 467 adults with NF1 diagnosed between 1977 and 2016 at one of the two national centers for rare diseases in Denmark. A total of 244 (56% response rate) completed a questionnaire that included standard measures of QoL, symptoms of depression and anxiety, indicators of disease-related severity, visibility, and need for professional support. Associations between disease severity and visibility and psychosocial burden were analyzed in descriptive and multivariate models. We observed impaired QoL (mean = 81.3; 95% CI, 76.2; 86.4); 19% reported symptoms of depression (mean = 5.7; SD = 5.4), and 15% reported anxiety (mean = 5.1; SD = 5.2) at a clinical level. Adults with NF1 also reported requiring professional support for physical, psychological, and work-related problems. Disease severity and (partly) visibility were significantly (p < .0001) associated with psychosocial well-being and a requirement for support. This study provides new understanding of the factors associated with impaired QoL, indicating that follow-up care should be optimized into adult life.
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http://dx.doi.org/10.1002/ajmg.a.61627DOI Listing
July 2020

The impact of childhood cancer on parental separation, divorce, and family planning in Denmark.

Cancer 2020 07 25;126(14):3330-3340. Epub 2020 May 25.

Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.

Background: Childhood cancer is a devastating experience for the family. The objective of the current study was to assess the impact of having a child with cancer on parental separation, divorce, and future family planning among families residing in Denmark.

Methods: The authors conducted a nationwide cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (7066 children and 12,418 case parents) were matched with 10 comparison parents of cancer-free children per case parent (69,993 children and 125,014 comparison parents). We used discrete-time Cox regression models to compare the risk of separation (end of cohabitation) and divorce between case and comparison parents, and to identify risk factors for separation and divorce among case parents only. Descriptive statistics were used to compare family planning between case and comparison parents.

Results: Case parents were found to have a slightly lower risk of separation (hazard ratio, 0.96; 95% confidence interval, 0.93-0.99) and divorce (hazard ratio, 0.92; 95% confidence interval, 0.87-0.97) than comparison parents. The authors found that case parents who were aged <45 years, with short education (an International Standard Classification of Education code indicating early childhood education, primary education, and lower secondary education), and who were unemployed were at an increased risk of separation and divorce. Moreover, the parents of children diagnosed with cancer at a young age (aged <15 years) were more likely to separate or divorce. No differences with regard to the total number of children and time to a next child after the cancer diagnosis were observed between case and comparison parents.

Conclusions: Having a child with cancer was not associated with an overall adverse impact on parents' risk of separation or divorce and future family planning. These encouraging findings should be communicated to parents to support them along their child's cancer trajectory.
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http://dx.doi.org/10.1002/cncr.32901DOI Listing
July 2020

Forming and ending marital or cohabiting relationships in a Danish population-based cohort of individuals with neurofibromatosis 1.

Eur J Hum Genet 2020 08 18;28(8):1028-1033. Epub 2020 May 18.

Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.

Individuals with neurofibromatosis 1 (NF1) may have problems in managing the transition between childhood and adulthood, such as forming a relationship or finding a partner. We aimed to determine the association between NF1 and forming and ending marital or cohabiting relationships by comparing a large Danish population of adults with NF1 with population comparisons. In this population-based cohort study, we compared a population of Danish adults who were hospitalized for or with complications to prior diagnosed NF1 (n = 787) with population comparisons matched on gender and birth year (n = 7787) through nationwide registries with annually updated information on marriage and cohabitation. Discrete-time survival models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the formation and termination of relationships, with adjustment for birth year, gender, and somatic and psychiatric comorbidities at entry. Individuals with NF1 were significantly less likely to form a relationship (HR = 0.65; 95% CI: 0.58-0.73), with the lowest association for individuals ≥33 years (HR 0.40; 95% CI: 0.25-0.63) and the highest for those aged 18-20 years (HR 0.82; 95% CI: 0.70-0.96). No significant difference was found for ending relationships (HR 1.00; 95% CI: 0.86-1.16). In conclusion, individuals who were hospitalized for NF1 are less likely to engage in marital or cohabiting relationships than population comparisons and are older when they form their first relationship. Once a relationship has been established, however, couples with a NF1-individual are not at greater risk of ending the relationship.
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http://dx.doi.org/10.1038/s41431-020-0645-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382505PMC
August 2020

The Feasibility of Implementing Deep Inspiration Breath-Hold for Pediatric Radiation Therapy.

Int J Radiat Oncol Biol Phys 2020 04 28;106(5):977-984. Epub 2020 Jan 28.

Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark.

