Although being an important part of the psychiatric treatment chain, there are few outcome studie... more Although being an important part of the psychiatric treatment chain, there are few outcome studies of treatment at psychiatric emergency units (PEU). The aim was to measure changes in psychopathology and humiliation during admission at a PEU. The sample consisted of 147 patients examined at admission and discharge. The instruments used were the Brief Psychiatric Rating Scale (BPRS), the Narcissistic Personality Inventory-29 (NPI-29), the Hospital Anxiety and Depression Scale (HADS), a combination of questions measuring negative experiences and Cantril's ladder measuring experienced humiliation. Outcome measures were clinically significant improvement [>10% reduction of the BPRS converted (0-100) score] and changes on the other instruments. Median hospitalization time was 13 days (mean 20.4 days). Fifty-six per cent of the patients showed clinical significant improvement (95% CI 48-64%), 42% showed some degree of improvement and 2% were unchanged. The more improved patients had higher scores at admission than those with less improvement on all scales, indicating a floor effect. Small changes were observed for narcissism and experienced humiliation and negative admission events. In multivariate analyses high admission scores on BPRS subscales, thinking disorder and activation and HADS total score were significantly associated with clinically significant improvement. Type and length of admission did not significantly affect the outcome. The BPRS, HADS and NPI-29 scores at discharge were mainly explained by corresponding admission scores. More than half the patients admitted to PEU have clinically significant reduction of psychopathology during their stay. Higher levels of psychopathology at admission were significantly associated with improvement. Negative admission experiences and involuntary admission did not influence outcome.
Purpose The purpose of this study is to study the influence of radical prostatectomy (RP) for pro... more Purpose The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate cancer on work status and working life in men 3 years after surgery. Methods In a prospective, questionnaire-based study on adverse effects after RP, 330 prostate cancer (PCa) patients who had been active in the workforce before RP described their work status 3 years after having surgery. We dichotomized their postoperative work status into "unchanged or increased" versus "reduced." The participants also reported whether their working life was influenced by the PCa trajectory to no, some, or a great extent. Univariate and multiple logistic regression models were established with sociodemographic and clinical characteristics as independent variables and "work status" or "influence of PCa trajectory on working life" as dependent variables. Results Twenty-five percent of the participants had retired. Of the remaining participants, approximately 20 % had a reduced work status, which in the multivariate analyses was significantly associated with increasing age. One third of the men still active in the workforce considered the PCa to negatively influence their working life. This was independently associated with bother related to urinary leakage, fatigue, and having undergone additional oncological therapy (pelvic radiotherapy and/or hormone treatment). Conclusion Though RP does not affect work status in most men, approximately one third of them experience problems in their working life due to adverse effects related to RP and/or additional post-RP anti-cancer therapy. Implications for Cancer Survivors Most PCa survivors can expect to remain in the workforce for at least 3 years after RP, but for some, persistent adverse effects after RP and /or additional anti-cancer treatment negatively affect their working life. Pre-RP counseling of men within the workforce should cover possible post-RP changes concerning work status and working life.
Purpose Neuroticism is a basic personality trait characterized by negative emotions triggered by ... more Purpose Neuroticism is a basic personality trait characterized by negative emotions triggered by stress such as a breast cancer diagnosis and its treatment. Due to lack of relevant research, the purpose of this study was to examine if high neuroticism is associated with seven common late adverse effects (LAEs) in long-term (≥ 5 years) breast cancer survivors (BCSs). Methods All female Norwegian BCSs aged 20–65 years when diagnosed with stage I–III breast cancer in 2011 or 2012 were invited to a questionnaire study in 2019 (N = 2803), of whom 48% participated (N = 1355). Neuroticism was self-rated using the abridged version of the Eysenck Personality Questionnaire, and scores dichotomized into high and low neuroticism. LAEs were defined by categorization of ratings on the EORTC QLQ-C30 (cognitive function, pain, and sleep problems) and QLQ-BR23 (arm problems) questionnaires, and categorizations of scale scores on mental distress, fatigue, and neuropathy. Associations between high neu...
The personality trait of neuroticism is associated with adverse health outcomes after cancer trea... more The personality trait of neuroticism is associated with adverse health outcomes after cancer treatment, but few studies concern men treated for prostate cancer. We examined men with high and low neuroticism treated with radical prostatectomy for curable prostate cancer without relapse. We compared overall problems and domain summary scores (DSSs) between these groups, and if high neuroticism at pre-treatment was a significant predictor of overall problems and DSSs at follow-up. A sample of 462 relapse-free Norwegian men self-rated neuroticism, overall problems, and DSSs by the EPIC-26 before surgery and at three years’ follow-up. Twenty-one percent of the sample had high neuroticism. Patients with high neuroticism reported significantly more overall problems and DSSs at pre-treatment. At follow-up, only overall bowel problems and urinary irritation/obstruction and bowel DSSs were different. High neuroticism was a significant predictor of overall bowel problems and bowel and irritati...
