ORCID Profile
0000-0002-5788-3380
Current Organisation
Karolinska Institutet
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Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-04-2009
Abstract: An association between socioeconomic status (SES) and survival in acute myeloid leukemia (AML) and multiple myeloma (MM) has not been established in developed countries. We assessed the impact of SES on survival in two large population-based cohorts of AML and MM patients diagnosed in Sweden 1973 to 2005. The relative risk of death (all cause and cause specific) in relation to SES was estimated using Cox's proportional hazards regression. We also conducted analyses stratified by calendar periods (1973 to 1979, 1980 to 1989, 1990 to 1999, and 2000 to 2005). We identified a total of 9,165 and 14,744 patients with AML and MM, respectively. Overall, higher white-collar workers had a lower mortality than other SES groups for both AML (P = .005) and MM (P .005). In AML patients, a consistently higher overall mortality was observed in blue-collar workers compared with higher white-collar workers in the last three periods (hazard ratio [HR], 1.26 95% CI, 1.05 to 1.51 HR, 1.23 95% CI, 1.05 to 1.45 HR, 1.28 95% CI, 1.04 to 1.57, respectively). In MM, no difference was observed in the first two calendar periods. However, in 1990 to 1999, self-employed (HR, 1.18 95% CI, 1.02 to 1.37), blue-collar workers (HR, 1.18 95% CI, 1.04 to 1.32), and retired (HR, 1.45 95% CI, 1.16 to 1.80) had a higher mortality compared to higher white-collar workers. In 2000 to 2005, blue-collar workers had a higher mortality (HR, 1.31 95% CI, 1.07 to 1.60) compared with higher white-collar workers. SES was significantly associated with survival in both AML and MM. Most conspicuously, a lower mortality was observed among the highest SES group during more recent calendar periods. Differences in management, comorbidity, and lifestyle, are likely factors to explain these findings.
Publisher: Oxford University Press (OUP)
Date: 27-01-2010
DOI: 10.1093/AJE/KWP432
Abstract: Selection bias is a concern in cohort studies in which selection into the cohort is related to the studied outcome. An ex le is chronic infection with hepatitis C virus, where the initial infection may be asymptomatic for decades. This problem leads to selection of more severely ill in iduals into registers of such infections. Cohort studies often adjust for this bias by introducing a time window between entry into the cohort and entry into the study. This paper describes and assesses a novel method to improve adjustment for this type of selection bias. The size of the time window is decided by calculating a standardized incidence ratio as a continuous function of the size of the time window. The resulting graph is used to decide on an appropriate window size. The method is evaluated by using the Swedish register of hepatitis C virus infections for 1990-2006. The complications studied were non-Hodgkin lymphoma and liver cancer. Selection bias differed for the studied outcomes, and a time window of a minimum of 2 months and 12 months, respectively, was judged to be appropriate. The novel method may have advantages compared with an interval-based method, especially in cohort studies with small numbers of events.
Publisher: BMJ
Date: 05-07-2011
DOI: 10.1136/BMJ.D4214
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2005
Publisher: Informa UK Limited
Date: 04-2004
DOI: 10.1080/02841860410028510
Abstract: In general, elderly patients with aggressive non-Hodgkin's lymphoma (NHL) have a less favourable prognosis than younger patients. Established predictors of prognosis in NHL are less discriminatory in the elderly, which is why there is a need for additional markers giving guidance on treatment decisions and prediction of outcome. The expected length of life of an in idual in the general population is intimately associated with that of his/her parents. The aim of this study was to test the hypothesis that parental longevity is associated with improved outcome also among elderly patients with aggressive NHL and thus serves as an easily accessible non-disease associated prognostic factor. A total of 220 patients ( > 60 years) with aggressive NHL with a median age of 71 years (range 60-86) were included. Patients were randomized to receive CHOP or CNOP (doxorubicin replaced with mitoxantrone) chemotherapy with or without the addition of granulocyte colony-stimulating factor. The median follow-up time was 56 (19-89) months. Parental data regarding age at death were available through parish offices for 425 (97%) parents. Relative risk (RR) of death (disease-specific and all-cause) associated with parental lifespan was assessed using Cox proportional hazards regression analyses, with adjustment for sex, age, prognostic index, symptoms, and calendar period of diagnosis. Maternal lifespan below (versus above) median was associated with a borderline significant reduced disease-specific (adjusted RR of death from NHL = 1.5 95% confidence interval 1.0-2.1) and overall survival. The effect of maternal lifespan was somewhat more pronounced in patients receiving CHOP than CNOP treatment. Paternal lifespan below the median was associated with a borderline significant increased disease-specific (adjusted RR of death from NHL = 0.8 [0.5-1.0]) and overall survival. Combined, maternal, and paternal lifespan had little impact on survival. These effects were true also when CHOP and CNOP treated patients were analysed separately. Maternal and paternal lifespan may predict survival in NHL, but with opposing effects. At present parental age appears not to be a clinically useful predictor of prognosis in the elderly with aggressive NHL.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2003
DOI: 10.1016/S0029-7844(03)00366-1
Abstract: To study whether interpregnancy interval is associated with increased risks of stillbirth and early neonatal death and whether this possible association is confounded by maternal characteristics and previous reproductive history. In a Swedish nationwide study of 410,021 women's first and second singleton deliveries between 1983 and 1997, we investigated the influence of interpregnancy interval on the subsequent risks of stillbirth and early neonatal death. Odds ratios (ORs) with 95% confidence intervals (CIs) estimated using unconditional logistic regression were adjusted for maternal characteristics and previous pregnancy outcome categorized into stillbirth, early neonatal death, preterm, or small for gestational age delivery. Compared with interpregnancy intervals between 12 and 35 months, very short interpregnancy intervals (0-3 months) were, in the univariate analyses, associated with increased risks of stillbirth and early neonatal death (crude OR 1.9 95% CI 1.3, 2.7 and 1.8 1.2, 2.8, respectively). However, after adjusting for maternal characteristics and previous reproductive history, women with interpregnancy intervals of 0 to 3 months were not at increased risks of stillbirth (adjusted OR 1.3 95% CI 0.8, 2.1) or early neonatal death (adjusted OR 0.9 95% CI 0.5, 1.6). Women with interpregnancy intervals of 72 months and longer were at increased risk of stillbirth (adjusted OR 1.5 95% CI 1.1, 2.1) and possibly early neonatal death (adjusted OR 1.3 95% CI 0.9, 2.1). Short interpregnancy intervals appear not to be causally associated with increased risk of stillbirth and early neonatal death, whereas long interpregnancy intervals were associated with increased risk of stillbirth and possibly early neonatal death.
Publisher: Massachusetts Medical Society
Date: 06-05-1999
Publisher: Stichting Nase
Date: 03-2015
DOI: 10.4193/RHINO14.070
Abstract: Introduction: Sinonasal malignancies (SNM) are rare and the prognosis is generally poor. Recently, a change in incidence for SNM has been reported. In this study, we investigated population-based trends for SNM in Sweden. Methods: We identified 3,221 patients from the Swedish National Cancer Registry diagnosed with primary malignancies arising from the nasal cavity, paranasal sinuses, or both, during the period 1960 through 2010. Incidence, gender and age, anatomical sites and relative survival were investigated. Results: The incidence for SNM decreased except for sinonasal malignant melanoma (SNMM) and adenoid cystic cancer (even though a very small group) during the study period. More than 50 % of the malignancies involved the nasal cavity. The five-year relative survival was highest for adenoid cystic cancer followed by adenocarcinoma. SNMM and undifferentiated carcinoma had the poorest prognosis. Conclusion: We found that the incidence for SNM has decreased during the study period 1960 through 2010, except for SNMM that has increased.
Publisher: Mary Ann Liebert Inc
Date: 07-2006
Abstract: The only established risk factor for differentiated thyroid cancer (DTC) is ionizing radiation. How ionizing radiation and other possible risk factors for DTC influence the prognosis has not extensively been investigated. We studied if factors such as smoking, number of children, previous thyroid disorders, previous radiotherapy toward the neck, family history of thyroid diseases, and malignancies influenced survival for patients with DTC. A nested case-control study was conducted within the cohort of all patients diagnosed with DTC in Sweden between 1958-1987. Cases consisted of patients who died from DTC. One control, matched by age at diagnosis, gender, and calendar period was randomly selected from the risk set for each case. Information of risk factors was collected from the medical records. Associations between these factors and prognosis were assessed using conditional logistic regression. Smokers had a borderline significant increased risk of dying from DTC. Previous radiotherapy towards the neck region had no prognostic implication. A family history of DTC influenced prognosis although not significant due to few cases. The remaining risk factors studied did not influence survival. In conclusion, smokers seemed to have a worsened prognosis compared to nonsmokers and a family history of thyroid cancer had a nonsignificant negative effect on survival.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Oxford University Press (OUP)
Date: 19-05-2021
DOI: 10.1093/AJE/KWAB146
Abstract: Net survival, estimated in a relative survival (RS) or cause-specific survival (CSS) framework, is a key measure of the effectiveness of cancer management. We compared RS and CSS in men with prostate cancer (PCa) according to age and risk category, using Prostate Cancer data Base Sweden, including 168,793 men younger than age 90 years, diagnosed 1998–2016 with PCa. RS and CSS were compared according to age and risk category based on TNM (tumor, nodes, and metastases) stage, Gleason score, and prostate-specific antigen level. Each framework requires assumptions that are unlikely to be appropriate for PCa. Ten-year RS was substantially higher than CSS in men aged 80–89 with low-risk PCa: 125% (95% confidence interval: 113, 138) versus 85% (95% confidence interval: 82, 88). In contrast, RS and CSS were similar for men under age 70 and for all men with regional or distant metastases. Both RS and CSS produce biased estimates of net survival for men with low- and intermediate-risk PCa, in particular for men over 80. Due to biases, net survival is overestimated in analysis of RS but underestimated in analysis of CSS. These results highlight the importance of evaluating the underlying assumptions for each method, because the “true” net survival is expected to lie between the limits of RS and CSS.
Publisher: American Medical Association (AMA)
Date: 22-11-2000
Abstract: High and low maternal hemoglobin concentrations during pregnancy have been reported to increase risk of small-for-gestational-age (SGA) birth, which is a predictor of stillbirth. The relationship between hemoglobin concentration during pregnancy and risk of stillbirth is unclear. To study the associations among hemoglobin concentration at first measurement during antenatal care, change in hemoglobin concentration during pregnancy, and risk of stillbirth. Population-based, matched case-control study of births from 1987 through 1996 in Sweden including 702 primiparous women with stillbirths occurring at 28 weeks' gestation or later and 702 primiparous women with live births. Risk of stillbirth, classified as malformed or nonmalformed, antepartum or intrapartum, preterm or term, and SGA or non-SGA, compared by maternal hemoglobin concentration at first antenatal measurement and weekly changes in hemoglobin concentration during pregnancy, adjusted for maternal age, body mass index, height, smoking, socioeconomic status, and week of first hemoglobin measurement. In multivariate analyses, compared with women with hemoglobin concentrations of 126 to 135 g/L at first antenatal measurement, women with concentrations of 146 g/L or higher were at increased risk of stillbirth (odds ratio [OR], 1.8 95% confidence interval [CI], 1.0-3.3). This risk was slightly increased when the analysis was restricted to antepartum stillbirths without malformations (OR, 2.0 95% CI, 1.1-3.8). When we further restricted the analyses to preterm and SGA antepartum nonmalformed stillbirths, the ORs increased to 2.7 (95% CI, 1.1-6.4) and 4.2 (95% CI, 1.3-13. 9), respectively. Excluding women with preecl sia and ecl sia further increased these risks. Average weekly change in hemoglobin concentration during early or late pregnancy was not significantly associated with risk of stillbirth, although a larger decrease in concentration tended to be protective. Anemia (hemoglobin concentration <110 g/L) was not significantly associated with risk of stillbirth in multivariate analyses (OR, 1.2 95% CI, 0.5-2.7). High hemoglobin concentration at first measurement during antenatal care appears to be associated with increased risk of stillbirth, especially preterm and SGA antepartum stillbirths. JAMA. 2000 :2611-2617.
Publisher: Springer Science and Business Media LLC
Date: 11-2004
DOI: 10.1007/S10654-004-1633-8
Abstract: The objective of this nationwide case-control study was to examine body mass index (BMI), alcohol use, coffee consumption, cigarette smoking, and leisure-time physical activity in relation to epithelial ovarian cancer (EOC) risk. Subjects were 655 newly diagnosed EOC cases and 3899 population controls, all 50-74 years of age at recruitment between 1993 and 1995. Data were collected through mailed questionnaires. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. Women with a BMI > or = 30 kg/m2 compared with those with a BMI or = 6 daily cups compared with non-users was 0.68 (95% CI: 0.42-1.10). Alcohol consumption was unrelated to EOC risk. Compared to non-smokers the ORs of EOC among current smokers were 0.70 (95% CI: 0.52-0.94) for those who smoked 1-10 cigarettes/day and 0.74 (95% CI: 0.53-1.02) for heavier smokers, while former smokers were at an unaltered risk (OR = 0.83, 95% CI: 0.66-1.04). Reduced EOC risks were observed among women in the highest compared with the lowest physical activity levels both at age 18-30 years (OR = 0.67, 95% CI: 0.52-0.87) and during the last years preceding study enrollment (OR = 0.68, 95% CI: 0.53-0.87). We conclude that women may avoid an excess risk of EOC through maintaining a normal BMI and reduce their risk by participation in leisure-time physical activity. The use of coffee, alcohol, or cigarette smoking does not appear to increase the risk of EOC.
Publisher: Wiley
Date: 18-04-2002
DOI: 10.1002/IJC.10420
Abstract: The prognosis among patients diagnosed with oesophageal cancer is poor with an overall 5-year survival close to 5% in most countries. Improved diagnostic and surgical strategies might influence the survival, however. We investigated the observed and relative survival among all patients in Sweden diagnosed with oesophageal adenocarcinoma (n = 1,441) or squamous cell carcinoma (n = 6395) from 1961-1996 with follow-up to December 1997. Observed survival rates were calculated by the life-table method. Relative survival rates were computed as the ratio of the observed to the expected survival. The expected survival was inferred from the survival among the entire Swedish population in the same age, sex and calendar year strata. The 5-year observed survival rate for adenocarcinoma increased from a stable figure close to 4% during the entire period 1961-1989 to 10.5% during 1990-1996. Similarly, the 5-year relative survival rate was stable around 5% during 1961-1989, but during 1990-1996 the survival was increased to 13.7%. For squamous cell carcinoma, the survival improved slightly by each decade, starting with 3.8% 5-year observed survival in 1961-1969 to 7.0% during 1990-1996. Similarly, the 5-year relative survival improved from 5.0% to 8.9% during the study period. In conclusion, the survival rates for both oesophageal adenocarcinoma and squamous cell carcinoma have increased significantly during the 1990s compared to those in the previous 3 decades (p < 0.001).
Publisher: Springer Science and Business Media LLC
Date: 19-09-2008
DOI: 10.1186/BCR2145
Publisher: Ferrata Storti Foundation (Haematologica)
Date: 09-2009
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2007
Abstract: To define patterns of survival among all multiple myeloma (MM) patients diagnosed in Sweden during a 30-year period. A total of 14,381 MM patients (7,643 males 6,738 females) were diagnosed in Sweden from 1973 to 2003 (median age, 69.9 years range 19 to 101 years). Patients were categorized into six age categories and four calendar periods (1973 to 1979, 1980 to 1986, 1987 to 1993, and 1994 to 2003). We computed relative survival ratios (RSRs) as measures of patient survival. One-year survival improved (P .001) over time in all age groups and RSRs were 0.73, 0.78, 0.80, and 0.82 for the four calendar periods however, improvement in 5-year (P .001) and 10-year (P .001) RSR was restricted to patients younger than 70 years and younger than 60 years, respectively. For the first time, in analyses restricted to MM patients diagnosed at age younger than 60 years, we found a 29% (P .001) reduced 10-year mortality in the last calendar period (1994 to 2003) compared with the preceding calendar period (1987 to 1993). Females with MM had a 3% (P = .024) lower excess mortality than males. One-year MM survival has increased for all age groups during the last decades 5-year and 10-year MM survival has increased in younger patients (younger than 60 to 70 years). High-dose melphalan with subsequent autologous stem-cell transplantation, thalidomide, and a continuous improvement in supportive care measures are probably the most important factors contributing to this finding. New effective agents with a more favorable toxicity profile are needed to improve survival further, particularly in the elderly.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLGC.2019.10.020
Abstract: While urinary bladder cancer is consistently more common in men worldwide, women have poorer prognosis. The aim of this study was to outline sex differences in prognostic factors and clinical management and to explore whether these can explain the poorer urinary bladder cancer outcome in women. We performed a population-based cohort study including all patients diagnosed with urothelial bladder cancer between 1997 and 2014 at age 18 to 89 who had data recorded in the Swedish Urinary Bladder Cancer Register (n = 36,344). Female-to-male odds ratios for clinical management parameters were estimated by logistic regression. To quantify sex differences in bladder cancer-specific survival, we estimated empirical survival proportions and mortality rates as well as applied flexible parametric models to estimate female-to-male hazard ratios and survival proportions over follow-up. Adjusted models included age, year, World Health Organization grade, stage, marital status, education, health care region, birth country, and comorbidity. Except for an adverse stage distribution in women, we found no evidence of unequal clinical management. Among those diagnosed with bladder cancer, women had a higher bladder cancer mortality (adjusted hazard ratio, 1.15 95% confidence interval, 1.08-1.23) driven by muscle-invasive tumors (adjusted hazard ratio, 1.24 95% confidence interval, 1.14-1.34). The female survival disadvantage was confined to the first 2 years after diagnosis. The excess bladder cancer mortality in women is limited to those diagnosed with muscle-invasive tumors and cannot be explained by the examined clinicopathologic factors. Further investigations of sex differences in therapeutic procedures and outcomes, including complications, of muscle-invasive bladder cancer, must be performed.
Publisher: Springer Science and Business Media LLC
Date: 11-2004
Publisher: Springer Science and Business Media LLC
Date: 06-2007
DOI: 10.1186/BCR1737
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Wiley
Date: 14-01-2022
Abstract: In Part I of our review of cancer outcome research, we analysed pros and cons of various measures relevant to quantifying the burden of cancer. Based on our recommendations in Part I, we now discuss in Part II opportunities and priorities in four areas of outcome research: primary prevention early detection screening treatment and quality‐of‐life assessment. We recommend the establishment of an infrastructure that facilitates high‐quality research in these areas: (a) progress in primary prevention can be assessed most directly by monitoring cancer incidence although the interpretation of temporal trends is notoriously confounded by numerous factors that complicate causal inference. (b) preventive screening, with the aim to prevent advanced disease, appears to work well in in some tumours but not in others. It will require randomized control trials (RCTs) to quantify benefits and harms although conclusive studies are increasingly difficult to undertake. We therefore propose learning screening programmes (randomization at the time of rolling out population‐based programmes) as the most feasible approach. (c) New therapeutic interventions tailored to the in idual patient often require assessment in RCTs with rather complex and dynamic structure, making their design and analyses increasingly challenging but also more suited to be executed as academic, PI‐initiated trials. (d) We next discuss assessment of quality‐of‐life aspects. Quality of life is a neglected component in outcome research with an urgent need for development, validation and standardization. We finally recommend four initiatives that would pave the way for a valid and informative assessment of the goals for improved cancer control in Europe as defined by the European Academy of Cancer Sciences.