Purpose: Radiation therapy delivery during deep inspiration breath-hold (DIBH) reduces the irradiation of the heart and lungs and is therefore recommended for adults with mediastinal lymphoma. However, no studies have addressed the use of DIBH in children. This pilot study investigates the feasibility of and compliance with DIBH in children.

Methods And Materials: Children from the age of 5 years were recruited to a training session to assess their ability to perform DIBH. No children received radiation therapy. The children were placed in a potential radiation therapy position. The DIBH was voluntary and monitored using an optical surface system providing visual feedback. Children who performed 3 stable DIBHs of 20 seconds each and remained motionless were deemed DIBH compliant. Compliance, equipment suitability, and coaching were further assessed in a semistructured interview.

Results: We included 33 children (18 healthy and 15 hospitalized children with cancer) with a mean age of 8.5 years (range, 5-15). A total of 28 (85%) children were DIBH compliant. Twenty children were deemed immediately DIBH compliant, and 8 were deemed conditionally DIBH compliant, as DIBH compliance was presumed with custom-made immobilization and/or additional DIBH training. Mean age of the DIBH-compliant and the non-DIBH-compliant children was 8.9 years (range, 5-15) and 6 years (range, 5-9), respectively. Only 1 of 15 hospitalized children was not DIBH compliant and only 1 of all 33 children was unable to grasp the DIBH concept. The available DIBH equipment was suitable for children, and 94% reported that they were happy with training and performing DIBH.

Conclusions: This pilot study demonstrated that children from the age of 5 years can potentially comply with the DIBH technique and perform stable and reproducible DIBHs suitable for radiation therapy. Custom-made immobilization and adequate training will potentially increase DIBH compliance. A prospective clinical trial (NCT03315546), investigating the dosimetric benefit of radiation therapy delivery in DIBH compared with free breathing with pediatric patients, has been initiated.
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http://dx.doi.org/10.1016/j.ijrobp.2019.12.025DOI Listing
April 2020

Effect of progressive resistance training on persistent pain after axillary dissection in breast cancer: a randomized controlled trial.

Breast Cancer Res Treat 2020 Jan 11;179(1):173-183. Epub 2019 Oct 11.

Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.

Purpose: Persistent pain is a known challenge among breast cancer survivors. In secondary analyses of a randomized controlled trial, we examined the effect of progressive resistance training on persistent pain in the post-operative year in women treated for breast cancer with axillary lymph node dissection.

Methods: We randomized 158 women after BC surgery with Axillary Lymph Node Dissection (ALND) (1:1) to usual care or a 1-year, supervised and self-administered, progressive resistance training intervention initiated 3 weeks after surgery. A questionnaire at baseline, 20 weeks and 12 months assessed the intensity and frequency of pain, neuropathic pain and influence of pain on aspects of daily life. We analysed the effect using linear mixed models and multinomial logistic regression models for repeated measures.

Results: A high percentage of participants experienced baseline pain (85% and 83% in the control and intervention groups respectively) and by the 12 month assessment these numbers were more than halved. A high proportion of participants also experienced neuropathic pain (88% and 89% in control and intervention group respectively), a finding that was stable throughout the study period. The effect on intensity of pain indicators favoured the exercise group, although most estimates did not reach statistical significance, with differences being small.

Conclusion: For women who had BC surgery with ALND, our progressive resistance training intervention conferred no benefit over usual care in reducing pain. Importantly, it did not increase the risk of pain both in the short and long term rehabilitative phase.
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http://dx.doi.org/10.1007/s10549-019-05461-zDOI Listing
January 2020

Looking beyond the mean in grief trajectories: A prospective, population-based cohort study.

Soc Sci Med 2019 07 19;232:460-469. Epub 2018 Oct 19.

Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark; Palliative Care Team, Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark.

Background: Most individuals adjust to the loss of a close person, but some experience adverse grief that challenges everyday life. No previous study has examined the development of grief symptoms in trajectories over time. We aimed to investigate trajectories of grief symptoms in bereaved partners and non-partners of severely ill patients starting before death until three years after death of the patient.

Method: We conducted a prospective population-based cohort study including 1138 partners and 597 non-partners of terminally ill patients. Participants completed the Prolonged Grief-13 scale pre-loss, six months post-loss, and three years post-loss. On this basis, we developed semi-parametric group-based trajectory models. Multinomial logistic regression models estimated, odds ratios (ORs) with 95% confidence intervals (CIs) between selected characteristics: age, gender, educational level, the patient's survival time, and types of grief trajectories.