PURPOSE To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) i... more PURPOSE To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) represent prognostic factors of overall mortality, cancer mortality, and first-time non–germ cell second cancer (SecCa) incidence. PATIENTS AND METHODS In 775 long-term TCSs (diagnosis: 1980-1994) who previously participated in a quality-of-life survey, 20-year mortality and SecCa incidence were compared between the surgery group (n = 272) and TCSs after platinum-based chemotherapy (PBCT; n = 503). A PBCT standard group (total cisplatin: ≤ 630 mg: n = 124) was separated from a PBCT high subgroup (total cisplatin: > 630 mg; n = 379). Univariate and multivariate analyses (Kaplan-Meier; Cox proportional hazard analyses) included age, treatment, and prior major physical comorbidity as nonmodifiable factors, whereas low socioeconomic status, unhealthy lifestyle, probable depression disorder, and neurotoxicity were modifiable AHOs. RESULTS For all TCSs, ...
Background: A major depressive episode (MDE) is typically self-rated by screening forms identifyi... more Background: A major depressive episode (MDE) is typically self-rated by screening forms identifying probable MDE (pMDE). This population-based cross-sectional questionnaire study examined the prevalence rates of pMDE identified by the PHQ-9 screener in long-term survivors of childhood and adolescence (CACSs) and young adult cancer (YACSs) and a normative sample (NORMs). Methods: Data from 488 CACSs, 1202 YACSs, and 1453 NORMs were analyzed, and pMDE was defined both by cut-off ≥10 on the total PHQ-9 score and by an algorithm. Results: The prevalence rates of pMDE among CACSs were 21.5%, 16.6% in YACSs, and 9.2% among NORMs using the cut-off definition. With the algorithm, the prevalence rates of pMDE were 8.0% among CACSs, 8.1% among YACSs, and 3.9% among NORMs. Independent of definition, CACSs and YACSs had significantly increased prevalence rates of pMDE compared to NORMs. Psychosocial factors and self-rated health were significantly associated with both definitions of pMDE in mul...
Purpose The personality trait of neuroticism represents vulnerability for mental distress to soma... more Purpose The personality trait of neuroticism represents vulnerability for mental distress to somatic health problems. There are few studies of neuroticism in prostate cancer patients. This study examines the levels of self-reported adverse effects (AEs) after robot-assisted radical prostatectomy (RALP) in Norwegian men with high or low levels of neuroticism. Neuroticism is also compared to relevant factors concerning their associations with various AEs. Methods Among 982 men who had RALP at Oslo University Hospital, Radiumhospitalet between 2005 and 2010, 79% responded to a mailed questionnaire in 2011. They rated AEs by completing the EPIC-26 questionnaire, and neuroticism on the Eysenck Personality Questionnaire (EPQ). Men with
Background Most studies of cervical cancer (CC) survivors describe sexual inactivity in relation ... more Background Most studies of cervical cancer (CC) survivors describe sexual inactivity in relation to treatment modalities, but few consider that inactivity varies with age and partner status. Aim The aim of this study was to investigate the prevalence of sexual inactivity in long-term CC survivors according to age and partner status, and to examine cancer-related, health, demographic, and psychological factors related to sexual inactivity. Methods All 974 women treated for CC from 2000 through 2007 in 2 areas of Norway, who were alive and cancer-free by the end of 2013, received a mailed questionnaire. Among them, 523 delivered valid data on current sexual activity (response rate 57%). The prevalence rates of sexual inactivity in relation to age groups and partner status were compared to normative sample (NORMs). Main Outcome Measure Sexual inactivity during the 4 weeks before the survey was administered. Results Median age of the sample at survey was 53 years (range 32–77) and media...
Reduced sexual function may have negative implications on health related quality of life among ly... more Reduced sexual function may have negative implications on health related quality of life among lymphoma survivors. A national cross-sectional study among long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplantation auto-SCT treated during 1987-2008 was conducted in 2012-2014. The current study explored sexual functioning among these survivors. Sixty-six percent (n=159) of eligible men with complete questionnaire data were included, median age was 55 years. The Brief Sexual Function Inventory (BSFI) was used to assess sexual function and sexual satisfaction, compared with age-matched controls. In addition, sexual problems were defined based on predetermined cutoff values for BSFI domain scores. Sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 30% and 41% of survivors, respectively. Sexual satisfaction was reported by 39% of survivors. The survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erection compared with controls. In multivariable models, cardiovascular disease was significantly associated with worse erectile function, while age >55 years, chronic fatigue, and physical inactivity were significantly associated with lower sexual functioning overall. Chronic fatigue and anxiety were related to lower sexual satisfaction.