Publisher: Wiley
Date: 1998
DOI: 10.1046/J.1464-410X.1998.00512.X
Abstract: To assess the validity and reliability of a questionnaire assessing 'physiological potency'. The study comprised 89 patients with prostate cancer and 43 men without the latter were attending a consultation clinic because of problems with erection. All men answered three questions assessing erectile rigidity during sexual activity, morning and spontaneous erections. In the questionnaire, 'potency' was defined as erectile rigidity 'sufficient for intercourse most of the time' or better. 'Potency' in one or more of the three aspects of erection was defined as 'physiological potency'. The patients with prostate cancer answered the questionnaire twice with a 3-week interval. The men attending the consultation clinic underwent two nights of erectile monitoring (using the RigiScan device) and the minimum criterion for RigiScan potency was defined as 55% rigidity at both tip and base. The test-retest assessment showed 93% conformity in the questionnaire diagnosis of 'physiological potency/impotence' between the tests. The sensitivity and specificity of the questionnaire assessment compared with the RigiScan method were 40% and 100%, respectively, when the question assessing sexually stimulated erectile rigidity was used alone. Using 'physiological potency', the sensitivity increased to about 60% without jeopardizing the specificity, and when men reporting depression were excluded from the analysis, the sensitivity increased to about 80%. The test-retest reliability of the questionnaire was satisfactory. Using questions in a self-administered questionnaire, 'physiological impotence' can be diagnosed with complete and 'physiological potency' with 60-80% sensitivity. The sensitivity of the self-assessment for 'potency' depended on the number of questions asked and the proportion of men reporting depression.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.AJOG.2008.08.066
Abstract: To assess the impact of infertility treatment with causes of infertility on incidence of breast cancer. Historical prospective cohort study of 1135 women attending major university clinics for treatment of infertility in Sweden, 1961-1976. Women were classified as users of clomiphene citrate or gonadotropins, or a combination of both therapies. Standardized incidence ratios were calculated to estimate relative risk of breast cancer. We observed 54 cases of breast cancer during 1961-2004, which did not significantly exceed those expected. Users of high-dose clomiphene citrate had an almost 2-fold increased risk (standardized incidence ratio, 1.90 95% confidence interval, 1.08-3.35). This association was more pronounced among women referred for nonovulatory factors, with 3-fold increased risk (standardized incidence ratio, 3.00 95% confidence interval, 1.35-6.67). No overall increased risk for breast cancer was shown with infertility treatment. Women with nonovulatory causes treated with high-dose clomiphene citrate therapy may have an elevated risk for breast cancer.
Publisher: American College of Physicians
Date: 16-01-2018
DOI: 10.7326/M17-0028
Publisher: Springer Science and Business Media LLC
Date: 11-04-2013
DOI: 10.1007/S10549-013-2522-1
Abstract: Converging evidence indicates that women with pregnancy-associated breast cancer (PABC) have increased mortality compared to women with breast cancer not diagnosed near pregnancy (non-PABC). Our aim was to investigate if the stage distribution differs between PABC and non-PABC and if stage at diagnosis can explain the poorer prognosis observed among women with PABC. We identified 3,282 breast cancers in women aged 15-44 years at diagnosis for whom staging data (tumor size, nodal involvement, metastasis) were available in the Swedish Cancer Register between 2002 and 2009. Information on reproductive history and vital status was obtained from the Multi-Generation Register and the Cause of Death Register. PABC was defined as breast cancers diagnosed during pregnancy and up to 2 years after delivery (n = 317). Non-PABC was defined as cases diagnosed before pregnancy or more than 2 years postpartum. Stage distributions were compared between PABC and non-PABC, and mortality rates were modeled using Cox regression. Compared to women with non-PABC, the mortality was almost 50 % higher in women with PABC [unadjusted hazard ratio (HR) 1.47 (95 % CI 1.04-2.08)], a difference which was reduced after adjustment for age and calendar year of diagnosis [HR 1.27 (95 % CI 0.88-1.83)]. Although advanced stage of breast cancer at diagnosis was more common among PABC than among non-PABC, further adjustment for stage only slightly reduced the HR [1.22 (95 % CI 0.84-1.78)]. The difference in mortality between PABC and non-PABC was more pronounced among women above 35 years and among women with PABC diagnosed within 1 year postpartum. Age, rather than stage at diagnosis, appears to act as the principal driver of the increased mortality observed in women with PABC. However, these findings do not preclude an untoward influence on mortality by pregnancy-associated factors affecting tumor aggressiveness and progression.
Publisher: Wiley
Date: 2003
Publisher: Informa UK Limited
Date: 22-04-2022
Publisher: Massachusetts Medical Society
Date: 19-02-2004
DOI: 10.1056/NEJMOA031587
Publisher: American Society of Hematology
Date: 25-07-2019
Publisher: European Respiratory Society (ERS)
Date: 02-1999
DOI: 10.1183/09031936.99.13243099
Abstract: Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-1998
Publisher: Springer Science and Business Media LLC
Date: 11-07-2023
Publisher: Informa UK Limited
Date: 2001
DOI: 10.1080/003655901750170407
Abstract: To investigate to what extent prostate cancer patients confide their emotional concerns, and whether having no one to confide in affects well-being. A population-based study using epidemiological methods. A questionnaire was mailed to all 431 living prostate cancer patients aged 50-80 at the time of selection, diagnosed 1.5-2 years previously in Stockholm County, and 435 randomly selected men in the same age group. The questionnaire was completed anonymously. The main outcome measures included questions assessing the extent to which the men could share emotionally taxing feelings with their partner or others and questions assessing well-being. The questionnaire was returned by 79% of the patients and by 73% of the randomly selected men. Approximately one in five patients had no one to confide in. Of patients living with a partner, only one in 10 confided in someone other than their partner. Three out of 10 patients living in a relationship could not confide in their partner. Men having no one to confide in were less content with their life and reported poorer psychological and overall well-being compared with other men. The prostate cancer patients were not more likely to have someone to confide in than men in general. The results indicate that a lack of emotional support may be a problem for many prostate cancer patients and that the traditional psychosocial support offered to most cancer patients in Sweden may not reach male patients. There may be a need for a gender-adapted approach to emotional support.
Publisher: Springer Science and Business Media LLC
Date: 02-2006
DOI: 10.1007/S10654-005-6030-4
Abstract: To date, few large web-based epidemiological studies have been performed in a population-based setting. Sweden has optimal prerequisites for web-based studies with more than 80% of the general population having access to the Internet. Our aim was to investigate (I) response rates in an epidemiological study using primarily the web as a tool for data collection and (II) whether socio-demographic patterns vary between responders to a web and a paper questionnaire. In 2003, we invited 47,859 women to complete a web questionnaire. Two reminders were sent to non-responders in the first a random s le received a paper questionnaire and in the second the majority received a paper questionnaire. All other non-responders received web questionnaires. Differences in response rates between responders to web and paper questionnaires with regard to socio-demographic and other variables were analyzed, and estimates of the bias introduced by these differences were estimated. In total, 41% of the women responded to the web questionnaire and 31% to the paper questionnaire (overall response rate 72%). The web-, paper- and non-responders respectively did not differ significantly in age, physical activity levels, and body mass index. Women answering web or paper questionnaires had a higher level of education and income and a lower level of smoking than non-responders. The bias associated with collecting information using web questionnaires was not greater than that caused by paper questionnaires. We conclude that web-based questionnaires are a feasible tool for data collection in large population based epidemiological studies in Sweden.
Publisher: Elsevier BV
Date: 09-2021
Publisher: American Medical Association (AMA)
Date: 09-06-2004
Publisher: Oxford University Press (OUP)
Date: 22-02-2021
DOI: 10.1093/AOB/MCAB026
Abstract: The fern Dicranopteris linearis is a hyperaccumulator of rare earth elements (REEs), aluminium (Al) and silicon (Si). However, the physiological mechanisms of tissue-level tolerance of high concentrations of REE and Al, and possible interactions with Si, are currently incompletely known. A particle-induced X-ray emission (μPIXE) microprobe with the Maia detector, scanning electron microscopy with energy-dispersive spectroscopy and chemical speciation modelling were used to decipher the localization and biochemistry of REEs, Al and Si in D. linearis during uptake, translocation and sequestration processes. In the roots & % of REEs and Al were in apoplastic fractions, among which the REEs were most significantly co-localized with Si and phosphorus (P) in the epidermis. In the xylem sap, REEs were nearly 100 % present as REEH3SiO42+, without significant differences between the REEs, while 24–45 % of Al was present as Al-citrate and only 1.7–16 % Al was present as AlH3SiO42+. In the pinnules, REEs were mainly concentrated in necrotic lesions and in the epidermis, and REEs and Al were possibly co-deposited within phytoliths (SiO2). Different REEs had similar spatial localizations in the epidermis and exodermis of roots, the necrosis, veins and epidermis of pinnae of D. linearis. We posit that Si plays a critical role in REE and Al tolerance within the root apoplast, transport within the vascular bundle and sequestration within the blade of D. linearis.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.EJCA.2017.07.013
Abstract: The aim of this study is to firmly delineate temporal and age trends regarding sex discrepancies in cancer risk and survival as well as quantifying the potential gain achieved by eliminating this inequality. We performed a population-based cohort study using data on all adult incident cancer cases (n = 872,397) recorded in the Swedish Cancer Register in 1970-2014. To assess the associations between sex and cancer risk and sex and survival, male-to-female incidence rate ratios (IRRs) and excess mortality ratios (EMRs) adjusted for age and year of diagnosis were estimated using Poisson regression. Men were at increased risk for 34 of 39 and had poorer prognosis for 27 of 39 cancers. Women were at increased risk for 5 of 39 and had significantly poorer survival for 2 of 39 cancers. IRRs among male predominant sites ranged from 1.05 95% confidence interval (CI), 1.03--1.1 (lung adenocarcinoma) to 8.0 95% CI, 7.5-8.5 (larynx). EMRs among sites with male survival disadvantage ranged from 1.1 95% CI, 1.03-1.1 (colon) to 2.1 95% CI, 1.5--2.8 (well-differentiated thyroid). Male sex is associated with increased risk and poorer survival for most cancer sites. Identifying and eliminating factors driving the observed sex differences may reduce the global cancer burden.
Publisher: SAGE Publications
Date: 04-2006
DOI: 10.1191/0269216306PM1139OA
Abstract: In this population-based study, we found that parents who are aware that their child will die from a malignancy are more likely to care for their child at home during the child’s last month of life compared to parents who are not aware. End-of-life home care was comparable to hospital care for satisfactory pain relief, access to pain relief and access to medications for other physical symptoms. Using an anonymous postal questionnaire, we obtained information from 449 parents in Sweden who had lost a child due to a malignancy between 1992 and 1997, 4 to 9 years before participating in our study. The prevalence of dying at home and being cared for at home during the last month of life was 23.7% when parents realized intellectually more than 1 month in advance that the child would die (versus 12% who did not), 28.7% for parents who sensed that the child was aware of his or her imminent death (versus 7.8% who did not sense this) and 21.9% for those who received information that the child’s illness was incurable (versus 9.4% who did not receive the information). Prevalence of children’s unrelieved pain was 11.6% for those receiving home care and 15.3% for those receiving care outside the home.
Publisher: American Society of Hematology
Date: 16-11-2004
DOI: 10.1182/BLOOD.V104.11.2408.2408
Abstract: Background: Over the last decades there have been advances in the treatment of patients with multiple myeloma (MM) and prognosis has improved with the introduction of new treatment strategies. However, few studies have addressed the issue which patients benefit most from these therapeutic changes over the years. Aims: To evaluate relative survival in all diagnosed MM patients in Sweden 1973–2001 and relate the changes to age, sex and type of hospital where diagnosis was made. Methods: All patients with MM notified to the Swedish Cancer Register in 1973–2001 were followed up by record linkage to the nationwide Cause of Death Register. Survival analyses were performed by obtaining relative survival (RS) defined as the ratio of observed versus expected survival. The study period was ided arbitrarily to four calendar periods: 1973–1979, 1980–1986, 1987–1993, and 1994–2002. Patients were grouped according to age at diagnosis (0–40, 41–50, 51–60, 61–70, 71–80, and 80+), sex, and hospital category. RS was estimated using SAS (Cary, NC, USA) and excess mortality modelled using Poisson regression. Results: A total of 13,376 patients (7,114 males and 6,262 females, mean age 69.8 years, and 32% diagnosed at a university hospital) were diagnosed with MM in Sweden between January 1st 1973 and December 31st 2001. The overall one-year RS estimates were 73%, 78%, 80%, and 81%, respectively, for the four calendar periods. The overall five-year RS was 31%, 32%, 34%, and 36% and the ten-year RS remained stable at 12%, 11% 13% in the first three periods ten-year RS could not be calculated for the last calendar period. The increase in one-year RS was observed in all age categories over the four calendar periods, while the increase in five-year RS was restricted to patients years. Younger age at onset was associated with a superior survival in all calendar periods. Differences in survival by age at diagnosis and calendar period were highly statistically significant (p .0001). Females had a superior 1- (p=0.002), 5- (p=0.024), and 10-year RS (p=0.019) compared to males, after adjusting for age and period. Patients diagnosed at university hospitals had superior 5- and 10-year RS (p=0.007) but not 1-year RS. Summary/conclusions: The present study shows an improved prognosis over time in a population-based study including 13,000 MM patients diagnosed during a 29-year period. Of interest is that even one-year RS has improved in all age groups over the whole study period. Increase in five-year RS was only observed in patients aged years. The ten-year RS did not improve over the first 20 years and could not be estimated for patients diagnosed in the last period. Younger age at diagnosis was associated with superior one-, five- and ten-year RS in all calendar periods. Females had a significantly better survival than males. A significant difference in survival was seen according to type of hospital, with patients diagnosed at a university hospital surviving longer. In conclusion, the results show that survival of MM patients has improved during the study period. However, long-term survival has not improved significantly. Males, elderly patients and patients diagnosed during early calendar periods experienced higher excess mortality.
Publisher: Wiley
Date: 02-2006
DOI: 10.1002/CNCR.21653
Abstract: Different scoring systems currently are being used to stratify patients with differentiated thyroid carcinoma (DTC) into risk groups. DTC is usually sub ided into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). The objective of the current study was to identify those factors that predict long-term unfavorable prognosis and to evaluate the predictive accuracy of the TNM staging system. The authors conducted a nested case-control study within the cohort of all patients (n=5123) diagnosed with DTC in Sweden between 1958-1987 who survived at least 1 year after diagnosis. One control, matched by age at diagnosis, gender, and calendar period, was randomly selected for each case (patients who died of DTC). All patients were classified at the time of diagnosis according to the TNM staging system. The effect of prognostic factors on DTC mortality was evaluated using conditional logistic regression. Patients with widely invasive FTC experienced a significantly higher mortality compared with PTC patients. The grade of differentiation was found to influence mortality significantly. Patients with TNM Stage IV disease had a higher mortality rate compared with patients with Stage II disease (odds ratio [OR]=9.1 95% confidence interval [95% CI], 5.7-14.6). Patients with lymph node metastases experienced a higher mortality (OR=2.5 95% CI, 1.6-4.1) and patients with distant metastasis at the time of diagnosis were found to have a nearly 7-fold higher mortality rate (OR=6.6 95% CI, 4.1-10.5). Incomplete surgical excision was associated with higher mortality, particularly in patients with Stage I disease. In the current study, the following were found to be clinically significant prognostic factors for patients with DTC: histopathologic subgroup, TNM staging including lymph node metastases and distant metastases, and completeness of the surgical excision.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2020
DOI: 10.1200/JCO.2020.38.15_SUPPL.E13593
Abstract: e13593 Background: Men are at increased risk of a majority of malignancies affecting both sexes. Since tall stature is associated with elevated cancer risk and since men are taller than women, we decided to investigate to what extent body stature, as a proxy for stem cell number within tissue, can explain the excess cancer risk in men. Methods: We performed a population-based cohort study investigating the association between male sex and cancer, accounting for body height. The analyses included all Swedish men and women with an adult height registration in either the Swedish Passport Register, the Conscription Register, and/or the Medical Birth Register (n = 6,156,659). Height data was linked to the Swedish Cancer Register where we observed 285,778 non-sex-specific cancer cases, diagnosed in 1960-2012. We applied contemporary causal mediation analysis methodology to assess the relative effect of male sex on lifetime cancer risk mediated by body height. Results: A vast majority of the investigated cancer sites were significantly associated with male sex (33 of 39) and height (27 of 39). The proportion of the excess cancer risk in men explained by sex differences in body height ranged from 0.5% (laryngeal) to 100% (salivary glands, colon, melanoma, and AML). The effect of body height and the mediated effect through height on cancer risk was most consistent and pronounced in malignancies with weak, few, or no known risk factors. Conclusions: A large proportion of the excess cancer risk in men is explainable by height. There is no known, height-associated cancer risk factor strong enough to provide an alternative pathway. Our findings supports the notion that a substantial proportion of cancer cases arise stochastically rather than are caused by underlying hereditary and/or environmental factors.
Publisher: Springer Science and Business Media LLC
Date: 07-2003
DOI: 10.1023/B:EJEP.0000036806.51918.40
Abstract: For reasons yet unknown, the incidence of esophageal and gastric cardia adenocarcinoma is increasing rapidly and moderately, respectively. These tumors occur predominantly among males. We hypothesized that stressful psychosocial working conditions might be involved in the etiology of these cancers. To study if job strain, work pace satisfaction and coping are linked to the risk of esophageal or cardia cancers. A nationwide Swedish population-based case-control study including 189 and 262 esophageal and cardia adenocarcinoma cases, respectively, 167 esophageal squamous-cell carcinoma cases, and 820 controls. All study subjects were interviewed. The relative risk was estimated using odds ratios, with 95% confidence intervals, adjusted for potential confounders. We found no statistically significant associations between two different measures of job strain and the three cancer types, except between one job strain measure and risk of cardia adenocarcinoma (OR: 2.2 95% CI: 1.0-4.8). There was a moderately strong association between having a covert coping style, compared to an overt, and risk of both esophageal (OR: 1.8 95% CI: 1.2-2.8) and cardia adenocarcinoma (OR: 1.5 95% CI: 1.0-2.3). Among subjects reporting low work pace satisfaction we found an almost 4-fold increased risk of esophageal squamous-cell carcinoma (OR: 3.8 95% CI: 1.3-11.0), and a nearly 3-fold increased risk of esophageal adenocarcinoma (OR: 2.8 95% CI: 1.1-7.0). Work-related stress does not seem to be of importance in the etiology of adenocarcinoma of the esophagus or the gastric cardia. However, the interaction of a stressful work environment and the in idual's responses to it may be associated with a moderately increased risk of these cancer types.
Publisher: Elsevier BV
Date: 05-2001
Abstract: Familial colorectal cancer (CRC) is a risk factor for CRC in healthy in iduals and, as indicated by case-control studies, possibly in ulcerative colitis. Little is known about the cancer risk in familial inflammatory bowel disease (IBD). We assessed the significance of familial CRC, or IBD, on the risk for CRC in patients with IBD. Population-based cohort study of 19,876 in iduals with ulcerative colitis or Crohn's disease born between 1941 and 1995. Registry-based follow-up and assessment of familial CRC, and IBD. Risk of CRC assessed as incidence proportion ("absolute risk," IP) and relative risk (RR). Familial CRC was associated with a more than 2-fold risk of CRC (adjusted RR = 2.5, 95% confidence interval 1.4-4.4) and an increase in the IP of CRC at 54 years of age from 3.8% to 6.9%. Patients with a first-degree relative diagnosed with CRC before 50 years of age had a higher RR (9.2, 95% confidence interval 3.7-23) and the highest IP (29%). No association with familial IBD was observed. Information on family history of CRC may be a simple way to identify in iduals with IBD at elevated risk of developing CRC.
Publisher: Springer Science and Business Media LLC
Date: 30-01-2018
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 08-01-2013
DOI: 10.1007/S10552-012-0141-5
Abstract: Studies of cancer patient survival typically report relative survival or cause-specific survival using data from patients diagnosed many years in the past. From a risk-communication perspective, such measures are suboptimal for several reasons their interpretation is not transparent for non-specialists, competing causes of death are ignored and the estimates are unsuitable to predict the outcome of newly diagnosed patients. In this paper, we discuss the relative merits of recently developed alternatives to traditionally reported measures of cancer patient survival. In a relative survival framework, using a period approach, we estimated probabilities of death in the presence of competing risks. To illustrate the methods, we present estimates of survival among 23,353 initially untreated, or hormonally treated men with intermediate- or high-risk localized prostate cancer using Swedish population-based data. Among all groups of newly diagnosed patients, the probability of dying from prostate cancer, accounting for competing risks, was lower compared to the corresponding estimates where competing risks were ignored. Accounting for competing deaths was particularly important for patients aged more than 70 years at diagnosis in order to avoid overestimating the risk of dying from prostate cancer. We argue that period estimates of survival, accounting for competing risks, provide the tools to communicate the actual risk that cancer patients, diagnosed today, face to die from their disease. Such measures should offer a more useful basis for risk communication between patients and clinicians and we advocate their use as means to answer prognostic questions.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.EJCA.2011.08.010
Abstract: Relative survival is a widely used measure of cancer patient survival, defined as the observed survival of the cancer patients ided by the expected survival of a comparable group from the general population, free from the cancer under study. In practise, expected survival is usually calculated from general population life tables. Such estimates are known to be biased since they also include mortality from the cancer patients, but the bias is ignored since mortality among in iduals with a specific cancer is thought to constitute only a small proportion of total mortality. Using the computerised population registers that exist in Sweden we had the unique opportunity to calculate expected survival both including and excluding in iduals with cancer, and thereby estimate the size of the bias arising from using general population estimates. We also evaluated a simple method to adjust expected survival probabilities estimated from general population statistics as an aid to researchers who do not have access to computerised registers of the entire national population. Our results show that the bias is sufficiently small to be ignorable for most applications, notably for cancers with high or low mortality and for younger age groups (<60 years). However, the bias in relative survival estimates can be greater than 1 percent unit for older age groups for common cancers and even larger for all sites combined. For ex le, the bias in 10-year relative survival for men aged 75+ diagnosed with prostate cancer was 2.6 percent units, which we think is of sufficient magnitude to warrant adjustment.