Results: We identified five specific grief trajectories for partners and four for non-partners. Low grief was identified in 34% of partners and 45% of non-partners, moderate/decreasing grief in 30% of partners and 31% of non-partners, high/decreasing grief in 20% of partners and 16% of non-partners, and high grief in 7% of partners and 8% of non-partners. In addition, a late grief trajectory was identified in 10% of partners. Low education compared to high education was associated with adverse grief trajectories (OR = 0.19 (95% CI = 0.80, 0.43) for partners following a high grief trajectory).

Conclusions: This study is the first to systematically describe specific trajectories of grief based on grief symptoms. The majority had a low or decreasing grief trajectory, whereas minor groups of partners and non-partners had a high grief trajectory, and a group of partners had a late grief trajectory. A consistent vulnerability factor was low education. Bereaved individuals may benefit from information on possible patterns of grief development, including adverse grief trajectories.
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http://dx.doi.org/10.1016/j.socscimed.2018.10.007DOI Listing
July 2019

Correction: Educational delay and attainment in persons with neurofibromatosis 1 in Denmark.

Eur J Hum Genet 2019 Jun;27(6):994-996

Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.

Since the publication of the article, the authors noticed that 'NFI cohort' and 'NFI-free cohort' columns in the 'Autism and the 'Autism/ADHD' rows had been erroneously interchanged in Table 3. This has now been updated in the HTML and PDF of the original article.
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http://dx.doi.org/10.1038/s41431-019-0378-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777544PMC
June 2019

Long-term Somatic Disease Risk in Adult Danish Cancer Survivors.

JAMA Oncol 2019 Apr;5(4):537-545

Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.

Importance: Long-term health effects of cancer in adult survivors are a major concern; however, it is difficult to differentiate between the consequences of cancer and cancer treatment and those of normal aging or comorbidity.

Objectives: To provide an overview and investigate the temporal pattern of hospitalizations for medically verified incident somatic disease in adult survivors compared with cancer-free comparison people, taking into consideration pretreatment comorbidity and the socioeconomic position of the participants.

Design, Setting, And Participants: In this nationwide, population-based cohort-cohort study, 458 646 survivors of the 12 most frequent first primary cancers listed in the Danish Cancer Registry between January 1, 1997, and December 31, 2014, and 2 121 567 matched cancer-free comparison people were identified from the Danish Central Population Registry. Hospitalizations for somatic diseases after cancer diagnosis or study entry were identified from the National Patient Register and stratified according to the 11 main diagnostic groups in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. A cohort of cancer survivors was formed for each combination of cancer type and diagnostic group, with a corresponding group of cancer-free people, resulting in 132 unique cohorts. Data analysis was performed from September 1, 2017, to January 15, 2018.

Main Outcomes And Measures: Risk of hospitalization and the temporal pattern of incidence were analyzed in Cox proportional hazards regression models. Cumulative incidence proportions were calculated by the pseudo-observation method.

Results: A total of 2 580 213 people were investigated, of whom 458 646 were cancer survivors (mean [SD] age, 69 [11.6] years; 230 793 [50.3%] male and 227 853 [49.7%] female) and 2 121 567 were comparison people (mean [SD] age, 69 [11.5] years; 1 054 465 [49.7%] male and 1 067 102 [50.3%] female). More cancer survivors vs comparison people had comorbid conditions at the time of cancer diagnosis or study entry (Charlson Comorbidity Index ≥1: 19% vs 13%). Overall, the risk of hospitalizations for somatic diseases was significantly higher for cancer survivors in almost all diagnostic groups (eg, diseases in the nervous system among breast cancer survivors: hazard ratio, 1.20; 95% CI, 1.17-1.22; diseases in the respiratory system in lung cancer survivors: hazard ratio, 5.85; 95% CI, 5.63-6.07; and diseases in blood and blood-forming organs in prostate cancer survivors: hazard ratio, 2.60; 95% CI, 2.50-2.71).

Conclusions And Relevance: The findings suggest that adult survivors of the 12 most common cancers are at significantly higher risk for a broad range of somatic diseases that require hospitalization compared with matched cancer-free comparison people. The results of this study suggest the importance of close, targeted monitoring for new somatic disease during follow-up care of cancer survivors.
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http://dx.doi.org/10.1001/jamaoncol.2018.7192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459216PMC
April 2019

Educational delay and attainment in persons with neurofibromatosis 1 in Denmark.

Eur J Hum Genet 2019 06 28;27(6):857-868. Epub 2019 Feb 28.

Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.