Purpose Personality traits, particularly neuroticism, have an impact on people’s health and lifes... more Purpose Personality traits, particularly neuroticism, have an impact on people’s health and lifestyle. Due to lack of previous studies, we examined old cancer survivors (OCSs) versus cancer-free age-matched controls aged ≥ 70 years, regarding prevalence of high neuroticism, health problems in those with high and low neuroticism, and sociodemographic and clinical variables that were significantly associated with high neuroticism. Methods We merged data from a Norwegian population–based health study (the HUNT-3) and from the Cancer Registry of Norway identifying OCSs. Three cancer-free controls were drawn at random for each OCS. Neuroticism was self-rated on a brief version of Eysenck Personality Questionnaire. Between-group statistical comparisons were made between OCS and controls, and among their subgroups with high and low neuroticism. Logistic regression analyses were used to investigate independent variables significantly associated with high neuroticism. Results Twenty-nine per...
The aim of this study was to examine satisfaction with the quality of the doctor-patient relation... more The aim of this study was to examine satisfaction with the quality of the doctor-patient relationship (QCD) and the information (INF) made available, as well as the influence of different treatment modalities and psychosocial variables in testicular cancer survivors (TCSs). Two-hundred and 6 TCSs, seen at 2 Norwegian university hospitals, were studied retrospectively and currently in a cross-sectional follow-up design. Questionnaires were filled in prior to and at the patients' follow-up examination. The mean length of time since their management period had ended was 6.5 years (range 0-17 years). The QCD was rated higher than the INF. The QCD was also the strongest contributor to the variance in the INF. The patients in the surveillance group had the lowest QCD. The relatively high QCD scores may reflect the fact that the patients had been cured from a life-threatening disease. The low INF scores may indicate that the TCSs were poorly informed about the potential health problems...
BACKGROUND 1.1 Oncological aspects of testicular cancer 1.2 Cognitive function in adult cancer pa... more BACKGROUND 1.1 Oncological aspects of testicular cancer 1.2 Cognitive function in adult cancer patients 1.3 Neuropsychological functioning and cognitive complaints in testicular cancer patients 1.4 Implications of cancer-related cognitive problems 1.5 Status on the relation between systemic chemotherapy and cognitive function at the onset of this thesis 2 THIS THESIS 2.1 Research setting 2.2 Aims of the studies 3 STUDY SAMPLES AND PROCEDURES 3.1 Paper I: The 1990'ies study (TCPs enrolled in three EORTC / MRC trials) 3.2 Paper II-IV: The Oslo-study 4 METHODS 4.1 Questionnaires 4.2 Semi-structured interviews 4.3 Neuropsychological evaluation 4.4 Definitions of main outcome measures 4.5 Data management 4.6 Statistical procedures 4.7 Ethical considerations 5 RESULTS 5.1 Paper I (The 1990'ies study) 6 5.2 The Oslo-study: Description of the sample of Papers II-IV 5.3 Paper II (The distress paper) 8 5.4 Paper III (The neuropsychological paper)
Journal of cancer survivorship : research and practice, Jan 13, 2014
The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate ca... more The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate cancer on work status and working life in men 3 years after surgery. In a prospective, questionnaire-based study on adverse effects after RP, 330 prostate cancer (PCa) patients who had been active in the workforce before RP described their work status 3 years after having surgery. We dichotomized their postoperative work status into "unchanged or increased" versus "reduced." The participants also reported whether their working life was influenced by the PCa trajectory to no, some, or a great extent. Univariate and multiple logistic regression models were established with sociodemographic and clinical characteristics as independent variables and "work status" or "influence of PCa trajectory on working life" as dependent variables. Twenty-five percent of the participants had retired. Of the remaining participants, approximately 20 % had a reduced work ...
ABSTRACT Background In men with prostate cancer ( PCa) large variations of patient-reported outco... more ABSTRACT Background In men with prostate cancer ( PCa) large variations of patient-reported outcomes ( PROs) after radical prostatectomy (RP) or high-dose radiotherapy (RAD) may be related to between-country differences of pre-treatment medical and socio-demographic variables , as well as to differences in pre-treatment PROs in the sexual and urinary domain. Methods In 1908 patients with localized PCa from Norway, USA or Spain the relation was investigated between pre-treatment data on medical (PSA, Gleason score , cT-category ) and socio-demographic variables (age, education ,marital status). Using the EPIC questionnaire pre-treatment PROs within the sexual and urinary domain were also considered . Results Compared to the European patients American patients were younger, fewer had co-morbid conditions and more had a high education level. Fifty-three % of the US-men eligible for RP had low-risk tumors compared to 42% and 31% among respectively the Norwegian and the Spanish patients. Among the Spanish RAD patients 54% had had low- risk tumors compared to respectively 34% of the American and 21% of the Norwegian men planned for RAD. Compared to the European patients significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups the number of patients with sexual or urinary dysfunctions exceeded that of patients with bother related to the reported dysfunction. Conclusions Statistically significant between-country differences were observed in pre-treatment medical and socio-demographic variables, as well as in pre-treatment PROs within the sexual and urinary domain. Large differences between reported dysfunction and related problems within the sexual and urinary domain indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, may in part explain the large variation of post-treatment side effects evident in the medical literature.