Publisher: Oxford University Press (OUP)
Date: 19-08-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC474
Abstract: To conduct the first-ever nationwide, population-based cohort study investigating survival patterns of all patients with incident SSc in Sweden compared with matched in iduals from the Swedish general population. We used the National Patient Register to identify patients with incident SSc diagnosed between 2004 and 2015 and the Total Population Register to identify comparators (1:5), matched on sex, birth year and residential area. We followed them until death, emigration or the end of 2016. Follow-up of the general population comparators started the same date as their matched patients were included. We estimated all-cause survival using the Kaplan–Meier method, crude mortality rates and hazard ratios (HRs) using flexible parametric models. We identified 1139 incident patients with SSc and 5613 matched comparators. The median follow-up was 5.0 years in patients with SSc and 6.0 years for their comparators. During follow-up, 268 deaths occurred in patients with SSc and 554 in their comparators. The 5-year survival was 79.8% and the 10-year survival was 67.7% among patients with SSc vs 92.9% and 84.8%, respectively, for the comparators (P & 0.0001). The mortality rate in patients with SSc was 42.1 per 1000 person-years and 15.8 per 1000 person-years in their comparators, corresponding to an HR of 3.7 (95% CI 2.9, 4.7) at the end of the first year of follow-up and 2.0 (95% CI 1.4, 2.8) at the end of the follow-up period. Despite advances in understanding the disease and in diagnostic methods over the past decades, survival is still severely impacted in Swedish patients diagnosed with SSc between 2004 and 2015.
Publisher: Wiley
Date: 05-02-2019
DOI: 10.1002/IJC.32142
Abstract: While Hodgkin lymphoma (HL) survival has improved, treatment-related complications remain a concern. As a measure of treatment-related diseases of the circulatory system (DCS) we report excess incidence of DCS and absolute risks among HL patients diagnosed in the modern treatment era. From the Swedish Cancer Register, we identified all HL patients diagnosed 1985 through 2013, at ages 18-80 years. Excess incidence rate ratios (EIRRs) with 95% confidence intervals (CIs) comparing excess DCS incidence between calendar periods were estimated overall, and at 5 and 10 years after diagnosis using flexible parametric models. Model-based predictions were used to obtain probabilities of being diagnosed with DCS, in the presence of competing risks. During follow-up, 726 (16%) of the 4,479 HL patients experienced DCS. Overall, the excess DCS incidence was lower during all calendar periods compared to the first (2009-2013 vs. 1985-1988: EIRR = 0.63, 95% CI: 0.42-0.95). The 5- and 10-year excess incidence of DCS decreased between 1985 and 1994 for 25-year-olds (5-year-EIRR
Publisher: Wiley
Date: 04-12-2017
DOI: 10.1002/IJC.31174
Abstract: There is evidence of poor prognosis in women with pregnancy-associated breast cancer (PABC) diagnosed during pregnancy or within 2 years of delivery. Using a large, population-based cohort, we examined clinicopathologic features and survival in women with PABC. A cohort of women diagnosed with invasive breast cancer between 1992 and 2009 at ages 15-44 years was identified in the Swedish Cancer Register and the Breast Cancer Quality Registers. Dates of childbirths for each woman were retrieved from the Swedish Multi-Generation Register. Age-standardized distributions of tumor stage (tumor size, nodal status, metastasis), Elston grade and ER/PR/HER2 status were compared between nulliparous women and women with breast cancer during pregnancy and up to 10 years postdelivery. Adjusted hazard ratios for all-cause mortality rates among patients were estimated using Cox regression. We identified 1,661 nulliparous women with breast cancer, 778 women with PABC (97 during pregnancy, 270 within first and 411 within second year postdelivery) and 3,598 during 2-10 years postdelivery. Compared to nulliparous women, women with PABC, and especially women diagnosed 0-12 months after delivery, had more advanced T and N stage, and higher proportions of ER/PR negative, HER2 positive and triple-negative tumors. Increased hazard ratios were observed in women diagnosed within 5 years of delivery after adjustment for age, year, education and region. Following additional adjustment for tumor characteristics, the hazard ratios were attenuated and nonsignificant. The poorer prognosis observed in women with PABC appears to be largely explained by more adverse tumor characteristics at diagnosis.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.CANEP.2016.05.002
Abstract: The survival inequality faced by Indigenous Australians after a cancer diagnosis is well documented what is less understood is whether this inequality has changed over time and what this means in terms of the impact a cancer diagnosis has on Indigenous people. Survival information for all patients identified as either Indigenous (n=3168) or non-Indigenous (n=211,615) and diagnosed in Queensland between 1997 and 2012 were obtained from the Queensland Cancer Registry, with mortality followed up to 31st December, 2013. Flexible parametric survival models were used to quantify changes in the cause-specific survival inequalities and the number of lives that might be saved if these inequalities were removed. Among Indigenous cancer patients, the 5-year cause-specific survival (adjusted by age, sex and broad cancer type) increased from 52.9% in 1997-2006 to 58.6% in 2007-2012, while it improved from 61.0% to 64.9% among non-Indigenous patients. This meant that the adjusted 5-year comparative survival ratio (Indigenous: non-Indigenous) increased from 0.87 [0.83-0.88] to 0.89 [0.87-0.93], with similar improvements in the 1-year comparative survival. Using a simulated cohort corresponding to the number and age-distribution of Indigenous people diagnosed with cancer in Queensland each year (n=300), based on the 1997-2006 cohort mortality rates, 35 of the 170 deaths due to cancer (21%) expected within five years of diagnosis were due to the Indigenous: non-Indigenous survival inequality. This percentage was similar when applying 2007-2012 cohort mortality rates (19% 27 out of 140 deaths). Indigenous people diagnosed with cancer still face a poorer survival outlook than their non-Indigenous counterparts, particularly in the first year after diagnosis. The improving survival outcomes among both Indigenous and non-Indigenous cancer patients, and the decreasing absolute impact of the Indigenous survival disadvantage, should provide increased motivation to continue and enhance current strategies to further reduce the impact of the survival inequalities faced by Indigenous people diagnosed with cancer.
Publisher: Wiley
Date: 25-02-2013
DOI: 10.1002/IJC.28041
Publisher: Springer Science and Business Media LLC
Date: 19-04-2015
DOI: 10.1007/S10549-015-3369-4
Abstract: The risk of breast cancer is at least two-fold increased in young women with a family history of breast cancer. Pregnancy has a dual effect on breast cancer risk a short-term increase followed by a long-term protection. We investigated if the risk of breast cancer during and within 10 years following pregnancy is affected by a family history of breast cancer. We followed a cohort of women aged 15-44 years between 1963 and 2009 identified in Swedish population-based registers. Family history was defined as having a mother or sister with breast cancer. We estimated incidence rate ratios of breast cancer during pregnancy and time intervals up to 10 years post-delivery, with a focus on pregnancy-associated breast cancer (PABC), defined as breast cancer during pregnancy or within 2 years post-delivery. In 3,452,506 women, there were 15,548 cases of breast cancer (1208 were PABC). Compared to nulliparous women, the risk of breast cancer was decreased during pregnancy, similar during first year and increased during second year post-delivery. The pattern was similar in women with or without family history of breast cancer. A peak in risk was observed 5-6 years following the first birth regardless of family history. After a second birth, this peak was only present in women with a family history. Our results indicate that women with a family history of breast cancer do not have a different breast cancer risk during and within 10 years following pregnancy compared to women without a family history.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2003
Publisher: Elsevier BV
Date: 07-2003
Publisher: Springer Science and Business Media LLC
Date: 09-11-2022
DOI: 10.1186/S12874-022-01773-9
Abstract: There are situations when we need to model multiple time-scales in survival analysis. A usual approach in this setting would involve fitting Cox or Poisson models to a time-split dataset. However, this leads to large datasets and can be computationally intensive when model fitting, especially if interest lies in displaying how the estimated hazard rate or survival change along multiple time-scales continuously. We propose to use flexible parametric survival models on the log hazard scale as an alternative method when modelling data with multiple time-scales. By choosing one of the time-scales as reference, and rewriting other time-scales as a function of this reference time-scale, users can avoid time-splitting of the data. Through case-studies we demonstrate the usefulness of this method and provide ex les of graphical representations of estimated hazard rates and survival proportions. The model gives nearly identical results to using a Poisson model, without requiring time-splitting. Flexible parametric survival models are a powerful tool for modelling multiple time-scales. This method does not require splitting the data into small time-intervals, and therefore saves time, helps avoid technological limitations and reduces room for error.
Publisher: Wiley
Date: 08-03-2010
DOI: 10.1002/SIM.3762
Abstract: Relative survival is used extensively in population‐based cancer studies to measure patient survival correcting for causes of death not related to the disease of interest. An advantage of relative survival is that it provides a measure of mortality associated with a particular disease, without the need for information on cause of death. Relative survival provides a measure of net mortality, i.e. the probability of death due to cancer in the absence of other causes. This is a useful measure, but it is also of interest to measure crude mortality, i.e. the probability of death due to cancer in the presence of other causes. A previous approach to estimate the crude probability of death in population‐based cancer studies used life table methods, but we show how the estimates can be obtained after fitting a relative survival model. We adopt flexible parametric models for relative survival, which use restricted cubic splines for the baseline cumulative excess hazard and for any time‐dependent effects. We illustrate the approach using an ex le of men diagnosed with prostate cancer in England and Wales showing the differences in net and crude survival for different ages. Copyright © 2010 John Wiley & Sons, Ltd.
Publisher: Wiley
Date: 08-02-2021
DOI: 10.1002/SIM.8894
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/02841860701766145
Abstract: Feelings of guilt are common after bereavement. We investigated whether feelings of guilt after the loss of a husband to cancer are associated with the health care provided at the time close to and at the moment of death. The study population consisted of 506 widows of men who died of prostate cancer in 1995 or of urinary bladder cancer in 1995 or 1996 at the ages 45-74 years. We collected information on the received health care at the time of the husband's death from the widows, through a postal questionnaire. Widows who perceived that their husbands did not get enough pain relief had an increased relative risk of 1.7 (95% CI 1.1-2.8), for guilt feelings, compared to widows who felt that their husbands had adequate pain relief. If a widow considered her husband being exposed to less satisfactory care or treatment, she had an almost two-fold increased relative risk, 1.9 (95% CI 1.2-3.1), for guilt feelings after the husband's death, compared to a widow who thought that satisfactory care or treatment was provided. Feelings of guilt after bereavement may occur in response to the perception of inadequate health care during the last months and at the actual moment of death of the significant other.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2003
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 22-06-2021
Abstract: In a mission that aims to improve cancer control throughout Europe, the European Academy of Cancer Sciences has defined two key indicators of progress: within one to two decades, overall cancer‐specific 10‐year survival should reach 75%, and in each country, overall cancer mortality rates should be convincingly declining. To lay the ground for assessment of progress and to promote cancer outcomes research in general, we have reviewed the most common population‐based measures of the cancer burden. We emphasize the complexities and complementary approaches to measure cancer survival and the novel opportunities for improved assessment of quality of life. We propose that: incidence and mortality rates are standardized to the European population net survival is used as the measure of prognosis but with proper adjustments for confounding when temporal trends in overall cancer survival are assessed and cancer‐specific quality of life is measured by a combination of existing questionnaires and utilizes emerging communication technologies. We conclude that all measures are important and that a meaningful interpretation also requires a deep understanding of the larger clinical and public health context.
Publisher: Wiley
Date: 23-08-2013
DOI: 10.1002/SIM.5943
Abstract: A useful summary measure for survival data is the expectation of life, which is calculated by obtaining the area under a survival curve. The loss in expectation of life due to a certain type of cancer is the difference between the expectation of life in the general population and the expectation of life among the cancer patients. This measure is used little in practice as its estimation generally requires extrapolation of both the expected and observed survival. A parametric distribution can be used for extrapolation of the observed survival, but it is difficult to find a distribution that captures the underlying shape of the survival function after the end of follow-up. In this paper, we base our extrapolation on relative survival, because it is more stable and reliable. Relative survival is defined as the observed survival ided by the expected survival, and the mortality analogue is excess mortality. Approaches have been suggested for extrapolation of relative survival within life-table data, by assuming that the excess mortality has reached zero (statistical cure) or has stabilized to a constant. We propose the use of flexible parametric survival models for relative survival, which enables estimating the loss in expectation of life on in idual level data by making these assumptions or by extrapolating the estimated linear trend at the end of follow-up. We have evaluated the extrapolation from this model using data on four types of cancer, and the results agree well with observed data.
Publisher: American Society of Hematology
Date: 19-11-2010
Publisher: Oxford University Press (OUP)
Date: 04-10-2006
DOI: 10.1093/BIOSTATISTICS/KXL030
Abstract: In population-based cancer studies, cure is said to occur when the mortality (hazard) rate in the diseased group of in iduals returns to the same level as that expected in the general population. The cure fraction (the proportion of patients cured of disease) is of interest to patients and is a useful measure to monitor trends in survival of curable disease. There are 2 main types of cure fraction model, the mixture cure fraction model and the non-mixture cure fraction model, with most previous work concentrating on the mixture cure fraction model. In this paper, we extend the parametric non-mixture cure fraction model to incorporate background mortality, thus providing estimates of the cure fraction in population-based cancer studies. We compare the estimates of relative survival and the cure fraction between the 2 types of model and also investigate the importance of modeling the ancillary parameters in the selected parametric distribution for both types of model.
Publisher: Oxford University Press (OUP)
Date: 03-2004
DOI: 10.1093/AJE/KWH063
Abstract: For diseases with an infectious etiology, birth order may dictate the age of exposure to childhood infection, while sibship size may be a proxy for the probability of exposure. The authors examined whether birth order, sibship size, and childhood housing density affect risk of tooth loss and periodontal disease. The study included 28,690 adults aged > or = 42 years who were participating in a 1998-2002 follow-up of persons listed in the Swedish Twin Registry. Logistic regression was used to calculate odds ratios and 95% confidence intervals, with adjustment for age, sex, education, and smoking and mutual adjustment for family composition (sibship size and/or birth order). Tooth loss and periodontal disease affected 8% and 19% of the twins, respectively. Each additional sibling increased the odds of tooth loss by 10% (95% confidence interval (CI): 1.06, 1.15) and the odds of periodontal disease by 5% (95% CI: 1.02, 1.08). Later birth order was associated with lower odds of periodontal disease. Each additional person per room in the childhood home increased the odds of tooth loss (odds ratio = 1.28, 95% CI: 1.03, 1.60) but lowered the odds of periodontal disease (odds ratio = 0.65, 95% CI: 0.48, 0.89). These findings are compatible with the hypotheses that adult oral diseases are associated with the probability of exposure in childhood and that earlier age at exposure lowers risk.
Publisher: Oxford University Press (OUP)
Date: 03-09-2009
DOI: 10.1111/J.1467-9876.2009.00677.X
Abstract: The cure fraction (the proportion of patients who are cured of disease) is of interest to both patients and clinicians and is a useful measure to monitor trends in survival of curable disease. The paper extends the non-mixture and mixture cure fraction models to estimate the proportion cured of disease in population-based cancer studies by incorporating a finite mixture of two Weibull distributions to provide more flexibility in the shape of the estimated relative survival or excess mortality functions. The methods are illustrated by using public use data from England and Wales on survival following diagnosis of cancer of the colon where interest lies in differences between age and deprivation groups. We show that the finite mixture approach leads to improved model fit and estimates of the cure fraction that are closer to the empirical estimates. This is particularly so in the oldest age group where the cure fraction is notably lower. The cure fraction is broadly similar in each deprivation group, but the median survival of the ‘uncured’ is lower in the more deprived groups. The finite mixture approach overcomes some of the limitations of the more simplistic cure models and has the potential to model the complex excess hazard functions that are seen in real data.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2023
DOI: 10.1186/S12885-023-10746-0
Abstract: An investigation of trends of incidence and net survival (NS) for endometrial cancer in Sweden. Morphologically verified endometrial carcinoma diagnosed 1960 to 2014 were collected from the nation-wide Swedish Cancer Registry. Endometrial cancer patients were assessed with regards to time trends for incidence and 54,825 cases remained for survival analyses. Cases diagnosed 1995 to 2014 were categorized according to detailed morphology and from 2005 to 2014 FIGO stage was also categorized. There was a trend of increasing incidence of endometrial carcinoma for women above 55 years of age. NS was improved at 5- and 10-year follow-up. The 5-year net survival in 2010–2014 was 86%. The most prominent improvement in NS was found in the elderly women above 75 years of age. This study observed increased incidence of endometrial cancer in Sweden from 1960 to 2014. The progress in diagnostics and treatment, seem to have improved the net survival, especially in elderly women.
Publisher: BMJ
Date: 11-1998
Abstract: Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure affects the estimation of social class differences in cancer patient survival. All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992. Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival relative survival, corrected (cause specific) survival, and relative survival adjusted for social class differences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up. The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class differences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The differences between the three measures were largest when the proportion of deaths from other causes was large, for ex le, in cancers with high survival, among older patients, and for longer follow up times. Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. If this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class differences and should be used with caution.
Publisher: Wiley
Date: 03-06-2003
DOI: 10.1002/IJC.11275
Abstract: Papillary (PTC) and follicular (FTC) thyroid cancers are rare disorders but are, nevertheless, among the most common cancers in in iduals below 40 years of age. From the population‐based Swedish Cancer Registry we identified 3,588 in iduals with PTC and 1,966 with FTC during 1958–87. Histopathology was determined by examining the original histopathology reports. The relative survival ratio (RSR) was used as the measure of patient survival. Incidence of both PTC and FTC was higher among women, especially for PTC and particularly during the fertile part of female life. Incidence of PTC increased significantly over time, a trend that was not observed for FTC. Five‐year relative survival appeared to be higher for patients diagnosed with PTC compared to FTC, although this difference was almost completely explained by the confounding effect of age. Patients with PTC experience lower mortality during the period 7–20 years after diagnosis. Excess mortality was lower among women, although the magnitude of the difference varied with age and histopathology. In contrast to our perceptions based on clinical practice, we observed no difference in excess mortality between patients diagnosed with PTC and FTC during the years immediately after diagnosis (where the majority of deaths occur). Our data suggest that there may exist a subgroup of thyroid tumors with superior prognosis diagnosed in women during the fertile part of female life. Sex hormones may play a role in the etiology of these tumors. © 2003 Wiley‐Liss, Inc.