Most research on psychosocial consequences of neurofibromatosis type 1 (NF1) has focused on the relationship between disease factors and cognitive functioning. NF1 may impair domains of learning and attention, resulting in low academic performance. This study is the first nationwide population-based cohort study to investigate educational attainment and delay in completing mandatory school by persons with NF1. Educational information was collected from 550 persons at the age of 30 (born 1965-1984). They were diagnosed with NF1 in Denmark and compared to a cohort of NF1-free persons matched on gender and age (n = 4295). Multinomial logistic models were applied to estimate odds ratios (ORs) for obtaining short (≤9 years) or medium (10-12 years) education compared to long education (>12 years) by the age of 30 years. We calculated the probability of graduating 9 year of mandatory school at different ages in 932 persons with NF1 and 7962 NF1-free persons (born 1965-2000) using quantile regression. The OR of educational completion for short- and medium-term education was three fold (95% CI 2.55-3.99) and 1.29 fold (95% CI 0.99-1.69) higher, respectively, for persons with NF1 than NF1-free persons after adjusting for birth year, gender, psychiatric and somatic morbidity and mother's education. Persons with NF1 were significantly delayed in graduating mandatory school education compared to NF1-free persons. When 90% of persons have graduated, persons with NF1 were 1.2 times older than the NF1-free persons. Experiencing delays in mandatory school likely affect further educational achievements and may impair employment and entering work force.
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http://dx.doi.org/10.1038/s41431-019-0359-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777448PMC
June 2019

Whose perspective is it anyway? Dilemmas of patient involvement in the development of a randomized clinical trial - a qualitative study.

Acta Oncol 2019 May 6;58(5):634-641. Epub 2019 Feb 6.

a Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark.

Patient and public involvement (PPI) is increasingly becoming a requirement in the effort to improve the relevance and quality of healthcare research. We examined how involving patients with lower education levels affected PPI in the development of the MyHealth randomized clinical trial of breast cancer follow-up from the perspectives of the patients and professionals. Eight women who had completed breast cancer treatment, four with fewer than 10 years of education, were recruited as members of a patient panel advising researchers in the development of the trial. We carried out individual and focus group interviews with panel members and recruiting nurses between April and September 2016. Researcher observations and changes made based on panel feedback were also documented. Patients were asked to evaluate the process according to a PPI theoretical framework with four dimensions: (i) ways of involvement, (ii) research vs. patient concerns, (iii) strength of the patient's voice, and (iv) degree of change. A combination of inductive and deductive thematic analysis was conducted whereby emerging themes were organized using the above framework. All patient contributors reported high satisfaction with being involved and PPI improved trial materials and recruitment strategy. However, contradictory perspectives between lay and expert approaches to research led to dilemmas not related to educational background. Patients were often more concerned with unmet needs after cancer than with research, and the scientific hierarchy made it difficult for researchers to include the patient perspective if it challenged research requirements. Nurses also faced ethical dilemmas when recruiting patients as PPI contributors. Our findings challenged the assumption that PPI automatically leads to a broad range of patient perspectives that can directly improve research relevance and quality. This highlights the need for more research and better guidance on the use of PPI in research.
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http://dx.doi.org/10.1080/0284186X.2019.1566776DOI Listing
May 2019

Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial.

Acta Oncol 2019 May 31;58(5):665-672. Epub 2019 Jan 31.

a Survivorship Unit, Danish Cancer Society Research Center , Copenhagen , Denmark.

To examine the effect of progressive resistance training (PRT) on health related quality of life and a predefined symptom cluster of pain-sleep-fatigue. This study was a planned secondary analysis of a randomized controlled trial examining the effect of PRT on prevention of arm lymphedema in a population of women between 18 and 75 years undergoing breast cancer surgery with axillary lymph node dissection. Participants were allocated by computer randomization to usual care control or a PRT intervention in a 1:1 ratio. The intervention, initiated in the third post-operative week, consisted of three times PRT per week, supervised in groups in the first 20 weeks, and self-administered in the following 30 weeks. Questionnaire assessments were made at baseline, 20 weeks and 12 months, with the European Organization for Research and Treatment in Cancer Core questionnaire (EORTC QLQ C30) and the Functional Assessment of Chronic Illness Therapy-(FACIT) fatigue questionnaire. The symptom cluster of pain-sleep-fatigue was measured with a constructed score adding EORTC C30 subscales of insomnia, pain, and fatigue. Data were treated as repeated measurements and analyzed with mixed models. Among 158 recruited participants, we found a clinically relevant increased emotional functioning with nine points at both follow-ups ( = .02), and 16 and 11 points at 20 weeks and 12 months respectively ( = .04) in social functioning. Furthermore, in the subgroup of women with the symptom cluster pain-sleep-fatigue present at baseline, a significant effect was found for global health status ( = .01) and social functioning ( = .02). To our knowledge, this is the first study to report clinically relevant effects of PRT on social and emotional functioning in the first postoperative year after breast cancer surgery. Furthermore, a subgroup of women with the pain-sleep-fatigue symptom cluster had particular benefit from PRT on global health status and social functioning.
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http://dx.doi.org/10.1080/0284186X.2018.1563718DOI Listing
May 2019

Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: Effects and mediation in a randomized controlled trial.