BACKGROUND. Recently two new methods for prospective studies of adverse effects after treatment h... more BACKGROUND. Recently two new methods for prospective studies of adverse effects after treatment have been developed: Proportions of patients regaining 90% of baseline function score (PBS-90) and Generalized Estimating Equation (GEE). We compared these methods to examine changes of sexual, urinary, and bowel functions after robot-assisted prostatectomy (RALP) and conformal external beam radiotherapy (EBRT) in patients without androgen deprivation therapy (ADT). METHODS. The post-treatment functional course was studied prospectively in 254 patients (N ¼ 150 RALP and N ¼ 104 EBRT) with PBS-90 and GEE. The time points at which functions reached stability and significant associations with function at 24 months were examined with PBS-90, and predictors were identified with GEE. The patients filled in the UCLA-PCI questionnaire at baseline and at 3, 6, 12, and 24-month post-treatment. RESULTS. The proportions reaching PBS-90 at 24 months were 69% EBRT and 34% RALP patients for urinary function, 70% of EBRT and 7% of RALP patients for sexual function, and 70% of EBRT and 86% of RALP patients for bowel function. GEE showed that the function scores at 6 months were significantly associated with the functions at 24 months. PBS-90 found that stability of function was reached at 3 months for urinary and 6 months for sexual and bowel functions. CONCLUSIONS. In outcome assessment PBS-90 mainly demonstrates when post-treatment level become stabilized and GEE shows the time points at which final outcome can be predicted. The two methods therefore supplement each other. Changes of functions corresponded to those reported in samples including patients having ADT.
Chronic fatigue (CF) is a distressing symptom that follows cancer treatment; however, it has rare... more Chronic fatigue (CF) is a distressing symptom that follows cancer treatment; however, it has rarely been studied in hormone-naïve prostate cancer survivors after radical prostatectomy (RP) or definitive radiotherapy (RAD). We investigated CF in prostate cancer survivors after RP or RAD as monotherapy and explored associations between CF and medical and psychosocial variables. A population-based, cross-sectional postal survey in 2006 included Norwegian hormone-naïve survivors with the diagnosis of prostate cancer in 2004 who were treated with RP (n ¼ 337) or RAD (n ¼ 184). The primary outcome variable was prevalence of CF (defined as fatigue lasting 6 months or longer). Twelve to 32 months after RP and RAD, 13.4 and 26.1% of the patients after, respectively, RP and RAD reported CF inversely associated with pretreatment age (P ¼ 0.003). In multivariate analysis, high neuroticism, post-treatment co-morbidity, pain, urinary and intestinal dysfunction, but not sexual dysfunction, were positively associated with reporting CF. Further studies of CF in prostate cancer survivors should take into consideration the survivors' pretreatment medical and psychosocial situation.
Although being an important part of the psychiatric treatment chain, there are few outcome studie... more Although being an important part of the psychiatric treatment chain, there are few outcome studies of treatment at psychiatric emergency units (PEU). The aim was to measure changes in psychopathology and humiliation during admission at a PEU. The sample consisted of 147 patients examined at admission and discharge. The instruments used were the Brief Psychiatric Rating Scale (BPRS), the Narcissistic Personality Inventory-29 (NPI-29), the Hospital Anxiety and Depression Scale (HADS), a combination of questions measuring negative experiences and Cantril's ladder measuring experienced humiliation. Outcome measures were clinically significant improvement [>10% reduction of the BPRS converted (0-100) score] and changes on the other instruments. Median hospitalization time was 13 days (mean 20.4 days). Fifty-six per cent of the patients showed clinical significant improvement (95% CI 48-64%), 42% showed some degree of improvement and 2% were unchanged. The more improved patients had higher scores at admission than those with less improvement on all scales, indicating a floor effect. Small changes were observed for narcissism and experienced humiliation and negative admission events. In multivariate analyses high admission scores on BPRS subscales, thinking disorder and activation and HADS total score were significantly associated with clinically significant improvement. Type and length of admission did not significantly affect the outcome. The BPRS, HADS and NPI-29 scores at discharge were mainly explained by corresponding admission scores. More than half the patients admitted to PEU have clinically significant reduction of psychopathology during their stay. Higher levels of psychopathology at admission were significantly associated with improvement. Negative admission experiences and involuntary admission did not influence outcome.