Publisher: Wiley
Date: 2003
Publisher: Springer Science and Business Media LLC
Date: 12-2010
Publisher: American Association for Cancer Research (AACR)
Date: 12-2006
DOI: 10.1158/1055-9965.EPI-06-0489
Abstract: The effect of classic breast cancer risk factors on hormone receptor-defined breast cancer is not fully clarified. We explored these associations in a Swedish population-based study. Postmenopausal women ages 50 to 74 years, diagnosed with invasive breast cancer during 1993 to 1995, were compared with 3,065 age frequency-matched controls. We identified 332 estrogen receptor (ER−) and progesterone receptor (PR−) negative, 286 ER+PR−, 71 ER−PR+, 1,165 ER+PR+, and 789 tumors with unknown receptor status. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Women ages ≥30 years, compared with those ages 20 to 24 years at first birth, were at an increased risk of ER+PR+ tumors (OR, 1.5 95% CI, 1.2-1.8) but not ER−PR− tumors (OR, 1.1 95% CI, 0.8-1.6). Women who gained ≥30 kg in weight during adulthood had an ∼3-fold increased relative risk of ER+PR+ tumors (OR, 2.7 95% CI, 1.9-3.8), but no risk increase of ER−PR− tumors (OR, 1.0 95% CI, 0.5-2.1), compared with women who gained & kg. Compared with never users, women who used menopausal estrogen-progestin therapy for at least 5 years were at increased risk of ER+PR+ tumors (OR, 3.0 95% CI, 2.1-4.1) but not ER−PR− tumors (OR, 1.3 95% CI, 0.7-2.5). In conclusion, other risk factors were similarly related to breast cancer regardless of receptor status, but high age at first birth, substantial weight gain in adult age, and use of menopausal estrogen-progestin therapy were more strongly related to receptor-positive breast cancer than receptor-negative breast cancer. (Cancer Epidemiol Biomarkers Prev 2006 (12):2482–8)
Publisher: Informa UK Limited
Date: 2002
DOI: 10.1080/02841860260088782
Abstract: In order to suggest therapy modifications with the aim of diminishing the risk of therapy-induced long-term distressful symptoms in cancer survivors, data are needed relating details of therapy to the long-term symptom situation. In this article, the concepts and means used to assess the latter while developing the Radiumhemmet scale for symptom assessment are described. The focus is on the subjective long-term situation, and symptoms as a perceived abnormality are defined. For conceptual clarity, one symptom at a time is considered, excluding scales in which items are summarized. Moreover, measures of disease occurrence in the population are translated (epidemiologically) into measures of symptom occurrence in an in idual. Nature distinguishes one long-term symptom from another. Occurrence of a symptom in an in idual is measured by an incidence (e.g. number of defecations per week) or prevalence rate (e.g. urinations with involuntary cessation ided by the total number of urinations). Any scale expressing symptom intensity is arbitrary, be it 'verbal' (no/little/moderate/much pain) or visual (analogue or with integers). A time period describes symptom duration. The relevance of a symptom to emotions and social activities, sometimes cited as the associated symptom-induced distress, is a separate issue from symptom occurrence, intensity, and duration.
Publisher: Wiley
Date: 2004
DOI: 10.1002/SIM.1597
Abstract: Four approaches to estimating a regression model for relative survival using the method of maximum likelihood are described and compared. The underlying model is an additive hazards model where the total hazard is written as the sum of the known baseline hazard and the excess hazard associated with a diagnosis of cancer. The excess hazards are assumed to be constant within pre-specified bands of follow-up. The likelihood can be maximized directly or in the framework of generalized linear models. Minor differences exist due to, for ex le, the way the data are presented (in idual, aggregated or grouped), and in some assumptions (e.g. distributional assumptions). The four approaches are applied to two real data sets and produce very similar estimates even when the assumption of proportional excess hazards is violated. The choice of approach to use in practice can, therefore, be guided by ease of use and availability of software. We recommend using a generalized linear model with a Poisson error structure based on collapsed data using exact survival times. The model can be estimated in any software package that estimates GLMs with user-defined link functions (including SAS, Stata, S-plus, and R) and utilizes the theory of generalized linear models for assessing goodness-of-fit and studying regression diagnostics.
Publisher: Wiley
Date: 23-05-2018
DOI: 10.1111/EJH.13090
Abstract: Forty percent of Hodgkin lymphoma (HL) patients are older than 50 years at diagnosis, a fact which is not commonly recognized. Older patients do significantly worse than younger patients and are rarely included in clinical trials. Using data from Swedish Cancer and Lymphoma Registries, we estimated relative survival ratios (RSRs) for 7997 HL patients (diagnosed 1973-2013 45% ≥50 years). The 1-year RSRs (95% confidence interval CI) for males aged 45-59, 60-69, 70-80, and 81 years and over, diagnosed in 2013, were 0.95 (0.91-0.97), 0.88 (0.81-0.92), 0.74 (0.63-0.81), and 0.52 (0.35-0.67), respectively. The corresponding 1-year RSRs for females were 0.97 (0.94-0.98), 0.91 (0.85-0.95), 0.82 (0.73-0.88), and 0.66 (0.50-0.77). No improvements in 1-year of 5-year relative survival from 2000 to 2013 were observed for patients aged 45-59 or 60-69 but there were modest improvements for patients aged 70 years and older. Importantly, we saw no changes in the distribution of disease or patient characteristics between 2000 and 2013. Elderly patients constitute a large group with clearly unmet medical needs. Our findings motivate a more active approach to including elderly patients in clinical trials. Our study provides a baseline for outcome comparison after the broader introduction of targeted drugs.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.FERTNSTERT.2008.01.073
Abstract: To study the association between hormonal infertility treatment and ovarian neoplasia. Historical cohort study. Three university hospitals in Sweden. A total of 2,768 women assessed and treated for infertility and infertility-associated disorders between 1961 and 1975. Exposed women received clomiphene citrate and/or gonadotropins. Incidence of ovarian neoplasia. No overall excess risk of invasive ovarian cancer emerged compared with the general population. In women with gonadotropin treatment for non-ovulatory disorders, the risk was elevated (standardized incidence ratio [SIR] = 5.89 95% confidence interval [CI] 1.91-13.75) four of the five cases reported hCG treatment only, rendering the biological plausibility uncertain. Multivariate analysis within the cohort indicated that treatment with gonadotropins only was associated with an increased risk of invasive cancer (relative risk = 5.28 95% CI 1.70-16.47). For borderline tumors, a more than threefold overall increase of tumors (SIR = 3.61 95% CI 1.45-7.44) was noted women exposed to clomiphene because of ovulatory disorders showed the highest risk (SIR = 7.47 95% CI 1.54-21.83). Our findings of increased risk of ovarian cancer after gonadotropins and of borderline tumors after clomiphene treatment need to be interpreted with caution. However, concern is raised, and further research on the long-term safety particularly of modern hormonal infertility treatment in IVF programs is warranted.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2018
DOI: 10.1038/S41380-018-0118-1
Abstract: Carriers of large recurrent copy number variants (CNVs) have a higher risk of developing neurodevelopmental disorders. The 16p11.2 distal CNV predisposes carriers to e.g., autism spectrum disorder and schizophrenia. We compared subcortical brain volumes of 12 16p11.2 distal deletion and 12 duplication carriers to 6882 non-carriers from the large-scale brain Magnetic Resonance Imaging collaboration, ENIGMA-CNV. After stringent CNV calling procedures, and standardized FreeSurfer image analysis, we found negative dose-response associations with copy number on intracranial volume and on regional caudate, pallidum and putamen volumes ( β = −0.71 to −1.37 P 0.0005). In an independent s le, consistent results were obtained, with significant effects in the pallidum ( β = −0.95, P = 0.0042). The two data sets combined showed significant negative dose-response for the accumbens, caudate, pallidum, putamen and ICV ( P = 0.0032, 8.9 × 10 −6 , 1.7 × 10 − 9 , 3.5 × 10 −12 and 1.0 × 10 −4 , respectively). Full scale IQ was lower in both deletion and duplication carriers compared to non-carriers. This is the first brain MRI study of the impact of the 16p11.2 distal CNV, and we demonstrate a specific effect on subcortical brain structures, suggesting a neuropathological pattern underlying the neurodevelopmental syndromes.
Publisher: BMJ
Date: 06-1997
Abstract: To examine equity in the health care system with regard to cancer patient care by estimating the level of systematic regional variation in cancer survival in the Nordic countries. Specifically, those cancer sites which exhibit high levels of systematic regional variation in survival and hence inequity were identified. Estimating the reduction in cancer deaths which could be achieved by eliminating this variation so that everyone receives effective care will provide a readily interpretable measure of the amount of systematic regional variation. A comprehensive analysis of regional variation in survival has not previously been conducted so appropriate statistical methodology must be developed. All those aged 0-90 years who had been diagnosed with at least one of 12 common malignant neoplasms between 1977 and 1992 in Denmark, Finland, Norway, and Sweden. A separate analysis was conducted for each country. Regression models for the relative survival ratio were used to estimate the relative risk of excess mortality attributable to cancer in each region after correcting for age and sex. An estimate of the amount of systematic regional variation in survival was obtained by subtracting the estimated expected random variation from the observed regional variation. An estimate was then made of the potential reduction in the number of cancer deaths for 2008-12 if regional variation in survival were eliminated so that everyone received the same level of effective care. Between 2008 and 2012, an estimated 2.5% of deaths from cancers in the 12 sites studied could be prevented by eliminating regional variation in survival. The percentage of potentially avoidable deaths did not depend on country or sex but it did depend on cancer site. There was no relationship between the level of regional variation in a given country and the level of survival. The cancer sites for which the greatest percentage savings could be achieved were melanoma (11%) and cervix uteri (6%). The sites for which the highest number of deaths could be prevented were prostate, colon, melanoma, and breast. This methodology showed a small amount of systematic regional variation in cancer survival in the Nordic countries. The cancer sites with high levels of regional variation identified are potential targets for cancer control programmes.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2011
DOI: 10.1007/S00127-010-0198-Y
Abstract: Higher education has been associated with distress and depression in students, and concerns that the proportion students afflicted is increasing have been raised. Findings on student depression have often been based on age-homogeneous s les leaving the results vulnerable to a confounding of student experience, transition from adolescence to adulthood and age on depression. We investigated self-reported depression and its associations with sociodemographic and educational factors in a demographically erse student population of first-year nursing students in Sweden. A base-line survey in a nation-wide cohort of 1,700 first-year nursing students was conducted in the fall of 2002. The participants answered a mailed questionnaire containing questions on sociodemography, educational factors, and health. Depression was measured by the Major Depression Inventory and associations to sociodemographic and educational factors were tested in logistic regressions. The overall response rate was 72.9%, and 10.2% (5.7% men, 10.7% women) reported depression. Younger age (<30), female gender, immigration from outside of Europe, high workload, dissatisfaction with education, low self-efficacy, and conflicts between personal and college demands were associated with high prevalence of depression. Prior work experience, less need for financial support, and work for pay during term time were related to low prevalence of depression. Older students and those who were parents reported home-college conflicts more often. Nursing students as a group show high levels of self-reported depression but the prevalence is affected by age with a higher proportion depressed among younger students. Even though older students and those who were parents show less depression, they were more vulnerable to home-college conflicts. As older students and parents constitute a large proportion of nursing students, it is of importance to find ways to lessen the effects of the obstacles they encounter in the education.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-09-2018
Abstract: With excellent cure rates for young patients with Hodgkin lymphoma (HL), there is an increasing number of female survivors of HL interested in becoming pregnant. Here, we report childbearing among contemporarily treated HL survivors in comparison with the general population. Using Swedish registers, 449 women (ages 18 to 40 years) diagnosed with HL between 1992 and 2009 and in remission 9 months after diagnosis were identified. Patients were age- and calendar-year–matched to 2,210 population comparators. Rates of first postdiagnosis childbirth were calculated. Hazard ratios (HRs) with 95% CIs were estimated for different follow-up periods using Cox regression. Cumulative probabilities of first childbirth were calculated in the presence of the competing risk of death or relapse. Twenty-two percent of relapse-free patients with HL had a child during follow-up, and first childbirth rates increased over time, from 40.2 per 1,000 person-years (1992 to 1997) to 69.7 per 1,000 person-years (2004 to 2009). For comparators, childbirth rates remained stable (70.1 per 1,000 person-years). Patients diagnosed between 2004 and 2009 had a cumulative probability of childbirth similar to comparators. Three years or more after diagnosis, no differences in childbirth rates were observed between patients and comparators, regardless of stage or treatment. Patients who received six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone had a lower childbirth rate than comparators during the first 3 years (HR, 0.23 95% CI, 0.06 to 0.94), as did patients who received six to eight courses of chemotherapy and radiotherapy (HR, 0.21 95% CI, 0.07 to 0.65). Childbearing potential among female survivors of HL has improved over time, and childbirth rates 3 years after diagnosis in contemporarily treated patients are, in the absence of relapse, similar to those in the general population, regardless of stage and treatment.
Publisher: Oxford University Press (OUP)
Date: 12-2001
Abstract: Low socioeconomic status (SES) is generally associated with increased risk of stillbirth, but the mechanisms have rarely been investigated. Our aim was to study the association between SES and risk of stillbirth, and to assess whether any differences in risk are mediated by other maternal socio-demographic or anthropometrical characteristics, differences in lifestyle, or attendance at antenatal care. Population-based in idually-matched case-control study including 702 cases of stillbirth and 702 controls among Swedish primiparous women giving birth 1987-1996. We estimated the risk of stillbirth, and subgroups of stillbirth, for various categories of SES. Odds ratios (OR) with 95% CI, estimated by conditional logistic regression, were used to approximate the relative risk. The estimates were adjusted for maternal age, height, body mass index, cigarette smoking, and when necessary mother's country of birth. Compared with women who were high level white-collar workers, the adjusted risks of stillbirth were as follows: unskilled blue-collar workers, 2.2 (95% CI : 1.3- 3.7), skilled blue-collar workers, 2.4 (95% CI : 1.3-4.1), low level white-collar workers, 1.9 (95% CI : 1.2-3.2), and intermediate level white-collar workers 1.4 (95% CI : 0.9-2.4). These risks were not substantially changed when we further adjusted for attendance at antenatal care, previous reproductive history, or excluded pregnancies with maternal diseases, and pregnancy-related disorders. Low social class was most associated with risks of term antepartum and intrapartum stillbirths. Low SES increases the risk of stillbirth. The association could not be explained by any of the factors we studied, and the underlying reasons remain unclear.
Publisher: Oxford University Press (OUP)
Date: 24-09-2010
DOI: 10.1002/BJS.7261
Abstract: Systematic surveillance of surgical-site infections is not standard. The aim of this retrospective cohort study was to evaluate the feasibility of using existing national health registers for surveillance of postoperative antibiotic treatment suggestive of surgical-site infection. Data from national registers on hospital admissions and drug use were combined. Antibiotic purchases by 8856 patients subject to ambulatory care for inguinal hernia repair in Sweden during 2006 were ascertained during a 30-day interval immediately after surgery (postsurgical period) and in an 11-month control period (6 months before and 5 months after the postsurgical period). The incidence of first purchases of skin and soft tissue antibiotics was 245 per 8697 person-months in the first postoperative month and 180 per 52 612 person-months in the preoperative control period, representing a 1-month risk difference of 2·4 (95 per cent confidence interval (c.i.) 2·0 to 2·7) per cent. Hence, a 1-month risk of 2·4 per cent could be attributed tentatively to the surgery. The rate of episodes with antibiotics used mainly for skin and soft tissue infection was sevenfold higher in the first postoperative month than in the control period (rate ratio 7·01, 95 per cent c.i. 5·94 to 8·27). The risk of antibiotic treatment during the postsurgical period was of the same order of magnitude as infection rates reported in the Swedish Hernia Register and review studies. Surveillance of postoperative antibiotic use may be considered as a resource-saving surrogate marker for surgical-site infections or an indicator of inappropriate use.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-06-2011
Abstract: Chronic myeloid leukemia (CML) management changed dramatically with the development of imatinib mesylate (IM), the first tyrosine kinase inhibitor targeting the BCR-ABL1 oncoprotein. In Sweden, the drug was approved in November 2001. We report relative survival (RS) of patients with CML diagnosed during a 36-year period. Using data from the population-based Swedish Cancer Registry and population life tables, we estimated RS for all patients diagnosed with CML from 1973 to 2008 (n = 3,173 1,796 males and 1,377 females median age, 62 years). Patients were categorized into five age groups and five calendar periods, the last being 2001 to 2008. Information on use of upfront IM was collected from the Swedish CML registry. Relative survival improved with each calendar period, with the greatest improvement between 1994-2000 and 2001-2008. Five-year cumulative relative survival ratios (95% Cls) were 0.21 (0.17 to 0.24) for patients diagnosed 1973-1979, 0.54 (0.50 to 0.58) for 1994-2000, and 0.80 (0.75 to 0.83) for 2001-2008. This improvement was confined to patients younger than 79 years of age. Five-year RSRs for patients diagnosed from 2001 to 2008 were 0.91 (95% CI, 0.85 to 0.94) and 0.25 (95% CI, 0.10 to 0.47) for patients younger than 50 and older than 79 years, respectively. Men had inferior outcome. Upfront overall use of IM increased from 40% (2002) to 84% (2006). Only 18% of patients older than 80 years of age received IM as first-line therapy. This large population-based study shows a major improvement in outcome of patients with CML up to 79 years of age diagnosed from 2001 to 2008, mainly caused by an increasing use of IM. The elderly still have poorer outcome, partly because of a limited use of IM.
Publisher: Oxford University Press (OUP)
Date: 05-02-2007
DOI: 10.1002/BJS.5635
Abstract: The extent of thyroidectomy in patients with differentiated thyroid cancer (DTC) remains controversial. The aim of this study was to identify how surgical technique and postoperative treatments influence survival and locoregional recurrence in DTC. A nested case-control study was conducted in a cohort of 5123 patients diagnosed with DTC in Sweden between 1958 and 1987. One matched control subject was selected randomly for each patient who died from DTC. Details regarding surgery and postoperative treatments were obtained from medical records. The effect of treatment on survival was estimated by conditional logistic regression. Patients not treated surgically had a poorer prognosis, but the risk of death from DTC was not affected by the choice of surgical technique. The extent of surgery influenced survival only in patients with TNM stage III disease. Locoregional recurrence resulted in a fivefold increased risk of death. Postoperative treatment was not associated with improved survival. In operated patients, the most important prognostic factor was complete removal of the tumour. The extent of removal of remaining thyroid tissue was of prognostic importance in stage III disease only. Adjuvant postoperative treatment did not influence the prognosis favourably.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2004
DOI: 10.1097/01.JU.0000143930.73016.C6
Abstract: Androgen deprivation therapy increases the risk of osteoporosis related fractures. This issue is of increasing importance in men with prostate cancer as increasingly more undergo androgen deprivation therapy and therapy is administered sooner following diagnosis. Data directly addressing the long-term fracture risk in men diagnosed with prostate cancer are limited. Using population based registries in Sweden we studied the incidence of hip fractures in 17,731 men diagnosed with prostate cancer from 1964 to 1996 who were treated with bilateral orchiectomy within 6 months of diagnosis. The fracture incidence was compared to the incidence in 43,230 men diagnosed with prostate cancer but not treated with orchiectomy and in 362,354 of similar age who were randomly selected from the general population. Men treated with orchiectomy were at increased risk for hip fracture. The estimated relative risk comparing men who underwent orchiectomy to population controls was 2.11 (95% CI 1.94 to 2.29) for femoral neck fractures and 2.16 (95% CI 1.97 to 2.36) for intertrochanter fractures. An increased risk of hip fracture was observed as early as 6 months after orchiectomy and the relative risk remained fairly constant up to 15 years following orchiectomy. Hip fracture risk increases almost immediately following orchiectomy and the excess risk persists for at least 15 years. This side effect should be considered when assessing the merits of androgen deprivation therapy, particularly in symptom-free men diagnosed with localized prostate cancer. Measures to prevent osteoporosis should be considered in men undergoing androgen deprivation therapy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-1997
DOI: 10.1097/00005392-199707000-00050
Abstract: We identified factors that affect sexual function in men 50 to 80 years old and, therefore, may confound the comparison among groups of elderly men. In particular, we identified factors that may influence a comparison between prostate cancer patients and the general population, or confound the relationship when comparing subgroups of patients in nonrandomized studies. A questionnaire, including the Radiumhemmet Scale of Sexual Function and modules assessing potential risk factors for waning sexual function, was sent to 431 patients 50 to 80 years old with prostate cancer diagnosed 1.5 to 2 years previously in the Stockholm area (Sweden) and a reference group of 435 age matched randomly selected men. Factors associated with physiological impotence included prostate cancer (relative risk 1.9), diabetes mellitus (relative risk 2.3), myocardial infarction (relative risk 1.5), medication with diuretics (relative risk 1.5), hydrogen blockers (relative risk 2.3) and warfarin type anticoagulants (relative risk 1.7). Patients treated for prostate cancer were more likely to be physiologically impotent compared to those with no initial treatment, and this was true for all treatment protocols after adjustment for confounding factors. Men treated with radical prostatectomy were more likely to be physiologically impotent than men treated with external beam radiation therapy (relative risk 1.5). Waning sexual function in the prostate cancer patients was largely due to side effects of the treatment and this could not be explained by confounding factors. In particular, confounding could not explain the greater risk of impotence after radical prostatectomy compared to external beam radiation therapy.