Psychooncology 2019 02 15;28(2):264-270. Epub 2018 Nov 15.

Research Unit for General Practice, Aarhus University, Aarhus, Denmark.

Objective: Specialized palliative care (SPC) interventions increasingly include patient-caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers' anxiety and depression.

Methods: We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home-based SPC and dyadic psychological support. In secondary outcome analyses, using mixed-effects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers' symptoms of anxiety and depression. (Clinicaltrials.gov NCT01885637).

Results: The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation.

Conclusions: Specialized palliative care and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been central in the intervention.
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http://dx.doi.org/10.1002/pon.4932DOI Listing
February 2019

Depressive symptoms and mental health-related quality of life in adolescence and young adulthood after early parental death.

Scand J Public Health 2019 Nov 17;47(7):782-792. Epub 2018 Oct 17.

From Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.

Little is known about long-term mental health in young adults who participate in ongoing grief counseling programs after early parental death in childhood, adolescence or young adulthood. The purpose of this study was to examine mental health in young adults according to early parental death and participation in grief counseling. : In a cross-sectional, questionnaire-based study, we included three samples of young adults age 18-41 years. One sample who had lost a parent between age 0 and 30 years and who had participated in grief counseling identified through four Danish grief-counseling organizations, and two registry-based samples of young adults included parentally bereaved and non-bereaved young adults. Multivariate-adjusted regression analyses were performed to characterize risk of depressive symptoms and mental health-related quality of life (HQoL) according to early parental death and participation in grief counseling. : A total of 2467 (45%) young adults participated. Bereaved young adults reported significantly more depressive symptoms (p<0.0001) and lower mental HQoL (p<0.0001) than non-bereaved young adults and than general population levels for both depressive symptoms (p<0.0001) and HQoL (p<0.0001). Bereaved young adults who had participated in grief counseling reported significantly more depressive symptoms (p<0.0001) and lower mental HQoL (p<0.0001) than bereaved persons who did not participate in grief counseling.
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http://dx.doi.org/10.1177/1403494818806371DOI Listing
November 2019

Is dog ownership associated with mortality? A nationwide registry study.

Eur J Public Health 2018 12;28(6):1169-1171

Survivorship Research Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.

We examined the association between dog ownership and mortality and whether the association depends on having a spouse in a population-based registry study. All Danish citizens over age 18 years who died in 2015 (N=45 864) were matched to five people who remained alive in 2015 (N=229 320). The total sample were linked to a mandatory nationwide register of dog ownership. Dog ownership was associated with slightly 8% lower all-cause mortality. The association was confined to people without a spouse (OR 0.86; 95% CI 0.82-0.91), while the association was weaker in people with a spouse (OR 0.98; 95% CI 0.93-1.03).
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http://dx.doi.org/10.1093/eurpub/cky164DOI Listing
December 2018

Pre-diagnostic changes in body mass index and mortality among breast cancer patients.

Breast Cancer Res Treat 2018 Aug 10;170(3):605-612. Epub 2018 Apr 10.

Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.

Purpose: We investigated whether changes in body mass index (BMI) before a breast cancer diagnosis affected mortality and whether trajectories more accurately predict overall mortality compared to a single measure of BMI.

Methods: Our prospective cohort comprised 2012 women with breast cancer who reported their weight in each decade from 20 to 50-64 years of age. We used trajectory analysis to identify groups with similar development patterns in BMI and Cox proportional hazards models to examine the association between trajectory groups and mortality, and interactions with oestrogen receptor status and smoking. We used c-index statistics to compare the trajectory model with the single measure model of BMI.

Results: We identified three distinct trajectory groups, with a mean BMI at age 20 of 19, 22 and 24 increasing to 23 (normal-to-normal), 29 (normal-to-overweight) and 37 (normal-to-obese) at 50-64 years of age, respectively. Women in the normal-to-obese trajectory group experienced significantly higher overall mortality than those in the normal-to-normal trajectory group (HR 1.76, 95% CI 1.21‒2.56). The association declined to a non-significant level after adjustments for clinical prognostic factors. Although not significant, the same tendency was seen for breast cancer-specific mortality. The association was strongest in women with oestrogen receptor-negative tumours. Weight changes over time were not significantly different from a single BMI measure before diagnosis to predict survival.