Although being an important part of the psychiatric treatment chain, there are few outcome studie... more Although being an important part of the psychiatric treatment chain, there are few outcome studies of treatment at psychiatric emergency units (PEU). The aim was to measure changes in psychopathology and humiliation during admission at a PEU. The sample consisted of 147 patients examined at admission and discharge. The instruments used were the Brief Psychiatric Rating Scale (BPRS), the Narcissistic Personality Inventory-29 (NPI-29), the Hospital Anxiety and Depression Scale (HADS), a combination of questions measuring negative experiences and Cantril's ladder measuring experienced humiliation. Outcome measures were clinically significant improvement [>10% reduction of the BPRS converted (0-100) score] and changes on the other instruments. Median hospitalization time was 13 days (mean 20.4 days). Fifty-six per cent of the patients showed clinical significant improvement (95% CI 48-64%), 42% showed some degree of improvement and 2% were unchanged. The more improved patients had higher scores at admission than those with less improvement on all scales, indicating a floor effect. Small changes were observed for narcissism and experienced humiliation and negative admission events. In multivariate analyses high admission scores on BPRS subscales, thinking disorder and activation and HADS total score were significantly associated with clinically significant improvement. Type and length of admission did not significantly affect the outcome. The BPRS, HADS and NPI-29 scores at discharge were mainly explained by corresponding admission scores. More than half the patients admitted to PEU have clinically significant reduction of psychopathology during their stay. Higher levels of psychopathology at admission were significantly associated with improvement. Negative admission experiences and involuntary admission did not influence outcome.
Purpose The purpose of this study is to study the influence of radical prostatectomy (RP) for pro... more Purpose The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate cancer on work status and working life in men 3 years after surgery. Methods In a prospective, questionnaire-based study on adverse effects after RP, 330 prostate cancer (PCa) patients who had been active in the workforce before RP described their work status 3 years after having surgery. We dichotomized their postoperative work status into "unchanged or increased" versus "reduced." The participants also reported whether their working life was influenced by the PCa trajectory to no, some, or a great extent. Univariate and multiple logistic regression models were established with sociodemographic and clinical characteristics as independent variables and "work status" or "influence of PCa trajectory on working life" as dependent variables. Results Twenty-five percent of the participants had retired. Of the remaining participants, approximately 20 % had a reduced work status, which in the multivariate analyses was significantly associated with increasing age. One third of the men still active in the workforce considered the PCa to negatively influence their working life. This was independently associated with bother related to urinary leakage, fatigue, and having undergone additional oncological therapy (pelvic radiotherapy and/or hormone treatment). Conclusion Though RP does not affect work status in most men, approximately one third of them experience problems in their working life due to adverse effects related to RP and/or additional post-RP anti-cancer therapy. Implications for Cancer Survivors Most PCa survivors can expect to remain in the workforce for at least 3 years after RP, but for some, persistent adverse effects after RP and /or additional anti-cancer treatment negatively affect their working life. Pre-RP counseling of men within the workforce should cover possible post-RP changes concerning work status and working life.
Purpose Neuroticism is a basic personality trait characterized by negative emotions triggered by ... more Purpose Neuroticism is a basic personality trait characterized by negative emotions triggered by stress such as a breast cancer diagnosis and its treatment. Due to lack of relevant research, the purpose of this study was to examine if high neuroticism is associated with seven common late adverse effects (LAEs) in long-term (≥ 5 years) breast cancer survivors (BCSs). Methods All female Norwegian BCSs aged 20–65 years when diagnosed with stage I–III breast cancer in 2011 or 2012 were invited to a questionnaire study in 2019 (N = 2803), of whom 48% participated (N = 1355). Neuroticism was self-rated using the abridged version of the Eysenck Personality Questionnaire, and scores dichotomized into high and low neuroticism. LAEs were defined by categorization of ratings on the EORTC QLQ-C30 (cognitive function, pain, and sleep problems) and QLQ-BR23 (arm problems) questionnaires, and categorizations of scale scores on mental distress, fatigue, and neuropathy. Associations between high neu...
The personality trait of neuroticism is associated with adverse health outcomes after cancer trea... more The personality trait of neuroticism is associated with adverse health outcomes after cancer treatment, but few studies concern men treated for prostate cancer. We examined men with high and low neuroticism treated with radical prostatectomy for curable prostate cancer without relapse. We compared overall problems and domain summary scores (DSSs) between these groups, and if high neuroticism at pre-treatment was a significant predictor of overall problems and DSSs at follow-up. A sample of 462 relapse-free Norwegian men self-rated neuroticism, overall problems, and DSSs by the EPIC-26 before surgery and at three years’ follow-up. Twenty-one percent of the sample had high neuroticism. Patients with high neuroticism reported significantly more overall problems and DSSs at pre-treatment. At follow-up, only overall bowel problems and urinary irritation/obstruction and bowel DSSs were different. High neuroticism was a significant predictor of overall bowel problems and bowel and irritati...