Publisher: Elsevier BV
Date: 1998
DOI: 10.1159/000019528
Abstract: To investigate the prevalence of urinary and bowel symptoms in population-based groups of men with and without prostate cancer. A self-administered questionnaire, assessing 5 urinary and 3 bowel symptoms, was sent to the 431 men diagnosed as having prostate cancer in the Stockholm area in 1992 who were still alive in October 1993 and to 435 randomly selected control subjects with an age distribution matching men with newly diagnosed prostate cancer in the same area. The results were evaluated as ratios of proportions. Among the prostate cancer patients, all urinary and bowel symptoms assessed were more common and the risk of having the various symptoms was 1.3-4.5 times that of the controls. The risks of having leakage of urine after radical prostatectomy and bowel urgency after external beam radiation therapy were fourfold when compared with the control group. We noted an increased risk ratio of proportions of leakage of faeces after radical prostatectomy and this risk was significantly increased when men with any of 11 specified diseases were excluded from the analysis to reduce confounding. Prostate cancer and its treatment affects urinary and bowel functions. The increased risk of having leakage of faeces after radical prostatectomy may be a chance phenomenon due to few patients subjected to surgery, but warrants further investigation.
Publisher: American Society of Hematology
Date: 20-11-2009
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-08-2012
Abstract: Reported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs. We identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 ( ided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival. Patient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P .001). Survival improved significantly over time (P .001) however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET. We found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.
Publisher: Wiley
Date: 30-05-2003
DOI: 10.1002/IJC.11258
Abstract: Ionizing radiation is the only established cause of thyroid cancer, though the effect of diagnostic administration of 131 I on thyroid cancer risk appears minimal. The annual number of thyroid examinations using radioiodine is currently 5 per 1,000 in iduals worldwide, so this issue is of public health importance. Our objective was to evaluate the excess risk of thyroid cancer following a range of known doses of 131 I administered for diagnostic purposes. We conducted a nationwide, population‐based cohort study in Sweden including all 36,792 in iduals who received 131 I for diagnostic purposes during 1952–1969 and were alive and free of thyroid cancer 2 years after exposure. Accrual of person‐time at risk commenced 2 years after the first 131 I administration. Follow‐up for cancer was to the end of 1998. Standardized incidence ratios (SIRs) were calculated as the ratio between the observed and expected numbers of thyroid cancers. Estimates were stratified by previous exposure to external radiation therapy to the neck, reason for thyroid examination, 131 I dose, sex, age at exposure and time since exposure. Thyroid cancers ( n = 129) were diagnosed during 886,618 person‐years at risk. Excess thyroid cancers were observed only among the 1,767 patients who reported previous external radiation therapy to the neck [SIR = 9.8, 95% confidence interval (CI) 6.3–14.6] and among those originally referred due to suspicion of a thyroid tumor (SIR = 3.5, 95% CI 2.7–4.4 for 11,015 patients without previous external radiation therapy). The 24,010 patients without previous exposure to external radiation therapy to the neck who were referred for a reason other than suspicion of a thyroid tumor received an estimated dose to the thyroid of 0.94 Gy. Among these patients, 36 thyroid cancers were observed compared to 39.5 expected (SIR = 0.91, 95% CI 0.64–1.26). We found no evidence that administration of 131 I for diagnostic purposes increases risk of thyroid cancer. However, our study included few patients under age 20, so the results apply primarily to exposure among adults. Our data suggest that protraction of dose may result in a lower risk than brief X‐ray exposure of the same total dose. © 2003 Wiley‐Liss, Inc.
Publisher: Public Library of Science (PLoS)
Date: 17-01-2006
Publisher: Wiley
Date: 19-07-2007
DOI: 10.1002/IJC.22948
Abstract: Colorectal cancer is the third most common cancer worldwide and the second most common cancer in Europe. Cumulative relative survival curves for both cancer of the colon and cancer of the rectum generally plateau after ∼6–8 years. When this occurs, “population” or “statistical” cure is reached. We analyzed data from the Finnish Cancer Registry over a 50‐year period using methods that simultaneously estimate the proportion of patients cured of disease (the cure fraction) and the survival time distribution of the “uncured” group. Our primary aim was to investigate temporal trends in the cure fraction and median survival of the uncured by age group for both cancer of the colon and rectum. For both cancers, the cure fraction has increased dramatically over time for all age groups. However, the difference in the cure fraction between age groups has reduced over time, particularly for cancer of the colon. Median survival in the uncured has also increased over time in all age groups but there still remains an inverse relationship between age and median survival, with shorter median survival with increasing age. The reasons for these impressive increases in patient survival are complex, but are highly likely to be strongly related to many improvements in cancer care over this same time period. © 2007 Wiley‐Liss, Inc.
Publisher: BMJ
Date: 2006
Publisher: Informa UK Limited
Date: 08-03-2022
Publisher: Springer Science and Business Media LLC
Date: 20-09-2005
Abstract: The aim was to ascertain whether thrombocyte MAO (trbc-MAO) activity and depressed state are genetically associated with the MAO locus on chromosome X (Xp11.3 – 11.4). We performed novel sequencing of the MAO locus and validated genetic variants found in public databases prior to constructing haplotypes of the MAO locus in a Swedish s le (N = 573 in iduals). Our results reveal a profound SNP desert in the MAOB gene. Both the MAOA and MAOB genes segregate as two distinct LD blocks. We found a significant association between two MAOA gene haplotypes and reduced trbc-MAO activity, but no association with depressed state. The MAO locus seems to have an effect on trbc-MAO activity in the study population. The findings suggest incomplete X-chromosome inactivation at this locus. It is plausible that a gene-dosage effect can provide some insight into the greater prevalence of depressed state in females than males.
Publisher: SAGE Publications
Date: 04-2015
DOI: 10.1177/1536867X1501500112
Abstract: When estimating patient survival using data collected by population-based cancer registries, it is common to estimate net survival in a relative-survival framework. Net survival can be estimated using the relative-survival ratio, which is the ratio of the observed survival of the patients (where all deaths are considered events) to the expected survival of a comparable group from the general population. In this article, we describe a command, strs, for life-table estimation of relative survival. We discuss three methods for estimating expected survival, as well as the cohort, period, and hybrid approaches for estimating relative survival. We also implement a life-table version of the Pohar Perme (2012, Biometrics 68: 113–120) estimator of net survival, and we describe two methods for age standardization. We also explain how, in addition to net probabilities of death, crude probabilities of death due to cancer and due to other causes can be estimated using the method of Cronin and Feuer (2000, Statistics in Medicine 19: 1729–1740). We conclude this article with discussion and ex les of modeling excess mortality using various approaches, including the full-likelihood approach (using the ml command) and Poisson regression (using the glm command with a user-specified link function).
Publisher: SAGE Publications
Date: 04-2015
DOI: 10.1177/1536867X1501500111
Abstract: Cancer registries are often interested in estimating net survival (NS), the probability of survival if the cancer under study is the only possible cause of death. Pohar Perme, Stare, and Estéve (2012, Biometrics 68: 113–120) proposed a new estimator of NS based on inverse probability weighting. They demonstrated that existing estimators of NS based on relative survival were biased, whereas the new estimator was unbiased. The new estimator was developed for continuous survival times, yet cancer registries often have only discrete survival times (for ex le, survival time in completed months or years). Therefore, we propose an approach to estimation for when survival times are discrete. In this article, we describe the stnet command for life-table estimation of NS, adapting the Pohar Perme estimation approach to life-table estimation. Estimates can be made using a period or hybrid approach in addition to the traditional cohort (or complete) approach, and age-standardized survival estimates are available.
Publisher: Springer Science and Business Media LLC
Date: 06-03-2023
DOI: 10.1007/S10549-023-06896-1
Abstract: Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.
Publisher: Springer Science and Business Media LLC
Date: 31-05-2005
Abstract: To examine whether early anthropometric measures and reproductive factors were associated with body mass index (BMI), overweight, and obesity. Cross-sectional, observational study. In all, 18 109 healthy women who participated in the Swedish Mammography Cohort aged 49-83 y. Early anthropometric (birthweight and body shape at age 10 y) and reproductive (age at menarche, age at the birth of the first child, and parity) variables were our predictors and current BMI, overweight (BMI 25-29.99 kg/m(2)), and obesity (BMI > or =30 kg/m(2)) were our outcomes. In multivariate-adjusted polytomous logistic regression analysis, risk of overweight and obesity increased with increasing body shape at age 10 y and decreased with increasing age at menarche and age at first birth (P for trend or =25 kg/m(2)), we detected significant interactions between body shape at 10 y and age (P<0.0001) body shape at 10 y and physical activity (P<0.0001) age at first birth and smoking (P=0.02) and parity and physical activity (P=0.004). The increased risk of ow/ob among women who reported a larger childhood body shape was reduced as women moved from the lowest to highest quartile of physical activity in adulthood. Likewise, the increasing risk of ow/ob among women with greater parity was reduced with increased physical activity. Early anthropometric measures and reproductive factors are significantly associated with BMI, overweight, and obesity among older women. The effects of childhood body weight, age at first birth, and parity may be modified by adult lifestyle choices, as well as age.
Publisher: Springer Science and Business Media LLC
Date: 08-2004
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.CANEP.2013.08.014
Abstract: Cure models can provide improved possibilities for inference if used appropriately, but there is potential for misleading results if care is not taken. In this study, we compared five commonly used approaches for modelling cure in a relative survival framework and provide some practical advice on the use of these approaches. Data for colon, female breast, and ovarian cancers were used to illustrate these approaches. The proportion cured was estimated for each of these three cancers within each of three age groups. We then graphically assessed the assumption of cure and the model fit, by comparing the predicted relative survival from the cure models to empirical life table estimates. Where both cure and distributional assumptions are appropriate (e.g., for colon or ovarian cancer patients aged <75 years), all five approaches led to similar estimates of the proportion cured. The estimates varied slightly when cure was a reasonable assumption but the distributional assumption was not (e.g., for colon cancer patients ≥75 years). Greater variability in the estimates was observed when the cure assumption was not supported by the data (breast cancer). If the data suggest cure is not a reasonable assumption then we advise against fitting cure models. In the scenarios where cure was reasonable, we found that flexible parametric cure models performed at least as well, or better, than the other modelling approaches. We recommend that, regardless of the model used, the underlying assumptions for cure and model fit should always be graphically assessed.
Publisher: Mary Ann Liebert Inc
Date: 04-2006
Abstract: Parental feelings of guilt can be a serious problem after the death of a child to a malignancy. This study identified predictors of feelings of guilt in parents during the year after a child's death. The Swedish Cause of Death Register and Swedish Cancer Register were used to identify all parents in Sweden who had a child who died of a malignancy between 1992-1997. Among parents not reporting recent depression, those who were not confident that their child would immediately receive help from the staff in the hospital while he or she was sick with a malignancy (compared to those who felt partly or entirely sure, relative risk [RR] 4.0 95% confidence interval [CI] 2.1-7.6), were at increased risk for reporting daily or weekly feelings of guilt in the year after the child's death. Parents who perceived that the staff in the pediatric cancer ward were incompetent were at increased risk (compared to parents reporting partial or total competence, RR 3.7 95% CI 1.6-8.6). Compared to parents reporting that their children had moderate or much access, those who felt their children had little or no access to pain relief, dietary advice, anxiety relief, and relief of other psychological symptoms beside anxiety were at more than two times greater risk for reporting feelings of guilt. Bereaved parents' perceptions of inadequate health care were associated with subsequent feelings of guilt during the year following their child's death due to a malignancy.
Publisher: Springer Science and Business Media LLC
Date: 08-2005
DOI: 10.1007/S10552-005-1723-2
Abstract: The rising incidence and the strong male predominance among patients with esophageal and gastric cardia adenocarcinoma remain unexplained. We hypothesized that occupational airborne exposures in a traditional male dominated industry might contribute to these observations. A prospective, large cohort study of Swedish construction workers was linked to the Swedish population-based registers of Cancer, Causes of Death and Total Population. 260,052 men were followed from 1971 through 2000. Industrial hygienists assessed specific exposures for 200 job titles, and occupational airborne exposures were analyzed separately and combined. Incidence rate ratios (IRR), with 95% confidence intervals (CI), were estimated in multivariable Cox regression models adjusted for attained age, calendar period, smoking status and body mass. We found positive associations between high exposure to asbestos (IRR 4.5 [95% CI 1.4-14.3]) and cement dust (IRR 3.8 [95% CI 1.5-9.6]) and risk of esophageal adenocarcinoma. Associations were seen between high exposure to asphalt fumes (IRR 2.3 [95% CI 1.0-5.3]) and wood dust (IRR 4.8 [95% CI 1.2-19.4]) and risk of cardia adenocarcinoma. No consistent associations regarding esophageal squamous-cell carcinoma were found. Exposure to asbestos and cement dust may be risk factors for esophageal adenocarcinoma, and exposure to asphalt fumes and wood dust may increase the risk of cardia adenocarcinoma. However, these associations cannot explain the major sex differences or the increasing incidence trends of these tumors.
Publisher: Informa UK Limited
Date: 10-2005
DOI: 10.1080/00926230591006476
Abstract: Experiencing a sexual abuse creates a life-long traumatic memory. The life-long effect of such abuse on sexuality, well-being, the risk of contracting cervical cancer, or problems after treatment for cervical cancer is not known. A population-based follow-up study in 1996-97 that used an anonymous postal questionnaire for data collection, 256 women with stage IB-IIA cervical cancer registered in 1991-92 in Sweden, and 350 women without cervical cancer frequency matched for age and region of residence, provided information. Among the women with a history of cervical cancer and the control women, 46 (18%) and 50 (15%), respectively, reported a history of sexual abuse. The follow-up was 1-70 years after the sexual abuse. The relative risk (with 95% confidence interval) of decreased well-being was 2.4 (1.1-5.2) among controls and 2.7 (1.1-6.4) among former cervical cancer patients. A history of both sexual abuse and cervical cancer gave a relative risk of 30.0 (7.0-129.0) for superficial dyspareunia. Sexual abuse increased the risk of sexual problems after treatment. The sexually abused cervical cancer patients were generally less willing than other patients to trade off possible maximal survival and forgo parts of the treatment. A history of sexual abuse and cervical cancer are both independent risk factors for sexual dysfunction and decreased well-being, and there may be a large synergy when both factors are combined. Diagnosis and treatment of cervical cancer may be improved by recognition of a sexual abuse history.
Publisher: Massachusetts Medical Society
Date: 12-09-2002
DOI: 10.1056/NEJMOA021483
Publisher: Springer Science and Business Media LLC
Date: 22-09-2020
DOI: 10.1038/S41467-020-18367-Y
Abstract: Cortical thickness, surface area and volumes vary with age and cognitive function, and in neurological and psychiatric diseases. Here we report heritability, genetic correlations and genome-wide associations of these cortical measures across the whole cortex, and in 34 anatomically predefined regions. Our discovery s le comprises 22,824 in iduals from 20 cohorts within the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank. We identify genetic heterogeneity between cortical measures and brain regions, and 160 genome-wide significant associations pointing to wnt/β-catenin, TGF-β and sonic hedgehog pathways. There is enrichment for genes involved in anthropometric traits, hindbrain development, vascular and neurodegenerative disease and psychiatric conditions. These data are a rich resource for studies of the biological mechanisms behind cortical development and aging.
Publisher: Oxford University Press (OUP)
Date: 13-09-2011
DOI: 10.1093/AJE/KWR211
Abstract: Selection bias and confounding are concerns in cohort studies where the reason for inclusion of subjects in the cohort may be related to the outcome of interest. Selection bias in prevalent cohorts is often corrected by excluding observation time and events during the first time period after inclusion in the cohort. This time period must be chosen carefully-long enough to minimize selection bias but not too long so as to unnecessarily discard observation time and events. A novel method visualizing and estimating selection bias is described and exemplified by using 2 real cohort study ex les: a study of hepatitis C virus infection and a study of monoclonal gammopathy of undetermined significance. The method is based on modeling the hazard for the outcome of interest as a function of time since inclusion in the cohort. The events studied were "hospitalizations for kidney-related disease" in the hepatitis C virus cohort and "death" in the monoclonal gammopathy of undetermined significance cohort. Both cohorts show signs of considerable selection bias as evidenced by increased hazard in the time period after inclusion in the cohort. The method was very useful in visualizing selection bias and in determining the initial time period to be excluded from the analyses.
Publisher: Wiley
Date: 06-2017
DOI: 10.1002/HON.2437_89
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-07-2015
Abstract: Myeloproliferative neoplasms (MPNs) are associated with a shortened life expectancy. We assessed causes of death in patients with MPN and matched controls using both relative risks and absolute probabilities in the presence of competing risks. From Swedish registries, we identified 9,285 patients with MPN and 35,769 matched controls. A flexible parametric model was used to estimate cause-specific hazard ratios (HRs) of death and cumulative incidence functions, each with 95% CIs. In patients with MPN, the HRs of death from hematologic malignancies and infections were 92.8 (95% CI, 70.0 to 123.1) and 2.7 (95% CI, 2.4 to 3.1), respectively. In patients age 70 to 79 years at diagnosis (the largest patient group), the HRs of death from cardiovascular and cerebrovascular disease were 1.5 (95% CI, 1.4 to 1.7) and 1.5 (95% CI, 1.3 to 1.8), respectively all were statistically significantly elevated compared with those of controls. In the same age group, no difference was observed in the 10-year probability of death resulting from cardiovascular disease in patients with MPN versus controls (16.8% v 15.2%) or cerebrovascular disease (5.6% v 5.2%). In patients age 50 to 59 years at diagnosis, the 10-year probability of death resulting from cardiovascular and cerebrovascular disease was elevated, 4.2% versus 2.1% and 1.9% versus 0.4%, respectively. Survival in patients with MPN increased over time, mainly because of decreased probabilities of dying as a result of hematologic malignancies, infections, and, in young patients, cardiovascular disease. Patients with MPN had an overall higher mortality rate than that of matched controls, primarily because of hematologic malignancy, infections, and vascular events in younger patients. Evidently, there is still a need for effective disease-modifying agents to improve patient outcomes.
Publisher: Elsevier BV
Date: 02-1999
Publisher: Springer Science and Business Media LLC
Date: 15-08-2015
Publisher: Springer Science and Business Media LLC
Date: 24-06-2012
Publisher: Wiley
Date: 19-11-2012
DOI: 10.1002/AJH.23351
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-09-2016
DOI: 10.1002/HEP.28775
Abstract: The Cancer Register (CR) in Sweden has reported that the incidence of primary liver cancer (PLC) has slowly declined over the last decades. Even though all cancers, irrespective of diagnostic method, should be reported to the CR, the PLC incidence may not reflect the true rate. Improved diagnostic tools have enabled diagnosis of hepatocellular carcinoma based on noninvasive methods without histological verification, possibly associated with missed cancer reports or misclassification in the CR. Our objective was to study the completeness and assess the underreporting of PLC to the CR and to produce a more accurate estimate based on three registers. The CR, the Cause of Death Register, and the Patient Register were investigated. Differences and overlap were examined, the incidence was estimated by merging data from the registers, and the number reported to none of the registers was estimated using a log‐linear capture‐recapture model. The results show that 98% of the PLCs reported to the CR were histologically verified 80% were hepatocellular carcinoma and 20% were intrahepatic cholangiocarcinoma. Unspecified liver cancer decreased over time and constituted % of all reported liver cancers. The CR may underestimate the liver cancer incidence by 37%‐45%, primarily due to missed cancer reports. The estimated annual number of liver cancers increased over time, but the standardized incidence was stable around 11 per 100,000. Hepatitis C‐associated liver cancer increased and constituted 20% in 2010. Conclusion : There was an underreporting of PLC diagnosed by noninvasive methods the incidence was considerably higher than estimated by the CR, with a stable incidence over time reporting needs to improve and combining registers is recommended when studying incidence. (H epatology 2017 :885‐892).