Conclusion: Weight gain affects overall mortality after breast cancer but clinical prognostic factors largely eliminate the association. Using trajectories of weight changes did not improve the predictive value compared to a single measure of BMI.
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http://dx.doi.org/10.1007/s10549-018-4771-5DOI Listing
August 2018

Early parental loss and intimate relationships in adulthood: A nationwide study.

Dev Psychol 2018 May 25;54(5):963-974. Epub 2018 Jan 25.

Survivorship Unit, Danish Cancer Society Research Center.

Being able to form and maintain intimate relationships is an essential part of development and the early loss of a parent may negatively affect this ability. This study investigates the association between parental loss before the age of 18 years and the formation and dissolution of marriage and cohabitation relationships in adulthood, in relation to factors that may help identify potentially vulnerable subgroups of bereaved children, that is, sex of the deceased parent, cause of death and child's age at the time of death. Using data from national registries, we followed all children born in Denmark between 1970 and 1995 (n = 1,525,173) and used Poisson regression models to assess rate ratios by gender for relationship formation and separation according to early parental loss. We stratified the analyses by sex of the deceased parent, cause of death and child's age at the time of death, and adjusted for the confounding effects of parental income, education level, and psychiatric illness. We found that parental loss was associated with a higher rate of relationship formation for young women, but not young men, and higher rates of separation for both men and women. The associations with separation were stronger for persons who lost a parent to suicide than to other causes. The effects were relatively small, a possible testimony to the resilience of developmental processes in most children. However, as long-term relationships are associated with physical and psychological health, interventions for bereaved children and families are important, especially in the subgroup bereaved by suicide. (PsycINFO Database Record
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http://dx.doi.org/10.1037/dev0000483DOI Listing
May 2018

Associations between residential traffic noise exposure and smoking habits and alcohol consumption-A population-based study.

Environ Pollut 2018 May 6;236:983-991. Epub 2017 Nov 6.

Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.

Background: Traffic noise stresses and disturbs sleep. It has been associated with various diseases, and has recently also been associated with lifestyle. Hence, the association between traffic noise and disease could partly operate via a pathway of lifestyle habits, including smoking and alcohol intake.

Objectives: We investigated associations between modelled residential traffic noise and smoking habits and alcohol consumption.

Methods: In a cohort of 57,053 participants, we performed cross-sectional analyses using data from a baseline questionnaire (1993-97), and longitudinal analyses of change between baseline and follow-up (2000-02). Smoking status (never, former, current) and intensity (tobacco, g/day) and alcohol consumption (g/day) was self-reported at baseline and follow-up. Address history from 1987-2002 for all participants were found in national registries, and road traffic and railway noise was modelled 1 and 5 years before enrolment, and from baseline to follow-up. Analyses were performed using logistic and linear regression, and adjusted for demographics, socioeconomic variables, leisure-time sports, and noise from the opposite source (road/railway).

Results: Road traffic noise exposure 5 years before baseline was positively associated with alcohol consumption (adjusted difference per 10 dB: 1.38 g/day, 95% confidence interval (CI): 1.10-1.65), smoking intensity (adjusted difference per 10 dB: 0.40 g/day, 95% CI: 0.19-0.61), and odds for being a current vs. never/former smoker at baseline (odds ratio (OR): 1.14; 95% CI: 1.10-1.17). In longitudinal analyses, we found no association between road traffic noise and change in smoking and alcohol habits. Railway noise was not associated with smoking habits and alcohol consumption, neither in cross-sectional nor in longitudinal analyses.

Conclusion: The study suggests that long-term exposure to residential road traffic is associated with smoking habits and alcohol consumption, albeit only in cross-sectional, but not in longitudinal analyses.
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http://dx.doi.org/10.1016/j.envpol.2017.10.093DOI Listing
May 2018

Residential road traffic noise exposure and colorectal cancer survival - A Danish cohort study.

PLoS One 2017 30;12(10):e0187161. Epub 2017 Oct 30.

Danish Cancer Society Research Center, Copenhagen, Denmark.

Background: Residential traffic noise exposure may entail sleep disruption and compromised circadian functioning; two factors which have been associated with a poor colorectal cancer (CRC) prognosis. Hence, the aim of the present study was to investigate the association between residential road traffic noise and CRC survival.