PURPOSE To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) i... more PURPOSE To evaluate whether selected modifiable patient-reported adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) represent prognostic factors of overall mortality, cancer mortality, and first-time non–germ cell second cancer (SecCa) incidence. PATIENTS AND METHODS In 775 long-term TCSs (diagnosis: 1980-1994) who previously participated in a quality-of-life survey, 20-year mortality and SecCa incidence were compared between the surgery group (n = 272) and TCSs after platinum-based chemotherapy (PBCT; n = 503). A PBCT standard group (total cisplatin: ≤ 630 mg: n = 124) was separated from a PBCT high subgroup (total cisplatin: > 630 mg; n = 379). Univariate and multivariate analyses (Kaplan-Meier; Cox proportional hazard analyses) included age, treatment, and prior major physical comorbidity as nonmodifiable factors, whereas low socioeconomic status, unhealthy lifestyle, probable depression disorder, and neurotoxicity were modifiable AHOs. RESULTS For all TCSs, ...
Background: A major depressive episode (MDE) is typically self-rated by screening forms identifyi... more Background: A major depressive episode (MDE) is typically self-rated by screening forms identifying probable MDE (pMDE). This population-based cross-sectional questionnaire study examined the prevalence rates of pMDE identified by the PHQ-9 screener in long-term survivors of childhood and adolescence (CACSs) and young adult cancer (YACSs) and a normative sample (NORMs). Methods: Data from 488 CACSs, 1202 YACSs, and 1453 NORMs were analyzed, and pMDE was defined both by cut-off ≥10 on the total PHQ-9 score and by an algorithm. Results: The prevalence rates of pMDE among CACSs were 21.5%, 16.6% in YACSs, and 9.2% among NORMs using the cut-off definition. With the algorithm, the prevalence rates of pMDE were 8.0% among CACSs, 8.1% among YACSs, and 3.9% among NORMs. Independent of definition, CACSs and YACSs had significantly increased prevalence rates of pMDE compared to NORMs. Psychosocial factors and self-rated health were significantly associated with both definitions of pMDE in mul...
Purpose The personality trait of neuroticism represents vulnerability for mental distress to soma... more Purpose The personality trait of neuroticism represents vulnerability for mental distress to somatic health problems. There are few studies of neuroticism in prostate cancer patients. This study examines the levels of self-reported adverse effects (AEs) after robot-assisted radical prostatectomy (RALP) in Norwegian men with high or low levels of neuroticism. Neuroticism is also compared to relevant factors concerning their associations with various AEs. Methods Among 982 men who had RALP at Oslo University Hospital, Radiumhospitalet between 2005 and 2010, 79% responded to a mailed questionnaire in 2011. They rated AEs by completing the EPIC-26 questionnaire, and neuroticism on the Eysenck Personality Questionnaire (EPQ). Men with
Background Most studies of cervical cancer (CC) survivors describe sexual inactivity in relation ... more Background Most studies of cervical cancer (CC) survivors describe sexual inactivity in relation to treatment modalities, but few consider that inactivity varies with age and partner status. Aim The aim of this study was to investigate the prevalence of sexual inactivity in long-term CC survivors according to age and partner status, and to examine cancer-related, health, demographic, and psychological factors related to sexual inactivity. Methods All 974 women treated for CC from 2000 through 2007 in 2 areas of Norway, who were alive and cancer-free by the end of 2013, received a mailed questionnaire. Among them, 523 delivered valid data on current sexual activity (response rate 57%). The prevalence rates of sexual inactivity in relation to age groups and partner status were compared to normative sample (NORMs). Main Outcome Measure Sexual inactivity during the 4 weeks before the survey was administered. Results Median age of the sample at survey was 53 years (range 32–77) and media...
Reduced sexual function may have negative implications on health related quality of life among ly... more Reduced sexual function may have negative implications on health related quality of life among lymphoma survivors. A national cross-sectional study among long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplantation auto-SCT treated during 1987-2008 was conducted in 2012-2014. The current study explored sexual functioning among these survivors. Sixty-six percent (n=159) of eligible men with complete questionnaire data were included, median age was 55 years. The Brief Sexual Function Inventory (BSFI) was used to assess sexual function and sexual satisfaction, compared with age-matched controls. In addition, sexual problems were defined based on predetermined cutoff values for BSFI domain scores. Sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 30% and 41% of survivors, respectively. Sexual satisfaction was reported by 39% of survivors. The survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erection compared with controls. In multivariable models, cardiovascular disease was significantly associated with worse erectile function, while age >55 years, chronic fatigue, and physical inactivity were significantly associated with lower sexual functioning overall. Chronic fatigue and anxiety were related to lower sexual satisfaction.