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.MIDW.2007.03.005
Abstract: to investigate long-term outcomes of mothers who have or have not held their stillborn baby, and predictors of having held the baby. postal questionnaires. a nation-wide cohort study of mothers who gave birth to a singleton stillborn baby in Sweden in 1991. 314 out of 380 women answered the questionnaire and 309 reported whether or not they had held their baby. scales measuring anxiety, depression and well-being. 126 (68%) mothers of 185 babies stillborn after 37 gestational weeks had held their baby and 82 (68%) mothers of 120 babies stillborn at gestational weeks 28-37 had also done so. Compared with mothers who agreed completely with the statement that staff gave enough support to hold the baby, mothers who did not agree were less likely to have held their baby [relative risk (RR) 4.1 95% confidence interval (CI) 2.7-6.1], and mothers with a low level of education were less likely to have held their baby than mothers with a higher level of education (RR 2.2 95% CI 1.3-3.8). Mothers who had not held their babies born after 37 gestational weeks had an increased risk of headache (RR 4.3 95% CI 1.1-16.5), and they were less satisfied with their sleep (RR 2.7 95% CI 1.5-5.0). The increased risk of long-term outcomes associated with not holding, compared with holding, a stillborn baby were less pronounced for women who gave birth at gestational week 28-37 compared with women who gave birth after 37 gestational weeks. in this cohort, we found an overall beneficial effect of having held a stillborn baby born after 37 gestational weeks, whereas findings for having held a stillborn baby born at gestational weeks 28-37 are uncertain. The attitude of staff influenced whether or not the mother held her stillborn baby. if the mother is guided by staff in a sensitive way to hold her stillborn term baby, the experience will possibly be beneficial for her in the long term.
Publisher: Wiley
Date: 05-2002
DOI: 10.1034/J.1600-0412.2002.810512.X
Abstract: More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments. In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden. A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each). The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.
Publisher: Elsevier BV
Date: 02-2001
Abstract: This study investigated whether the risk of antepartum stillbirth increases with body mass index during early pregnancy and also investigated the association between weight gain during pregnancy and the risk of antepartum stillbirth. This population-based case-control study included 649 women with antepartum stillbirths and 690 control subjects among Swedish nulliparous women. Compared with lean mothers (body mass index or = 30.0 kg/m2) odds ratio, 2.1 (95% confidence interval, 1.2-3.6). For term antepartum death corresponding risks were even higher, with odds ratios of 1.6 (95% confidence interval, 0.9-2.6) for normal weight, 2.7 (95% confidence interval, 1.5-5.0) for overweight, and 2.8 (95% confidence interval, 1.3-6.0) for obese women, respectively. Maternal weight gain during pregnancy was not associated with risk of antepartum stillbirth. Maternal overweight condition increased the risk of antepartum stillbirth, especially term antepartum stillbirth, whereas weight gain during pregnancy was not associated with risk.
Publisher: Cold Spring Harbor Laboratory
Date: 03-09-2018
DOI: 10.1101/399402
Abstract: The cerebral cortex underlies our complex cognitive capabilities, yet we know little about the specific genetic loci influencing human cortical structure. To identify genetic variants, including structural variants, impacting cortical structure, we conducted a genome-wide association meta-analysis of brain MRI data from 51,662 in iduals. We analysed the surface area and average thickness of the whole cortex and 34 regions with known functional specialisations. We identified 255 nominally significant loci ( P ≤ 5 × 10 −8 ) 199 survived multiple testing correction ( P ≤ 8.3 × 10 −10 187 surface area 12 thickness). We found significant enrichment for loci influencing total surface area within regulatory elements active during prenatal cortical development, supporting the radial unit hypothesis. Loci impacting regional surface area cluster near genes in Wnt signalling pathways, known to influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson’s disease, insomnia, depression and ADHD. Common genetic variation is associated with inter-in idual variation in the structure of the human cortex, both globally and within specific regions, and is shared with genetic risk factors for some neuropsychiatric disorders.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Publisher: BMJ
Date: 05-2006
DOI: 10.1111/J.1525-1438.2006.00601.X
Abstract: The aim of the study was to acquire knowledge that can be used to refine radical hysterectomy to improve quality-of-life outcome. Data were collected in 1996-1997 by means of an anonymous postal questionnaire in a follow-up study of two cohorts (patients and population controls). We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-1992 at the seven departments of gynecological oncology in Sweden and 489 population controls. Ninety three (37%) of the 256 women with a history of cervical cancer who answered the questionnaire (77%) were treated with surgery alone. Three-hundred fifty population controls answered the questionnaire (72%). Women treated with radical hysterectomy, as compared with controls, had an 8-fold increase in symptoms indicating lymphedema (25% reported distress due to lymphedema), a nearly 9-fold increase in difficult emptying of the bladder, and a 22-fold increase in the need to strain to initiate bladder evacuation. Ninety percent of the patients were not willing to trade off survival for freedom from symptoms. Avoiding to induce long-term lymphedema or bladder-emptying difficulties would probably improve quality of life after radical hysterectomy (to cure cervical cancer). Few women want to compromise survival to avoid long-term symptoms.
Publisher: Wiley
Date: 03-2010
DOI: 10.1111/J.1365-2141.2009.08026.X
Abstract: Large age-dependent differences in temporal trends in 1- and 5-year relative survival have been observed in patients with acute myeloid leukaemia (AML) in Sweden. This investigation used an alternative approach to studying patient survival that simultaneously estimated the proportion of patients cured from their cancer and the survival of the 'uncured'. We conducted a population-based study including 6439 AML patients aged 19-80 years in Sweden between 1973 and 2001. Mixture cure models were estimated, with age at diagnosis categorised (19-40, 41-60, 61-70 and 71-80) and year of diagnosis modelled using splines. In 1975 the cure proportion was < or =6% in all age groups and the median survival time for 'uncured' patients was <0.5 years. In 2000 the cure proportion was 68% (95% confidence interval 56-77%) in the youngest group, and 32% (25-39%), 8% (3-21%), and 4% (2-8%) in the other groups, respectively. The median survival times for 'uncured' were 0.74 (0.43-1.26), 0.71 (0.53-0.97), 0.69 (0.51-0.95) and 0.37 (0.31-0.44) years, respectively. A dramatic improvement in the cure proportion was seen in younger patients, whereas improvement in older ages was mainly within the survival of the 'uncured'. This novel approach of analysing survival data could be a valuable tool for physicians, patients, health care planners and health economists.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-02-2017
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-04-2013
Abstract: Hodgkin lymphoma (HL) survival in Sweden has improved dramatically over the last 40 years, but little is known about the extent to which efforts aimed at reducing long-term treatment-related mortality have contributed to the improved prognosis. We used population-based data from Sweden to estimate the contribution of treatment-related mortality caused by diseases of the circulatory system (DCS) to temporal trends in excess HL mortality among 5,462 patients diagnosed at ages 19 to 80 between 1973 and 2006. Flexible parametric survival models were used to estimate excess mortality. In addition, we used recent advances in statistical methodology to estimate excess mortality in the presence of competing causes of death. Excess DCS mortality within 20 years after diagnosis has decreased continually since the mid-1980s and is expected to further decrease among patients diagnosed in the modern era. Age at diagnosis and sex were important predictors for excess DCS mortality, with advanced age and male sex being associated with higher excess DCS mortality. However, when accounting for competing causes of death, we found that excess DCS mortality constitutes a relatively small proportion of the overall mortality among patients with HL in Sweden. Excess DCS mortality is no longer a common source of mortality among Swedish patients with HL. The main causes of death among long-term survivors today are causes other than HL, although other (non-DCS) excess mortality also persists for as long as 20 years after diagnosis, particularly among older patients.
Publisher: Harborside Press, LLC
Date: 09-2020
Abstract: Background: The increasing number of colorectal cancer (CRC) survivors need survival estimates that account for the time already survived. The aim of this population-based study was to determine conditional survival, cure proportions, and time-to-cure (TTC) of patients with colon or rectal cancer. Materials and Methods: All patients with pathologic stage I–III CRC treated with endoscopy or surgery, diagnosed and registered in the Netherlands Cancer Registry between 1995 and 2016, and aged 18 to 99 years were included. Conditional survival was calculated for those diagnosed before and after 2007. Cure proportions were calculated using flexible parametric models. Results: A total of 175,384 patients with pathologic stage I (25%), II (38%), or III disease (37%) were included. Conditional 5-year survival of patients with stage I, II, and III colon cancer having survived 5 years was 98%, 94%, and 92%, respectively. For patients with stage I–III rectal cancer, this was 96%, 89%, and 85%, respectively. Statistical cure in patients with colon cancer was reached directly after diagnosis (stage I) to 6 years (stage III) after diagnosis depending on age, sex, and disease stage. Patients with rectal cancer reached cure 0.5 years after diagnosis (stage I) to 9 years after diagnosis (stage III). In 1995, approximately 42% to 46% of patients with stage III colon or rectal cancer, respectively, were considered cured, whereas in 2016 this percentage increased to 73% to 78%, respectively. Conclusions: The number of patients with CRC reaching cure has increased substantially over the years. This study’s results provide valuable insights into trends of CRC patient survival and are important for patients, clinicians, and policymakers.
Publisher: Elsevier BV
Date: 2002
Publisher: American Association for Cancer Research (AACR)
Date: 09-2008
DOI: 10.1158/1055-9965.EPI-08-0390
Abstract: Background: Epithelial ovarian cancer is associated with reproductive factors, but we lack knowledge if hormonal factors during pregnancy influence the mother's risk. Because pregnancy hormones are primarily produced by the placenta, placental weight may be an indirect marker of hormone exposure during pregnancy. Methods: In a nationwide Swedish cohort study, we included women with singleton births from 1982 to 1989. Women were followed for occurrence of invasive epithelial ovarian cancer, death, or emigration through 2004. Hazard ratios (HR) with 95% confidence intervals (95% CI) from Cox models were used to estimate associations between pregnancy exposures and epithelial ovarian cancer. Results: Among 395,171 women with information on placental weight in their first recorded birth, 316 women developed invasive epithelial ovarian cancer. Mean age at diagnosis was 44 years. Compared with women with a placental weight of 500 to 699 g, women with a high (≥700 g) placental weight had an increased risk of developing epithelial ovarian cancer (HR, 1.47 95% CI, 1.14-1.90). Compared with women with term pregnancies (40-41 weeks), women with post-term (≥42 weeks) pregnancies had an increased risk of developing epithelial ovarian cancer (HR, 1.48 95% CI, 1.00-2.19). These associations were slightly stronger when we included information about women's overall first birth, and slightly weaker when we included information about last recorded birth or ever last birth from 1982 to 1989. Conclusions: Because pregnancy hormone levels increase with placental weight, our study supports the hypothesis that hormone exposures during pregnancy influence the risk of invasive epithelial ovarian cancer among young women. (Cancer Epidemiol Biomarkers Prev 2008 (9):2344–9)
Publisher: Informa UK Limited
Date: 1999
Abstract: The study of survival of cancer patients is essential for monitoring the effectiveness of cancer control. The previous monograph describing cancer patient survival in Finland was published by the Finnish Cancer Registry in 1981 and covered patients diagnosed in 1953-1974. This new supplement assesses cancer patient survival up to the year 1995. The study includes over 560000 tumours registered at the Finnish Cancer Registry with a date of diagnosis between 1955 and 1994. Patients were followed up to the end of 1995. Trends in relative survival rates are studied over four 10-year diagnostic periods from 1955 to 1994. In addition, detailed results are presented for patients diagnosed during 1985-1994, including relative survival rates tabulated by stage, sex, and age. Additional sections describe differences in cancer patient survival according to social class and region of residence and a comparison of cancer patient survival in Finland to other European countries. Patient survival improved over time for almost all anatomical sites. The main exception is in cancer of the cervix uteri, where patient survival has decreased slightly from 1965-1974 to 1985-1994 due to the selective prevention of less aggressive tumours through cytologic screening. Very few differences in patient survival are observed between males and females. A substantial improvement in survival can be seen for childhood cancers. The increasing survival rates reflect improvements that have taken place in various areas of cancer control, from health education and early diagnosis to treatment and aftercare. This study provides valuable reference information for both clinicians and health administrators, as well as a baseline for more detailed studies of patient survival for in idual anatomical sites.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.CANEP.2013.12.006
Abstract: A large proportion of patients with cutaneous malignant melanoma (CMM) do not experience excess mortality due to their disease. This group of patients is referred to as the cure proportion. Few studies have examined the possibility of cure for CMM. The aim of this study was to estimate the cure proportion of patients with CMM in a Swedish population. We undertook a population-based study of 5850 CMM patients in two Swedish health care regions during 1996-2005. We used flexible parametric cure models to estimate cure proportions and median survival times (MSTs) of uncured by stage, sex, age and anatomical site. Disease stage at diagnosis was the most important factor for the probability of cure, with a cure proportion of approximately 1.0 for stage IA. While the probability of cure decreased with older age, the influence of age was smaller on the MST of uncured. Differences in prognosis between males and females were mainly attributed to differences in cure as opposed to differences in MST of uncured. This population-based study showed approximately 100% cure among stage IA disease. Almost 50% of patients had stage IA disease and the high cure proportion for this large patient group is reassuring.
Publisher: Wiley
Date: 11-11-2021
DOI: 10.1111/EJH.13720
Abstract: To evaluate temporal trends in survival and causes of death in patients with chronic lymphocytic leukemia (CLL) in a nationwide study. The cohort consisted of 13,009 Swedish CLL patients diagnosed 1982–2013. Relative survival (RS) and excess mortality rate ratios (EMRR) with 95% confidence intervals (95% CIs) were estimated using flexible parametric survival models. Cause‐specific hazard ratios (HRs) were estimated for the linear effect of 10‐year increase in year of diagnosis. The excess mortality decreased comparing 2003–2013 to 1982–1992 (EMRR = 0.53, 95% CI 0.48–0.58). The 5‐year RS increased between 1982 and 2012 for patients years at diagnosis and improved for patients ≤51 years after 2002. The rate of CLL‐specific deaths decreased over time (HR = 0.78, 95% CI 0.75–0.81). Compared to patients with no comorbidity, patients with 1 and 2+ Charlson Comorbidity Index points had HR = 1.35 (95% CI 1.25–1.45) and HR = 1.47 (95% CI 1.37–1.57) for CLL‐related mortality, respectively. Survival in CLL patients improved in the era of chemoimmunotherapy, and this was largely explained by reduced CLL‐related mortality. The increased rate of CLL‐related mortality in patients with comorbidities emphasizes the importance of the newer and better tolerated targeted therapy.
Publisher: American Association for Cancer Research (AACR)
Date: 09-2007
DOI: 10.1158/1055-9965.EPI-06-0962
Abstract: Background: Pregnancy influences subsequent maternal ovarian cancer risk. To date, there is limited evidence whether two characteristics of pregnancy, gestational age and birth weight, could modify risk. Materials and Methods: We studied 1.1 million Swedish women who delivered singleton births between 1973 and 2001. Information on infant gestational age and birth weight was abstracted from the nationwide Swedish Birth Register. Women were followed prospectively through linkage with other population-based registers for occurrence of ovarian cancer, death, or emigration through 2001. Hazard ratios [relative risk (RR), 95% confidence interval (95% CI)] from Cox models were used to estimate associations between gestational age, birth weight, and epithelial ovarian cancer risk. Results: During 12.6 million person-years, 1,017 epithelial ovarian cancers occurred. Mean age at diagnosis was 43 years. Compared with women with term deliveries (≥40 weeks), women with moderately (35-36 weeks) or very (& weeks) preterm deliveries had increased risks of epithelial ovarian cancer (RR 1.4, 95% CI 1.0-2.0 and RR 2.3, 95% CI 1.3-3.8, respectively). In contrast, women giving birth to small-for-gestational-age babies had a reduced risk (RR 0.7, 95% CI 0.4-1.0). Stratifying on birth weight and gestational age, there was a strong protective effect of low birth weight on maternal risk of epithelial ovarian cancer among term deliveries, whereas birth weight seemed to have little effect among preterm births (Pinteraction = 0.022). Conclusions: Our results lend further support that the hormonal milieu of a pregnancy may modify long-term risk of developing ovarian cancer. (Cancer Epidemiol Biomarkers Prev 2007 (9):1828–32)
Publisher: Oxford University Press (OUP)
Date: 23-08-2017
DOI: 10.1093/AJE/KWX303
Abstract: Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for ex le, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-09-2007
Abstract: Because the incidence of breast cancer is increasing and prognosis is improving, a growing number of women are at risk of developing bilateral disease. Little is known, however, about incidence trends and prognostic features of bilateral breast cancer. Among 123,757 women with a primary breast cancer diagnosed in Sweden from 1970 to 2000, a total of 6,550 developed bilateral breast cancer. We separated synchronous (diagnosed within 3 months after a first breast cancer) and metachronous bilateral cancer, and analyzed incidence and mortality rates of breast cancer using Poisson regression models. The incidence of synchronous breast cancer increased by age and by 40% during the 1970s, whereas the incidence of metachronous cancer decreased by age and by approximately 30% since the early 1980s, most likely due to increasing use of adjuvant therapy. Women who developed bilateral cancer within 5 years and at age younger than 50 years were 3.9 times (95% CI, 3.5 to 4.5) more likely to die as a result of breast cancer than women with unilateral cancer. Women with a bilateral cancer diagnosed more than 10 years after the first cancer had a prognosis similar to that of a unilateral breast cancer. Adjuvant chemotherapy of primary cancer is a predictor of poor survival after diagnosis of early metachronous cancers. We found profound differences in the incidence trends and prognostic outlook between synchronous and metachronous bilateral breast cancer diagnosed at different ages. Adjuvant chemotherapy therapy has a dual effect on metachronous cancer: it reduces the risk, while at the same time it seems to worsen the prognosis.
Publisher: American Society of Hematology
Date: 16-11-2007
Publisher: Springer Science and Business Media LLC
Date: 15-06-2010
Publisher: Springer Science and Business Media LLC
Date: 2003
Publisher: Wiley
Date: 12-2009
DOI: 10.3109/00016340903317974
Abstract: To study how social support is associated with ensuing maternal depression following stillbirth. Data from a population-based national postal questionnaire. Setting. Sweden. A total of 314 (83%) of all 380 Swedish-speaking women who gave birth to singleton stillborn infants in Sweden during 1991, identified through the Swedish Medical Birth Register. Postal questionnaires addressing maternal social support and demographics were completed three years following the stillbirth. The association between support-related factors and later maternal depression was assessed using multivariable regression models. The Center for Epidemiologic Studies Depression Scale. In adjusted analyses, a father's refusal to talk about a stillborn baby with the mother was associated with an almost five-fold risk of later maternal depressive symptoms [adjusted risk ratio (RR) 4.6, 95% confidence interval (CI) 1.5-14.5]. The mother's belief that she could talk with the infant's father about the child was associated with a reduced risk (adjusted RR 0.5, 95% CI 0.1-0.9). Unwillingness of the father to discuss a stillborn infant with the mother was related to subsequent maternal depressive symptomatology.