Methods And Materials: Road traffic noise was calculated for all residential addresses from 1987 to February 2012 for incident CRC cases (n = 1,234) in a cohort of 57,053 Danes. We used Cox Proportional Hazard Models to investigate the association between residential road traffic noise at different time-windows, and overall and CRC-specific mortality. Furthermore, we investigated interaction with sex, age, prognostic factors, and comorbidity. Mortality Rate Ratios (MRR) were calculated in unadjusted models, and adjusted for railway noise, lifestyle factors, and socioeconomic variables.

Results: During a median follow-up of 4 years, 594 patients died; 447 from CRC. We found no association between road traffic noise exposure and overall (MRR 1.00 (0.88-1.13) per 10 dB) or CRC-specific mortality (MRR 0.98 (0.85-1.13) per 10 dB) over the entire follow-up period, or 1 year preceding death. Results did not differ when examining colon and rectal cancer separately. Interaction analyses suggested that patients with less clinically advanced disease could be more susceptible to harmful effects of traffic noise.

Conclusion: The present study suggests no overall association between residential road traffic noise and concurrent mortality in CRC patients. As it is the first study of its kind, with relatively limited power, further studies are warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187161PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662233PMC
November 2017

The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study.

Acta Oncol 2017 Dec 31;56(12):1682-1689. Epub 2017 Jul 31.

c Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark.

Aim: Our aim was to determine the feasibility and effectiveness of an individual, nurse-navigator intervention for relieving distress, anxiety, depression and health-related quality of life in women who have been treated for breast cancer (BC) and are experiencing moderate-to-severe psychological and physical symptoms.

Methods: Fifty women with newly diagnosed BC who reported distress (score ≥7 on distress thermometer) before surgery were included consecutively in a pilot study and randomized 1:1 to the intervention or the control group. The intervention comprised repeated screening with patient reported outcome measures and nurse navigation. A total of 66 women who were not distressed (score <7) were followed longitudinally as an observational group. Participants filled in four questionnaires, at baseline, after 6 months and 12 months. The primary outcome was psychological distress and the secondary outcomes were anxiety, depression, health-related quality of life and feasibility of the intervention.

Results: Women in the intervention group reported significantly greater satisfaction with treatment and rehabilitation and lower levels of distress (mean 2.7 vs. 5.1, p<.01), anxiety (mean 5.1 vs. 7.8, p = .02) and depression (mean 2.2 vs. 4.4, p = .04) after 12 months compared to the control group. No significant effects were seen on health-related quality of life.

Conclusions: The study shows promising feasibility of the individually tailored nurse-navigation intervention and while no significant effects were observed after 6 months, we did find statistically significant effects on distress, anxiety and depression 12 months after diagnosis. Our results will assist in developing rehabilitation to the most vulnerable patients.
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http://dx.doi.org/10.1080/0284186X.2017.1358462DOI Listing
December 2017

Feasibility and acceptability of electronic symptom surveillance with clinician feedback using the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in Danish prostate cancer patients.

J Patient Rep Outcomes 2017 12;1(1). Epub 2017 Sep 12.

2Department of Oncology, The Finsen Centre, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.

Background: The aim was to examine the feasibility, acceptability and clinical utility of electronic symptom surveillance with clinician feedback using a subset of items drawn from the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a cancer treatment setting.

Methods: Danish-speaking men with castration-resistant metastatic prostate cancer receiving treatment at the Department of Oncology, Rigshospitalet, Copenhagen between March 9, 2015 and June 8, 2015 were invited to participate ( = 63 eligible). Participants completed the PRO-CTCAE questionnaire on tablet computers using AmbuFlex software at each treatment visit in the outpatient clinic. In total, 22 symptomatic toxicities (41 PRO-CTCAE items), corresponding to the symptomatic adverse-events profile associated with the regimens commonly used for prostate cancer treatment (Docetaxel, Cabazitaxel, Abiraterone, Alpharadin), were selected. Participants' PRO-CTCAE responses were presented graphically to their treating oncologists via an AmbuFlex dashboard, for real-time use to enhance the patient-clinician dialogue that occurs during the consultation prior to each treatment cycle. Technical and clinical barriers and acceptability were evaluated through semi-structured interviews with both patients and oncologists. Patients receiving active treatment at the end of the study period completed an evaluation questionnaire.