Purpose Personality traits, particularly neuroticism, have an impact on people’s health and lifes... more Purpose Personality traits, particularly neuroticism, have an impact on people’s health and lifestyle. Due to lack of previous studies, we examined old cancer survivors (OCSs) versus cancer-free age-matched controls aged ≥ 70 years, regarding prevalence of high neuroticism, health problems in those with high and low neuroticism, and sociodemographic and clinical variables that were significantly associated with high neuroticism. Methods We merged data from a Norwegian population–based health study (the HUNT-3) and from the Cancer Registry of Norway identifying OCSs. Three cancer-free controls were drawn at random for each OCS. Neuroticism was self-rated on a brief version of Eysenck Personality Questionnaire. Between-group statistical comparisons were made between OCS and controls, and among their subgroups with high and low neuroticism. Logistic regression analyses were used to investigate independent variables significantly associated with high neuroticism. Results Twenty-nine per...
The aim of this study was to examine satisfaction with the quality of the doctor-patient relation... more The aim of this study was to examine satisfaction with the quality of the doctor-patient relationship (QCD) and the information (INF) made available, as well as the influence of different treatment modalities and psychosocial variables in testicular cancer survivors (TCSs). Two-hundred and 6 TCSs, seen at 2 Norwegian university hospitals, were studied retrospectively and currently in a cross-sectional follow-up design. Questionnaires were filled in prior to and at the patients' follow-up examination. The mean length of time since their management period had ended was 6.5 years (range 0-17 years). The QCD was rated higher than the INF. The QCD was also the strongest contributor to the variance in the INF. The patients in the surveillance group had the lowest QCD. The relatively high QCD scores may reflect the fact that the patients had been cured from a life-threatening disease. The low INF scores may indicate that the TCSs were poorly informed about the potential health problems...
BACKGROUND 1.1 Oncological aspects of testicular cancer 1.2 Cognitive function in adult cancer pa... more BACKGROUND 1.1 Oncological aspects of testicular cancer 1.2 Cognitive function in adult cancer patients 1.3 Neuropsychological functioning and cognitive complaints in testicular cancer patients 1.4 Implications of cancer-related cognitive problems 1.5 Status on the relation between systemic chemotherapy and cognitive function at the onset of this thesis 2 THIS THESIS 2.1 Research setting 2.2 Aims of the studies 3 STUDY SAMPLES AND PROCEDURES 3.1 Paper I: The 1990'ies study (TCPs enrolled in three EORTC / MRC trials) 3.2 Paper II-IV: The Oslo-study 4 METHODS 4.1 Questionnaires 4.2 Semi-structured interviews 4.3 Neuropsychological evaluation 4.4 Definitions of main outcome measures 4.5 Data management 4.6 Statistical procedures 4.7 Ethical considerations 5 RESULTS 5.1 Paper I (The 1990'ies study) 6 5.2 The Oslo-study: Description of the sample of Papers II-IV 5.3 Paper II (The distress paper) 8 5.4 Paper III (The neuropsychological paper)
Journal of cancer survivorship : research and practice, Jan 13, 2014
The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate ca... more The purpose of this study is to study the influence of radical prostatectomy (RP) for prostate cancer on work status and working life in men 3 years after surgery. In a prospective, questionnaire-based study on adverse effects after RP, 330 prostate cancer (PCa) patients who had been active in the workforce before RP described their work status 3 years after having surgery. We dichotomized their postoperative work status into "unchanged or increased" versus "reduced." The participants also reported whether their working life was influenced by the PCa trajectory to no, some, or a great extent. Univariate and multiple logistic regression models were established with sociodemographic and clinical characteristics as independent variables and "work status" or "influence of PCa trajectory on working life" as dependent variables. Twenty-five percent of the participants had retired. Of the remaining participants, approximately 20 % had a reduced work ...
ABSTRACT Background In men with prostate cancer ( PCa) large variations of patient-reported outco... more ABSTRACT Background In men with prostate cancer ( PCa) large variations of patient-reported outcomes ( PROs) after radical prostatectomy (RP) or high-dose radiotherapy (RAD) may be related to between-country differences of pre-treatment medical and socio-demographic variables , as well as to differences in pre-treatment PROs in the sexual and urinary domain. Methods In 1908 patients with localized PCa from Norway, USA or Spain the relation was investigated between pre-treatment data on medical (PSA, Gleason score , cT-category ) and socio-demographic variables (age, education ,marital status). Using the EPIC questionnaire pre-treatment PROs within the sexual and urinary domain were also considered . Results Compared to the European patients American patients were younger, fewer had co-morbid conditions and more had a high education level. Fifty-three % of the US-men eligible for RP had low-risk tumors compared to 42% and 31% among respectively the Norwegian and the Spanish patients. Among the Spanish RAD patients 54% had had low- risk tumors compared to respectively 34% of the American and 21% of the Norwegian men planned for RAD. Compared to the European patients significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups the number of patients with sexual or urinary dysfunctions exceeded that of patients with bother related to the reported dysfunction. Conclusions Statistically significant between-country differences were observed in pre-treatment medical and socio-demographic variables, as well as in pre-treatment PROs within the sexual and urinary domain. Large differences between reported dysfunction and related problems within the sexual and urinary domain indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, may in part explain the large variation of post-treatment side effects evident in the medical literature.