Publisher: American Medical Association (AMA)
Date: 04-2020
Publisher: Massachusetts Medical Society
Date: 20-12-2001
DOI: 10.1056/NEJMOA010323
Publisher: Springer Science and Business Media LLC
Date: 22-06-2011
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-08-2016
Abstract: A dramatic improvement in the survival of patients with chronic myeloid leukemia (CML) occurred after the introduction of imatinib mesylate, the first tyrosine kinase inhibitor (TKI). We assessed how these changes affected the life expectancy of patients with CML and life-years lost as a result of CML between 1973 and 2013 in Sweden. Patients recorded as having CML in the Swedish Cancer Registry from 1973 to 2013 were included in the study and followed until death, censorship, or end of follow-up. The life expectancy and loss in expectation of life were predicted from a flexible parametric relative survival model. A total of 2,662 patients with CML were diagnosed between 1973 and 2013. Vast improvements in the life expectancy of these patients were seen over the study period larger improvements were seen in the youngest ages. The great improvements in life expectancy translated into great reductions in the loss in expectation of life. Patients of all ages diagnosed in 2013 will, on average, lose 3 life-years as a result of CML. Imatinib mesylate and new TKIs along with allogeneic stem cell transplantation and other factors have contributed to the life expectancy in patients with CML approaching that of the general population today. This will be an important message to convey to patients to understand the impact of a CML diagnosis on their life. In addition, the increasing prevalence of patients with CML will have a great effect on future health care costs as long as continuous TKI treatment is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2004
Publisher: Ferrata Storti Foundation (Haematologica)
Date: 16-07-2009
Publisher: American Association for Cancer Research (AACR)
Date: 12-2005
DOI: 10.1158/1055-9965.EPI-05-0317
Abstract: Purpose: Despite a uniform regional breast cancer care program, breast cancer survival differs within regions. We therefore examined breast cancer survival in relation to differences in diagnostic activity, tumor characteristics, and treatment in seven Swedish counties within a single health care region. Methods: We conducted a population-based observational study using a clinical breast cancer register in one Swedish health care region. Eligible women (n = 7,656) ages 40 to 69 years diagnosed with primary breast cancer between 1992 and 2002 were followed up until 2003. The 7-year relative survival ratio was used to estimate breast cancer survival. Excess mortality was modeled using Poisson regression to study differences in survival between counties. Results: The 7-year relative survival for breast cancer patients was significantly lower (up to 7% in absolute risk difference) in one county (county A) compared with the others. This difference existed only among women diagnosed before 1998, ages 50 to 59 years, and was strongest among stage II breast cancer patients. Adjustment for amount of diagnostic activity eliminated the survival differences among the counties. The amount of diagnostic activity was also lower in county A during the same time period. After county A, during 1997-1998, began to adhere strictly to the regional breast cancer care program, neither any survival differences nor diagnostic activity differences were observed. Interpretations: Markers of diagnostic activity explained survival differences within our region, and the underlying mechanisms may be several. Low diagnostic activity may entail later diagnosis or inadequate characterization of the tumor and thereby missed treatment opportunities. Strengthening of multidisciplinary management of breast cancer can improve survival. (Cancer Epidemiol Biomarkers Prev 2005 (12):2914–8)
Publisher: Ferrata Storti Foundation (Haematologica)
Date: 22-03-2018
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.CANEP.2011.05.010
Abstract: It is vital that unbiased estimates of relative survival are estimated and reported by cancer registries. A single figure of relative survival is often required to make reporting simpler. This can be obtained by pooling all ages or, more commonly, by using age-standardisation. The various methods for providing a single figure estimate of relative survival can give very different estimates. The problem is illustrated through an ex le using Finnish thyroid cancer data. The differences are further explored through a simulation study that investigates the effect of age on the estimates of relative survival. The ex le highlights that in practice the all-age estimates from the various methods can be substantially different (up to 6 percentage units at 15 years of follow-up). The simulation study confirms the finding that differing estimates for the all-age estimates of relative survival are obtained. Performing age-standardisation makes the methods more comparable and results in better estimation of the true net survival. The all-age estimates of relative survival rarely give an appropriate estimate of net survival. We feel that modelling or stratifying by age when calculating relative survival is vitally important as the lack of homogeneity in the cohort of patients leads to potentially biased estimates. We feel that the methods using modelling provide a greater flexibility than life-table based approaches. The flexible parametric approach does not require an arbitrary splitting of the time-scale, which makes it more computationally efficient. It also has the advantage of easily being extended to incorporate time-dependent effects.
Publisher: Springer Science and Business Media LLC
Date: 06-1996
DOI: 10.1038/BJC.1996.268
Abstract: The objective was to investigate how prostate cancer and its treatment affects sexual, urinary and bowel functions and to what extent eventual complications cause distress. A questionnaire was sent to 431 men aged 50-80 years with prostate cancer diagnosed in 1992 in the Stockholm area (Sweden) and 435 randomly selected men with a similar age distribution. Sexual function, as compared with their youth, was diminished in a majority of all men. The prostate cancer patients were, however, more likely to report low frequency and/or intensity in all aspects of sexual function. A majority of the men were distressed by a waning sexual capacity. The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group. The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group. Urinary and bowel symptoms were less common than a waning sexual function in both groups, and few appeared to be severely distressed by urinary or bowel symptoms. A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer.
Publisher: S. Karger AG
Date: 20-12-2008
DOI: 10.1159/000112729
Abstract: i Background: /i Inflammation is associated with Alzheimer’s disease (AD) and dementia. In light of the chronic inflammatory properties of the atopic disorders asthma, eczema and rhinitis, we hypothesized an association with dementia. i Methods: /i Self-reported asthma, eczema or rhinitis was assessed (prior to dementia follow-up) through questionnaires in the 1960s or 1970s in twins from the population-based Swedish Twin Registry. Dementia was assessed both longitudinally (n = 22,188), through linkages to two population-based registers, and cross-sectionally (n = 7,800), through telephone cognitive screening followed by a clinical evaluation of suspects of dementia. Risk ratios were estimated with Cox and logistic regression models controlling for vascular disease and genetic confounding. i Results: /i In the longitudinal study, a history of atopy was positively associated with dementia (HR = 1.16 1.01–1.33). In the cross-sectional study we found overall lower risks, none of which was statistically significant. Asthma was associated with a shorter survival time following AD onset. i Conclusions: /i Atopy is associated with a modestly increased risk of AD and dementia that is not mediated by vascular disease or due to genetic confounding. A history of asthma is associated with shorter life expectancy after AD diagnosis.
Publisher: Public Library of Science (PLoS)
Date: 27-06-2019
Publisher: Elsevier BV
Date: 12-2001
Publisher: American Society of Hematology
Date: 16-04-2009
DOI: 10.1182/BLOOD-2008-09-179341
Abstract: We evaluated survival patterns for all registered acute myeloid leukemia (AML) patients diagnosed in Sweden in 1973 to 2005 (N = 9729 median age, 69 years). Patients were categorized into 6 age groups and 4 calendar periods (1973-1980, 1981-1988, 1989-1996, and 1997-2005). Relative survival ratios were computed as measures of patient survival. One-year survival improved over time in all age groups, whereas 5- and 10-year survival improved in all age groups, except for patients 80+ years. The 5-year relative survival ratios in the last calendar period were 0.65, 0.58, 0.36, 0.15, 0.05, and 0.01 for the age groups 0 to 18, 19 to 40, 41 to 60, 61 to 70, 71 to 80, and 80+ years, respectively. Intensified chemotherapy, a continuous improvement in supportive care, and allogeneic stem cell transplantation are probably the most important factors contributing to this finding. In contrast, there was no improvement in survival in AML patients with a prior diagnosis of a myelodysplastic syndrome during 1993 to 2005 (n = 219). In conclusion, AML survival has improved during the last decades. However, the majority of AML patients die of their disease and age remains an important predictor of prognosis. New effective agents with a more favorable toxicity profile are needed to improve survival, particularly in the elderly.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-11-2016
Publisher: Springer Science and Business Media LLC
Date: 26-04-2021
DOI: 10.1186/S12885-021-08169-W
Abstract: Despite improved surgical and oncological treatment, ovarian cancer continues to be the most lethal of the gynecologic malignancies. We aimed to analyze survival trends in epithelial ovarian cancer with regard to age, tumor site, and morphology in Sweden 1960 to 2014. A nationwide population-based study was conducted using data from the Swedish Cancer Registry on 46,350 women aged 18 or older with a diagnosis of epithelial ovarian, fallopian tube, peritoneal, or undesignated abdominal elvic cancer 1960 to 2014. Analyses of age-standardized incidence and relative survival (RS) were performed and time trends modelled according to age, tumor site, and morphology. Overall incidence of ovarian, tubal, peritoneal, and undesignated abdominal elvic cancers declined since 1980. Median age at diagnosis increased. Serous carcinoma increased in incidence. RS at 1, 2 and 5 years from diagnosis improved since 1960, although not for the youngest and the oldest patients. Ten-year RS did not improve. The best RS was found for fallopian tube cancer and the worst RS for undesignated abdominal elvic cancer. Among the morphologic subgroups, endometrioid carcinoma had the best RS. Survival in epithelial ovarian, tubal, peritoneal, and undesignated abdominal elvic cancers in Sweden has improved over the last six decades. Advances in epithelial ovarian cancer treatment have extended life for the first 5 years from diagnosis but 10-year survival remains poor.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2004
Publisher: Springer Science and Business Media LLC
Date: 05-02-2016
DOI: 10.1038/BCJ.2016.3
Abstract: We evaluated temporal trends in survival of Swedish acute myeloid leukemia (AML) patients diagnosed between 1973 and 2011 using relative survival ratios (RSRs) and a measure called the loss in expectation of life (LEL). RSRs increased most for patients years at diagnosis during the first calendar periods, but between 1997–2005 and 2006–2011 the most pronounced increase was for those aged 61–70 years at diagnosis RSR changed from 0.16 (95% confidence interval (CI): 0.13–0.19) to 0.28 (95% CI: 0.23–0.33), respectively. The LEL for males aged 35 years at diagnosis was 41.0 (95% CI: 40.1–41.8) years in 1975 and 19.5 (95% CI: 16.4–22.5) years in 2011. For males aged 65 years, the corresponding figures were 13.8 (95% CI: 13.7–14.0) and 12.0 (95% CI: 11.3–12.8). Conditional LEL estimates suggested that patients who survive 5 years postdiagnosis have shorter remaining lifespan than the general population. The proportion of expected life lost (PELL) suggested that male 65-year-old patients lost 75% of their life expectancy in 2005 and 66% if they were diagnosed in 2011. Survival continued to increase to 2011, with larger improvements in those aged 61–70 years at diagnosis. The LEL and PELL are intuitive measures that may be useful in communicating survival statistics to patients, clinicians and health-care providers.
Publisher: American Medical Association (AMA)
Date: 06-10-2004
Publisher: American Thoracic Society
Date: 03-2020
Publisher: Elsevier BV
Date: 05-2000
Publisher: Springer Science and Business Media LLC
Date: 21-05-2019
Publisher: Elsevier BV
Date: 11-2009
Publisher: Elsevier
Date: 2023
Publisher: Informa UK Limited
Date: 1998
Abstract: The results of a Nordic collaborative project revealed that Danish cancer patients had a poorer prognosis than patients in the other Nordic countries for some major cancer sites. The present study was undertaken to further explore the differences in survival between Denmark and the other Nordic countries. All cancer cases diagnosed in the Nordic countries during 1958 to 1991/92 were included in the analysis. Relative survival and excess mortality were calculated for intervals in the first five years after diagnosis. Since the 1950s, the prognosis of cancer patients has improved in all the countries, but more moderately in Denmark. For cancers of the stomach, colon, rectum, breast (female), and prostate, the Danish patients had a markedly lower relative survival than the patients in the other countries. They also had the lowest proportion of localized tumours. It appears that Danish cancer patients are diagnosed at a later stage of disease than patients in the other Nordic countries.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Oxford University Press (OUP)
Date: 1996
Abstract: Relevant information for clinical decision-making in a wide spectrum of diseases includes the extent to which sexual function is intact, how important it is to preserve sexual capacity and whether waning sexual function causes distress. Little information is available on elderly men. We aimed to obtain this basic information. Radiumhemmet's Scale of Sexual Function was posted to 435 randomly selected men aged 50-80 years. Assessments included sexual desire, erectile capacity, orgasm and ejaculation and to what extent waning sexual function distressed the men. The questions were answered anonymously. Information was obtained from 319 men (73%). Of these, 83% stated that sex was 'very important', 'important' or a 'spice to life'. Physiological potency for men aged 50-59, 60-69 and 70-80 amounted to 97%, 76% and 51% respectively. Among the oldest men (70-80 years), 46% reported orgasm at least once a month. Over 80% of all men who reported some level of erection stated that it was of importance to them to maintain the present level of erection stiffness. Most men who reported waning sexual function (compared with their youth) stated that this distressed them. Sex is important to elderly men. Even among the 70-80-year-olds, an intact sexual desire, erection and orgasm are common and it is considered important to preserve them. Sexual function should be considered in the clinical assessment of elderly men.
Publisher: Informa UK Limited
Date: 08-07-2021
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.UROLONC.2019.08.001
Abstract: It has consistently been shown that women who are diagnosed with bladder cancer have lower survival than men, but the exact mechanism remains unknown. Most studies assumed that the sex-specific mortality ratio is constant over time, possibly resulting in inaccurate estimates in various periods of follow-up. This study aimed to investigate the sex-specific excess mortality in bladder cancer patients and its variation over follow-up time. Observational cohort study. Using data from the population-based Netherlands Cancer Registry, we studied 24,169 patients diagnosed between 2003 and 2014 with histologically confirmed ≥T1 bladder cancer with follow-up until January 2018. We used flexible parametric relative survival models to estimate excess mortality as a function of time for each sex and to explore the effect of covariates on these functions. Female patients (24%) had worse clinical tumor, node, and metastasis-stage at diagnosis and more often a nonurothelial tumor histology. The excess mortality ratio of sex was not constant over time in the first two years after diagnosis excess mortality rates for women were higher than for men, but lower thereafter this applied to both nonmuscle-invasive and muscle-invasive bladder cancer subgroups. Baseline differences in age, tumor, node, and metastasis-stage and histology accounted for only part of the excess mortality gap. The assumption of proportional hazards over time leads to underestimation of the excess mortality ratio for women in the first two years and overestimation thereafter, when excess mortality is comparable for women and men. Clinicians should incorporate the initial sex-specific poorer outcome in their considerations regarding prognosis and treatment options for female patients, e.g., more invasive treatment and neo-adjuvant treatment. These findings also point towards a mechanism of micrometastatic disease, warranting assessment of sex-specific efficacy in randomized controlled trials on treatments in this patient population.
Publisher: Wiley
Date: 08-2006
DOI: 10.1111/J.1365-2796.2006.01677.X
Abstract: Data on cancer patient survival are an invaluable tool in the evaluation of therapeutic progress against cancer as well as other lethal diseases. As with all quantitative information routinely used in evidence-based clinical management--including diagnostic tests, prognostic markers and comparisons of therapeutic interventions--data on patient survival require evaluation based on an understanding of the underlying statistical methodology, methods of data collection and classification, and, most notably, clinical and biologic insight. This article contains an introduction to the methods used for estimating cancer patient survival, including cause-specific survival, relative survival and period analysis. The methods, and their interpretation, are illustrated through presentation of trends in incidence, mortality and patient survival for a range of different cancers. Our aim was to lay out the strengths and limitations of survival analysis as a tool in the evaluation of progress in the diagnosis and treatment of cancer.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2019
Publisher: Oxford University Press (OUP)
Date: 04-04-2017
Abstract: Recent studies of youth alcohol consumption indicate a collective downward drinking trend at all levels of consumption, i.e. reductions occurring 'in concert'. We re-examine the collectivity of drinking theory by applying quantile regression methods to the analysis and interpretation of Swedish youth alcohol consumption. Changes in youth alcohol consumption between 2000 and 2014 were assessed using a school-based survey conducted in Stockholm (n = 86,402). Participants were Swedish youth aged 15-18 years. The rate of change in consumption was examined using quantile regression, and compared to Ordinary Least Squares modelling. The hypothesis of parallelism or 'in concert' changes in consumption was assessed using the test of the equality of linear regression slopes corresponding to different quantiles of log consumption. In both models, changes in consumption over time did not occur in parallel, contrary to the collectivity of drinking theory. Instead, a clear ergence in the rate of drinking was observed, with most adolescent quantiles reducing consumption, while heavy consuming remained stable. Contrary to previous studies, our findings do not support a collectivity of drinking behaviour among Swedish youth. Quantile regression is a robust and appropriate method for analysing temporal changes in alcohol consumption data.
Publisher: Informa UK Limited
Date: 1999
Abstract: The effects of primary site, sex, age, stage and histological type on cancer patient survival were analysed on the basis of the population-based material of the Finnish Cancer Registry from 1985 to 1994. In addition, trends in survival were constructed for the period 1955-1994. Detailed site-specific data are published as Supplement 12 to Vol. 38 of Acta Oncologica. Within a given site, the survival differences by gender were not large. However, because of different site distributions, the average prognosis for female patients, all sites taken together, was superior to that of males: the 5-year relative survival rates (RSR) were 58% and 43%, respectively. In general, older patients had a poorer outcome compared with younger patients (partly because of different stage and histology distributions). Stage was a strong determinant of patient survival. In some cancers with a poor average prognosis the 5-year RSR for localized tumours was reasonable, e.g. 61% for stomach cancer, males, 34% for gallbladder cancer, females, and 29% for lung cancer, males. Most of the survival rates clearly increased over time. In addition to improvements in cancer treatment, changes over time in several other factors affect the trends, such as changes in the stage distribution (early diagnosis as a result of health education, improved diagnostic methods, screening, etc.) and in the composition of the patient material because of changing definitions of cancer (e.g. papilloma versus papillary carcinoma of the bladder, occult carcinoma of the thyroid, and early prostate cancer). The large Cancer Registry material (466,000 patients) enabled accurate estimates of the survival rates of cancer patients in Finland. These rates reflect the effectiveness of the healthcare system as a whole and are useful for planning and evaluation purposes. However, the estimated survival rates are based on grouped data, and cannot be directly applied for predicting the prognoses of in idual patients, although they can be used as guidelines.
Publisher: Wiley
Date: 13-11-2020
DOI: 10.1111/TRF.16175
Publisher: Oxford University Press (OUP)
Date: 03-04-2002
Abstract: Estrogen replacement therapy (ERT), which is mainly used to relieve climacteric symptoms, increases a woman's risk for uterine endometrial cancer and epithelial ovarian cancer (EOC). Estrogens are often combined with progestins in hormone replacement therapy (HRT) to reduce the risk of uterine endometrial cancer. Data on the association between HRT including progestins and EOC risk are limited. This nationwide case-control study examined EOC risk in relation to HRT regimens with sequentially added progestins (HRTsp) and continuously added progestins (HRTcp). Between 1993 and 1995, we enrolled 655 histologically verified incident case patients with EOC and 3899 randomly selected population controls, all 50-74 years of age. Data on HRT use were collected through mailed questionnaires. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by the use of unconditional logistic regression. Risks of EOC were elevated among ever users as compared with never users of both ERT (OR = 1.43, 95% CI = 1.02 to 2.00) and HRTsp (OR = 1.54, 95% CI = 1.15 to 2.05) risks were elevated for serous, mucinous, and endometrioid subtypes. For all EOC types combined, the greatest risk increases were seen with hormone use exceeding 10 years. Ever use of HRTcp was not associated with increased EOC risk relative to HRTcp never use (OR = 1.02, 95% CI = 0.73 to 1.43). The risk of EOC was elevated among HRTsp ever users as compared with HRTcp ever users (OR = 1.78, 95% CI = 1.05 to 3.01). ORs for EOC after ever use of low-potency estrogens were 1.18 (95% CI = 0.89 to 1.55) for oral and 1.33 (95% CI = 1.03 to 1.72) for vaginal applications, but no relationship was seen between EOC risk and duration of use. Ever users of ERT and HRTsp but not HRTcp may be at increased risk of EOC.
Publisher: Springer Science and Business Media LLC
Date: 23-01-2007
Publisher: Elsevier BV
Date: 2001
DOI: 10.1159/000049766
Abstract: To study the excess prevalence of distressful symptoms after radical surgery for urinary bladder cancer. We included all patients who underwent cystectomy due to bladder cancer before 1996 in Stockholm County. A control group was randomly selected from the general population. Information was collected by means of an anonymous postal questionnaire. Completed questionnaires were returned by 310 (71%) controls and 251 (85%) cystectomized in iduals. A 5-fold (reservoir) and 9-fold (conduit) increase in defecation urgency and a 4-fold (reservoir) and 6-fold (conduit) increase in faecal leakage were reported in in iduals operated on. Urinary tract infection was increased 3-fold in cystectomized in iduals compared with controls, during the previous year 26% of the patients reported a symptomatic infection. The perception of a reduced physical attractiveness due to disease was more than 5-fold increased in the men operated on compared to the controls. The majority, 135 out of 201 (67%), reported that they would have refused alternative bladder-sparing procedures if they decreased the prospects of survival by even as little as 1%. The patient's situation after cystectomy is considerably impaired due to changed bowel and sexual function, urinary tract infections and a sense of decreased attractiveness. However, most patients are in spite of this unwilling to compromise survival.