Results: Fifty-four out of sixty-three (86%) eligible patients were enrolled. The PRO-CTCAE questionnaire was completed a total of 168 times by 54 participants (median number per patient was 3, range 1-5). Eight surveys were missed, resulting in a compliance rate of 97%. At the end of the study period, 35 patients (65%) were still receiving active treatment and completed the evaluation questionnaire. Patients reported that their PRO-CTCAE responses served as a communication tool. Oncologists stated that the availability of the PRO-CTCAE self-reports during the consultation improved patient-clinician communication about side effects.

Conclusion: Electronic capture of symptomatic toxicities using PRO-CTCAE and the submission of self-reports to clinicians prior to consultation were feasible among metastatic prostate cancer patients receiving chemotherapy in an outpatient setting, and this procedure was acceptable to both patients and clinicians. Continued research, including a cluster-randomized trial, will evaluate the effects of submitting patients' PRO-CTCAE results to clinicians prior to consultation on the quality of side-effects management and resultant clinical outcomes.
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http://dx.doi.org/10.1186/s41687-017-0005-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934932PMC
September 2017

Residential road traffic noise exposure and survival after breast cancer - A cohort study.

Environ Res 2016 Nov 28;151:814-820. Epub 2016 Sep 28.

Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.

Background: It is generally acknowledged that patients with already existing clinical conditions are especially vulnerable to the effects of traffic noise exposure. The aim of the present study was to investigate the association between residential road traffic noise and breast cancer survival.

Methods: Road traffic noise was calculated for all residential addresses from 1987 to February 2012 for incident breast cancer cases (n=1,759) in a cohort of 57,053 Danes. We used Cox Proportional Hazard Models to investigate the association between residential road traffic noise at different time-windows, and overall and breast cancer-specific mortality. Furthermore, we investigated interaction with prognostic and socioeconomic factors. Mortality Rate Ratios (MRR) were calculated in both unadjusted models, and adjusted for residential railway noise, lifestyle factors and socioeconomic variables.

Results: During a median of 7.3 years of follow-up, 402 patients died; 274 from breast cancer. We found no association between time-weighted averages of residential road traffic noise 1-, 3- or 5-years before death, or over the entire follow-up period, and overall or breast cancer-specific mortality. A 10dB higher road traffic noise from diagnosis until censoring was associated with an adjusted MRR of 0.94 (0.81-1.08) for all-cause mortality. The association was modified by lymph node involvement, with a MRR of 1.20 (0.97-1.48) for those with tumor-positive lymph nodes and 0.76 (0.59-0.98) for those without.

Conclusion: The present study suggests no association between residential road traffic noise and concurrent mortality. As it is the first study of its kind, with relatively limited power, further studies are warranted.
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http://dx.doi.org/10.1016/j.envres.2016.09.016DOI Listing
November 2016

Danish Translation and Linguistic Validation of the U.S. National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

J Pain Symptom Manage 2016 08 15;52(2):292-7. Epub 2016 Apr 15.

Unit of Survivorship, Danish Cancer Society, Copenhagen, Denmark; Department of Oncology, The Finsen Centre, Rigshospitalet, Copenhagen, Denmark.

Context: The Common Terminology Criteria for Adverse Events (CTCAE) is the basis for standardized clinician-based grading and reporting of adverse events in cancer clinical trials. The U.S. National Cancer Institute has developed the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE) to incorporate patient self-reporting of symptomatic adverse events.

Objectives: The aim of the study was to translate and linguistically validate a Danish language version of PRO-CTCAE.

Methods: The U.S. English language PRO-CTCAE was translated into Danish using forward and backward procedures with reconciliation. The linguistic validity of the PRO-CTCAE Danish was examined in two successive rounds of semistructured cognitive interviews in a sample of 56 patients equally distributed by gender and cancer type (prostate, head and neck, lung, breast, gynecological, gastrointestinal, and hematological cancer), and who were currently undergoing cancer treatment.

Results: In the first round of linguistic validation (n = 42), the phrasing of five symptomatic toxicities was adjusted, and the refined phrasing was retested in a second round of interviews (n = 14). Agreement about phrasing that was both culturally acceptable and semantically comprehensible was achieved in the second round. Statements from participants describing the meaning of the PRO-CTCAE symptomatic toxicities support conceptual equivalence to the U.S. English language version.

Conclusion: Availability of the NCI PRO-CTCAE in languages beyond English will support international congruence in self-reporting of side effects of cancer treatment. A rigorous methodology was used to develop the Danish language version of PRO-CTCAE. Results provide preliminary support for the use of PRO-CTCAE in cancer clinical trials that include Danish speakers.
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http://dx.doi.org/10.1016/j.jpainsymman.2016.02.008DOI Listing
August 2016