BACKGROUND. Recently two new methods for prospective studies of adverse effects after treatment h... more BACKGROUND. Recently two new methods for prospective studies of adverse effects after treatment have been developed: Proportions of patients regaining 90% of baseline function score (PBS-90) and Generalized Estimating Equation (GEE). We compared these methods to examine changes of sexual, urinary, and bowel functions after robot-assisted prostatectomy (RALP) and conformal external beam radiotherapy (EBRT) in patients without androgen deprivation therapy (ADT). METHODS. The post-treatment functional course was studied prospectively in 254 patients (N ¼ 150 RALP and N ¼ 104 EBRT) with PBS-90 and GEE. The time points at which functions reached stability and significant associations with function at 24 months were examined with PBS-90, and predictors were identified with GEE. The patients filled in the UCLA-PCI questionnaire at baseline and at 3, 6, 12, and 24-month post-treatment. RESULTS. The proportions reaching PBS-90 at 24 months were 69% EBRT and 34% RALP patients for urinary function, 70% of EBRT and 7% of RALP patients for sexual function, and 70% of EBRT and 86% of RALP patients for bowel function. GEE showed that the function scores at 6 months were significantly associated with the functions at 24 months. PBS-90 found that stability of function was reached at 3 months for urinary and 6 months for sexual and bowel functions. CONCLUSIONS. In outcome assessment PBS-90 mainly demonstrates when post-treatment level become stabilized and GEE shows the time points at which final outcome can be predicted. The two methods therefore supplement each other. Changes of functions corresponded to those reported in samples including patients having ADT.
Chronic fatigue (CF) is a distressing symptom that follows cancer treatment; however, it has rare... more Chronic fatigue (CF) is a distressing symptom that follows cancer treatment; however, it has rarely been studied in hormone-naïve prostate cancer survivors after radical prostatectomy (RP) or definitive radiotherapy (RAD). We investigated CF in prostate cancer survivors after RP or RAD as monotherapy and explored associations between CF and medical and psychosocial variables. A population-based, cross-sectional postal survey in 2006 included Norwegian hormone-naïve survivors with the diagnosis of prostate cancer in 2004 who were treated with RP (n ¼ 337) or RAD (n ¼ 184). The primary outcome variable was prevalence of CF (defined as fatigue lasting 6 months or longer). Twelve to 32 months after RP and RAD, 13.4 and 26.1% of the patients after, respectively, RP and RAD reported CF inversely associated with pretreatment age (P ¼ 0.003). In multivariate analysis, high neuroticism, post-treatment co-morbidity, pain, urinary and intestinal dysfunction, but not sexual dysfunction, were positively associated with reporting CF. Further studies of CF in prostate cancer survivors should take into consideration the survivors' pretreatment medical and psychosocial situation.
Although being an important part of the psychiatric treatment chain, there are few outcome studie... more Although being an important part of the psychiatric treatment chain, there are few outcome studies of treatment at psychiatric emergency units (PEU). The aim was to measure changes in psychopathology and humiliation during admission at a PEU. The sample consisted of 147 patients examined at admission and discharge. The instruments used were the Brief Psychiatric Rating Scale (BPRS), the Narcissistic Personality Inventory-29 (NPI-29), the Hospital Anxiety and Depression Scale (HADS), a combination of questions measuring negative experiences and Cantril's ladder measuring experienced humiliation. Outcome measures were clinically significant improvement [>10% reduction of the BPRS converted (0-100) score] and changes on the other instruments. Median hospitalization time was 13 days (mean 20.4 days). Fifty-six per cent of the patients showed clinical significant improvement (95% CI 48-64%), 42% showed some degree of improvement and 2% were unchanged. The more improved patients had higher scores at admission than those with less improvement on all scales, indicating a floor effect. Small changes were observed for narcissism and experienced humiliation and negative admission events. In multivariate analyses high admission scores on BPRS subscales, thinking disorder and activation and HADS total score were significantly associated with clinically significant improvement. Type and length of admission did not significantly affect the outcome. The BPRS, HADS and NPI-29 scores at discharge were mainly explained by corresponding admission scores. More than half the patients admitted to PEU have clinically significant reduction of psychopathology during their stay. Higher levels of psychopathology at admission were significantly associated with improvement. Negative admission experiences and involuntary admission did not influence outcome.
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