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.AHJ.2009.11.017
Abstract: Prior studies relating parity with maternal cardiovascular disease (CVD) have been performed in relatively small study s les without accounting for pregnancy-related complications associated with CVD. We examined the associations between parity and maternal risk of later-life CVD in a population-based cohort study using data from the Swedish population registers. Women born from 1932 to 1955 were followed until the occurrence of CVD, death, emigration, or end of follow-up (December 31, 2005). Cox proportional hazards models were used to estimate associations between parity and risk of CVD accounting for birth year, yearly income, education level, country of birth, hypertension (pregestational hypertension or gestational hypertension, with or without proteinuria), diabetes (type 1, type 2, or gestational diabetes), preterm birth, small for gestational age, and stillbirth. During a median follow-up time of 9.5 years (range 0-23.5), there were 65,204 CVD events in the full s le of women. Among 1,332,062 women, parity was associated with CVD in a J-shaped fashion, with 2 births representing the nadir of risk (global P value /=5 births were 1.09 (1.03-1.15) and 1.47 (1.37-1.57), respectively. In conclusion, parity was associated with incident maternal CVD in a J-shaped fashion, even after accounting for socioeconomic factors and pregnancy-related complications.
Publisher: American Society of Hematology
Date: 18-11-2011
Publisher: American Society of Clinical Oncology (ASCO)
Date: 02-2016
Abstract: Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL. Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model. Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non–pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76 the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51). We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.
Publisher: Oxford University Press (OUP)
Date: 15-08-2002
DOI: 10.1093/AJE/KWF048
Abstract: This case-control study evaluated reproductive and other factors in relation to epithelial ovarian cancer (EOC) risk. Between 1993 and 1995, the authors recruited 655 EOC cases and 3,899 population controls aged 50-74 years who were born in and residents of Sweden. Data were collected through mailed questionnaires. Odds ratios were estimated by unconditional logistic regression. Parity reduced EOC risk (odds ratio = 0.61, 95% confidence interval (CI): 0.46, 0.81) for uniparous compared with nulliparous women. The risk of EOC decreased with incomplete pregnancies, early menopausal age, late age at first birth, and unilateral oophorectomy increased with family history of ovarian cancer and was not associated with menarcheal age, lactation, irregular menses, and menopausal symptoms. Histology-specific odds ratios of EOC for ever compared with never users of oral contraceptives were: serous, 0.56 (95% CI: 0.42, 0.74) mucinous, 1.96 (95% CI: 1.04, 3.68) endometrioid, 0.71 (95% CI: 0.49, 1.03) clear cell, 0.66 (95% CI: 0.31, 1.43) and all EOCs, 0.73 (95% CI: 0.59, 0.90). Prolonged oral contraceptive use reduced EOC risk, with persistent protection up to 25 years after the last use. Ever use of hormone replacement therapy increased EOC risk (odds ratio = 1.41, 95% CI: 1.15, 1.72). Among etiologic hypotheses, the retrograde transportation hypothesis accommodates most epidemiologic findings concerning EOC risk.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.EJCA.2010.05.028
Abstract: Differences in the survival of colon cancer patients by socioeconomic status have been demonstrated in several populations, but the underlying reasons for the differences are not well understood. By simultaneously estimating the proportion of patients cured from colon cancer and the survival times of the 'uncured' we hope to increase understanding of how socioeconomic status affects survival following a diagnosis of colon cancer. We conducted a population-based cohort study of 58,873 patients diagnosed with colon cancer in Sweden 1965-2000. Socioeconomic status was classified based on occupation. We fitted mixture cure models and Poisson regression models adjusted for age, sex and calendar period. We observed higher excess mortality, lower proportion cured and shorter survival times among the uncured in patients from lower socioeconomic groups compared to the highest socioeconomic group. There was no evidence that the gap between the socioeconomic groups reduced over time. Farmers had the lowest odds of cure (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.75-0.95) compared to higher non-manual workers followed by self-employed (0.91, 0.81-1.03), manual workers (0.93, 0.85-1.03) and lower non-manual workers (0.98, 0.89-1.08). Patients from lower socioeconomic groups in Sweden experience worse survival following a diagnosis of colon cancer. Differences exist in both the cure proportion and the survival time of the uncured, suggesting that socioeconomic differences cannot be attributed solely to lead time bias.Although this study has furthered our understanding of socioeconomic differences in survival, more detailed studies are required in order to identify, and subsequently remove, the underlying reasons for the differences.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.CANEP.2011.09.007
Abstract: Relative survival is an extensively used method in population based cancer studies as it provides a measure of survival without the need for accurate cause of death information. It gives an estimate for the probability of dying from cancer in the absence of other causes by estimating the excess mortality in the study population when compared to an external group. The external group is usually the general population within a country or state and mortality estimates are taken from national life tables that are broken down by age, sex, calendar year and, where applicable, race/ethnicity. One potential bias when using relative survival that is most often overlooked occurs when there are a high proportion of deaths due to a specific cancer in the external group. This paper uses data from the Finnish Cancer Registry to illustrate, through the use of a simple sensitivity analysis, the impact that specific cancer deaths in the population mortality figures can have on the estimate of relative survival. We found that when examining specific diseases such as breast cancer and colon cancer, the proportion of deaths due to these specific cancers in the general population is so small in comparison to the total mortality that they make little difference to the relative survival estimates. However, prostate cancer proved to be an exception to this. For all cancer sites combined the sensitivity analysis illustrates a major limitation for this type of analysis, particularly with the older age groups. We recommend that, with a classification of diseases as wide as all cancer sites, relative survival should not be used without appropriate adjustment.
Publisher: Springer Science and Business Media LLC
Date: 02-2006
DOI: 10.1186/BCR1378
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.BREAST.2019.03.005
Abstract: Many studies have found evidence of socioeconomic differences in breast cancer survival. This study aimed to quantify the impact of removing differences in stage distribution and stage-specific relative survival between education groups in Swedish women with breast cancer. Using information from a breast cancer research database, the study population contained 62 121 women diagnosed with breast cancer in three healthcare regions of Sweden from 1992 to 2012. The loss in expectation of life and life years lost due to breast cancer were estimated using flexible parametric relative survival models by education group and age at diagnosis. The potential gain in life years and postponable deaths were calculated by applying the 1) stage distribution, 2) stage-specific relative survival, and 3) both stage distribution and stage-specific relative survival of the high education group to the low and medium education groups. For a cohort of around 3500 women diagnosed with breast cancer residing in three Swedish healthcare regions in a typical calendar year, we estimated that removing stage differences would postpone an additional 25 deaths at five years after diagnosis, and result in a gain of approximately 573 life years. Alternatively, if stage-specific breast cancer survival could be equated, approximately 692 life years could be saved and an additional 26 deaths could be postponed five years after diagnosis. Results such as these can help guide decisions on interventions intended to minimise socioeconomic differences in breast cancer outcomes.
Publisher: Wiley
Date: 06-2008
Publisher: Wiley
Date: 13-07-2020
DOI: 10.1111/JOIM.13139
Publisher: Wiley
Date: 04-2020
DOI: 10.1111/JOIM.13019
Publisher: Springer Science and Business Media LLC
Date: 08-2003
Publisher: Springer Science and Business Media LLC
Date: 17-05-2015
Publisher: American Society of Hematology
Date: 20-11-2009
Publisher: Informa UK Limited
Date: 21-10-2014
DOI: 10.3109/10428194.2014.953141
Abstract: Imatinib has revolutionized the treatment of chronic myeloid leukemia (CML). We evaluated clinical outcome and cost-effectiveness, using Swedish registry data based on patients with CML diagnosed 1973-2008. Outcome from three time periods (I: 1973-1979 II: 1991-1997 III: 2002-2008) associated with symptomatic treatment, interferon-α/stem cell transplant and implementation of imatinib, respectively, were compared and a lifetime cost-effectiveness model developed. Survival data from population registries, estimated resource use from clinical practice and quality of life estimates were employed. Substantial health gains were noted over time, paralleled by increased treatment costs. Median survival was 1.9, 4.0 and 13 years during the respective time periods. The incremental cost-effectiveness ratio (ICER) between periods III and II was €52,700 per quality-adjusted life year (QALY) gained. An estimated 80% price reduction of imatinib, related to patent expiry, would reduce this ICER to €22,700. Our data from four decades reveal dramatically improved survival in CML, paralleled by ICER levels generally accepted by health authorities.
Publisher: American Association for Cancer Research (AACR)
Date: 02-06-2022
DOI: 10.1158/1055-9965.EPI-21-1323
Abstract: The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014. Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis. In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000 thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.
Publisher: Elsevier BV
Date: 2001
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2004
Publisher: Elsevier BV
Date: 04-2023
Publisher: Springer Science and Business Media LLC
Date: 06-01-2007
DOI: 10.1007/S10654-006-9091-0
Abstract: Web-questionnaires are an important tool for future epidemiological research because these allow for rapid and cost-efficient assembly of self-reported information on risk factors and health outcomes. However, to achieve high response rates it is essential to accommodate factors that prevent drop out and so insure validity of future studies. We aim to study how socio-demographic variables as well as design issues such as the ordering and level of difficulty (Easy-to-hard vs. Hard-to-easy) of questions in a web-questionnaire affects the probability of drop out and non-response. In 2003 we invited 47,859 women participating in an ongoing prospective study to a follow-up using a web-based mode. Two versions of the questionnaire existed, varying in level of difficulty (Easy-to-hard vs. Hard-to-easy). We report drop out (proportion non-completers) between groups defined by level of difficulty and estimated adjusted risk differences. The drop out differs significantly depending on the order of the questions in the web-questionnaire. The socio-demographic pattern among lurkers (participants that enter, start responding to, but do not complete a web-questionnaire) differs from that among completers of web-questionnaires. An additional 6% units of completers--persons initiating and completing the questionnaire--can be obtained by considering the ordering of questions. A group uniquely identified in web-surveys, as lurkers are potentially easier to persuade to complete an already started web-questionnaire compared to a non-responder. Lurkers thus constitute a unique opportunity of decreasing the drop out rate and therefore merit future research.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.CANEP.2018.07.009
Abstract: There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics. "InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites Breast, Colon, Rectum, Stomach, Melanoma and Lung. Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, in idualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of in idual risk and differences between various measures. "InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.
Publisher: Springer Science and Business Media LLC
Date: 03-1998
Publisher: American Association for the Advancement of Science (AAAS)
Date: 20-03-2020
Abstract: The cerebral cortex underlies our complex cognitive capabilities. Variations in human cortical surface area and thickness are associated with neurological, psychological, and behavioral traits and can be measured in vivo by magnetic resonance imaging (MRI). Studies in model organisms have identified genes that influence cortical structure, but little is known about common genetic variants that affect human cortical structure. To identify genetic variants associated with human cortical structure at both global and regional levels, we conducted a genome-wide association meta-analysis of brain MRI data from 51,665 in iduals across 60 cohorts. We analyzed the surface area and average thickness of the whole cortex and 34 cortical regions with known functional specializations. We identified 369 nominally genome-wide significant loci ( P 5 × 10 −8 ) associated with cortical structure in a discovery s le of 33,992 participants of European ancestry. Of the 360 loci for which replication data were available, 241 loci influencing surface area and 66 influencing thickness remained significant after replication, with 237 loci passing multiple testing correction ( P 8.3 × 10 −10 187 influencing surface area and 50 influencing thickness). Common genetic variants explained 34% (SE = 3%) of the variation in total surface area and 26% (SE = 2%) in average thickness surface area and thickness showed a negative genetic correlation ( r G = −0.32, SE = 0.05, P = 6.5 × 10 −12 ), which suggests that genetic influences have opposing effects on surface area and thickness. Bioinformatic analyses showed that total surface area is influenced by genetic variants that alter gene regulatory activity in neural progenitor cells during fetal development. By contrast, average thickness is influenced by active regulatory elements in adult brain s les, which may reflect processes that occur after mid-fetal development, such as myelination, branching, or pruning. When considered together, these results support the radial unit hypothesis that different developmental mechanisms promote surface area expansion and increases in thickness. To identify specific genetic influences on in idual cortical regions, we controlled for global measures (total surface area or average thickness) in the regional analyses. After multiple testing correction, we identified 175 loci that influence regional surface area and 46 that influence regional thickness. Loci that affect regional surface area cluster near genes involved in the Wnt signaling pathway, which is known to influence areal identity. We observed significant positive genetic correlations and evidence of bidirectional causation of total surface area with both general cognitive functioning and educational attainment. We found additional positive genetic correlations between total surface area and Parkinson’s disease but did not find evidence of causation. Negative genetic correlations were evident between total surface area and insomnia, attention deficit hyperactivity disorder, depressive symptoms, major depressive disorder, and neuroticism. This large-scale collaborative work enhances our understanding of the genetic architecture of the human cerebral cortex and its regional patterning. The highly polygenic architecture of the cortex suggests that distinct genes are involved in the development of specific cortical areas. Moreover, we find evidence that brain structure is a key phenotype along the causal pathway that leads from genetic variation to differences in general cognitive function. ( A ) Measurement of cortical surface area and thickness from MRI. ( B ) Genomic locations of common genetic variants that influence global and regional cortical structure. ( C ) Our results support the radial unit hypothesis that the expansion of cortical surface area is driven by proliferating neural progenitor cells. ( D ) Cortical surface area shows genetic correlation with psychiatric and cognitive traits. Error bars indicate SE. IMAGE CREDITS: (A) K. COURTNEY (C) M. R. GLASS
Publisher: SAGE Publications
Date: 30-09-2017
Abstract: Automated breast volume scanner (ABVS) is an ultrasound (US) device with a wide scanner that sweeps over a large area of the breast and the acquired transverse images are sent to a workstation for reconstruction and review. Whether ABVS is as reliable as handheld US is, however, still not established. To compare the sensitivity and specificity of ABVS to handheld breast US for detection of breast cancer, in the situation of recall after mammography screening. A total of 113 women, five with bilateral suspicious findings, undergoing handheld breast US due to a suspicious mammographic finding in screening, underwent additional ABVS. The methods were assessed for each breast and each detected lesion separately and classified into two categories: breasts with mammographic suspicion of malignancy and breasts with a negative mammogram. Twenty-six cancers were found in 25 women. In the category of breasts with a suspicious mammographic finding (n = 118), the sensitivity of both handheld US and ABVS was 88% (22/25). The specificity of handheld US was 93.5% (87/93) and ABVS was 89.2% (83/93). In the category of breasts with a negative mammography (n = 103), the sensitivity of handheld US and ABVS was 100% (1/1). The specificity of handheld US was 100% (102/102) and ABVS was 94.1% (96/102). ABVS can potentially replace handheld US in the investigation of women recalled from mammography screening due to a suspicious finding. Due to the small size of our study population, further investigation with larger study populations is necessary before the implementation of such practice.
Publisher: SAGE Publications
Date: 26-03-2020
Abstract: Background parenchymal enhancement (BPE) of normal tissue at breast magnetic resonance imaging is suggested to be an independent risk factor for breast cancer. Its association with established risk factors for breast cancer is not fully investigated. To study the association between BPE and risk factors for breast cancer in a healthy, non-high-risk screening population. We measured BPE and mammographic density and used data from self-reported questionnaires in 214 healthy women aged 43–74 years. We estimated odds ratios for the univariable association between BPE and risk factors. We then fitted an adjusted model using logistic regression to evaluate associations between BPE (high vs. low) and risk factors, including mammographic breast density. The majority of women had low BPE (84%). In a multivariable model, we found statistically significant associations between BPE and age ( P = 0.002) and BMI ( P = 0.03). We did find a significant association between systemic progesterone medication and BPE, but due to small numbers, the results should be interpreted with caution. The adjusted odds ratio for high BPE was 3.1 among women with density D (compared to B) and 2.1 for density C (compared to B). However, the association between high BPE and density was not statistically significant. We did not find statistically significant associations with any other risk factors. Our study confirmed the known association of BPE with age and BMI. Although our results show a higher likelihood for high BPE with increasing levels of mammographic density, the association was not statistically significant.
Publisher: Informa UK Limited
Date: 24-10-2011
Publisher: Elsevier BV
Date: 02-2002
DOI: 10.1016/S0167-8140(01)00455-8
Abstract: Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy. We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 in iduals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias. Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free. About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.
Publisher: American Society of Hematology
Date: 16-11-2005
DOI: 10.1182/BLOOD.V106.11.1845.1845
Abstract: Background AML is an aggressive disease, which is rapidly fatal without specific therapy. Such treatment was not available until the early 1970’s when combinations of anthracyclines and cytarabine were introduced. Since then major improvements have been made in chemotherapy, stem cell transplantation (SCT) and supportive care. The aim of this study was to define the impact of modern AML treatment strategies on outcome. Extrapolation of results from clinical trials may not be appropriate for estimation of outcome in the whole population because of a varying degree of patient selection. In this study relative survival rates (RSR) were estimated in relation to age, sex, calendar period and region of residence in a cohort of 5,809 AML patients. Methods Records on all patients with AML reported to the Swedish Cancer Register between 1973 and 2001 were linked to the nationwide Cause of Death Register. Information on the number of SCT in AML patients in Sweden during the study period was obtained from the EBMT register. Survival analysis were performed by computing relative survival rates (RSR), defined as the ratio of observed survival of the patients in the cohort versus the expected survival among in iduals of the same age, sex, and calendar year of observation. Results 5809 AML patients diagnosed between January 1, 1973 and December 31, 2001 were identified. The cases were ided into six age groups 0–18, 19–40, 41–60, 61–70, 71–80, and 80+ years. The study period was arbitrarily ided into 7-year intervals. Improvement was seen in all age groups but the eldest. However, patients 60 years benefited most from new treatment strategies (table 1). There was a marked increase in SCT during the study period with allogeneic SCT dominating in the last period (fig 1). A comparison between regions (with different therapeutical traditions) was made. The regions of Stockholm, Uppsala and Örebro have cooperated since 1971 within the Leukemia Group of Middle Sweden (LGMS) and was therefore considered as one region and compared with the rest of the country. During the first calendar period the 5-year RSR of residents with AML in LGMS counties was significantly higher than that of patients in remaining regions. However, this difference has disappeared with time. Conclusion Improvement in overall survival of AML patients was mainly confined to young patients ( years). However, among patients 60–71 years at diagnosis, a slightly improved RSR was observed. For patients above the age of 70 years, the prognosis remains very poor stressing the fact that the decision to use aggressive chemotherapy for this group of patients should consider the risk of iatrogenic morbidity and mortality as well as projected benefit. The early creation of a cooperative clinical AML group probably explains the improved RSR rates during the first study period (1973–1979). Table 1. Five-year RSR (%) according to age group and calendar period calendar period/age group (years) 1973–1979 1980–1986 1987–1993 1994–2000 0–18 17 31 52 68 19–40 14 17 38 58 41–60 7 13 22 36 61–70 6 8 12 15 71–80 3 3 7 6 81+ 1 0 0 1 Fig. 1 Number of stem cell transplantation in Sweden 1973–2001 Fig. 1. Number of stem cell transplantation in Sweden 1973–2001
Publisher: Wiley
Date: 31-10-2007
DOI: 10.1002/IJC.23076
Abstract: Although Scandinavian moist snuff ("snus"), no doubt, is a safer alternative to smoking, there is limited evidence against an association with gastroesophageal cancers. In a retrospective cohort study, we investigated esophageal and stomach cancer incidence among 336,381 male Swedish construction workers who provided information on tobacco smoking and snus habits within a health surveillance program between 1971 and 1993. Essentially complete follow-up through 2004 was accomplished through linkage to several nationwide registers. Multivariable Cox proportional hazards regression models estimated relative risks (RR) and 95% confidence intervals (CIs). Compared to never-users of any tobacco, smokers had increased risks for adenocarcinoma (RR = 2.3, 95% CI 1.4-3.7) and squamous cell carcinoma (RR = 5.2, 95% CI 3.1-8.6) of the esophagus, as well as cardia (RR = 2.1, 95% CI 1.5-3.0) and noncardia stomach (RR = 1.3, 95% CI 1.2-1.6) cancers. We also observed excess risks for esophageal squamous cell carcinoma (RR = 3.5, 95% CI 1.6-7.6) and noncardia stomach cancer (RR = 1.4, 95% CI 1.1-1.9) among snus users who had never smoked. Although confounding by unmeasured exposures, and some differential misclassification of smoking, might have inflated the associations, our study provides suggestive evidence for an independent carcinogenic effect of snus.
No related grants have been discovered for Paul Dickman.