Work ability 8 years after breast cancer: exploring the role of social support in a nation-wide survey.

INTRODUCTION: As the 5-year survival rate after breast cancer in Norway is 92%, the population of breast cancer survivors (BCSs) is increasing. Knowledge of work ability in this population is scarce. In a population-based cohort of BCSs, we explored work ability 8 years after diagnosis and the association between work ability and social support, and cancer-related variables including late effects and lifestyle factors. METHODS: In 2019, all Norwegian women < 59 years when diagnosed with stage I-III breast cancer in 2011 or 2012, were identified by the Cancer Registry of Norway and invited to participate in a survey on work life experiences. Work ability was assessed using the Work Ability Index (scale 0-10). Factors associated with excellent work ability (score ≥ 9) were identified using univariate and multivariate logistic regression analyses, and adjusted for socioeconomic-, health- and cancer-related variables. RESULTS: Of the 1951 eligible BCSs, 1007 (52.8%) responded. After excluding survivors with relapse (n = 1), missing information on work ability score (n = 49), or work status (n = 31), the final sample comprised 926 BCSs within working age at survey (< 67 years). Mean age at survey was 56 years and 8 years (SD 0.7) had passed since diagnosis. Work ability had been reduced from 8.9 (SD 2.3) at diagnosis to 6.3 (SD 3.1). One in three BCSs reported poor work ability (WAS ≤ 5), and seven out of ten reported that their physical work ability had been reduced due to cancer. Social support from colleagues during cancer therapy was associated with excellent work ability, which was not observed for social support provided by supervisors or the general practitioner. Cognitive impairment and fatigue were inversely associated with work ability. None of the cancer-related variables, including treatment, were associated with work ability 8 years after diagnosis. CONCLUSION: In this population-based sample, one in three BCSs reported poor work ability 8 years after diagnosis. Collegial social support during cancer therapy appears to be a protective factor for sustained work ability, whilst survivors struggling with fatigue and cognitive impairments may represent a particularly vulnerable group for reduced work ability.

Work status changes and associated factors in a nationwide sample of Norwegian long-term breast cancer survivors.

PURPOSE: The study aims to describe work status at diagnosis and 8 years post-diagnosis in a nationwide sample of breast cancer survivors (BCSs), and investigate associated and self-reported factors of reduced work status. METHODS: Women aged 20-65 years when diagnosed with stage I-III breast cancer (BC) in 2011 or 2012 were invited to participate in a questionnaire study in 2019 (n = 2803), of whom 49% (n = 1361) responded. For this sub-study, we included 974 BCSs below the legal retirement age in Norway (< 67 years) at survey and with complete work status data. Reduced work status was defined as being in paid work at BC diagnosis and not working at time of survey. Logistic regression analyses were applied to identify factors associated with reduced work status. RESULTS: Of BCSs who were in paid work at diagnosis (n = 845), 63% maintained their work status to 8 years later. Reduced work status was associated with not living with children (OR .44, 95% CI .24-.82), age (OR 1.16, 95% CI 1.11-1.21), chemotherapy (OR 2.83, 95% CI 1.24-6.61), > 2 comorbid conditions (OR 2.27, 95% CI 1.16-4.32), cognitive function (OR .99, 95% CI .98-.99), fatigue (OR 1.02, 95% CI 1.01-1.03), and neuroticism (OR 1.57, 95% CI 1.00-2.46). BC and late effects were reported as reasons for reduced work status and disability. CONCLUSIONS: The majority of BCSs who were in paid work at diagnosis were working 8 years later. IMPLICATIONS FOR CANCER SURVIVORS: Our results suggest a need to focus on fatigue and reduced cognitive function among long-term BCSs, with the ultimate aim of improving work sustainability.

Is hyperemesis gravidarum associated with placental weight and the placental weight-to-birth weight ratio? A population-based Norwegian cohort study.

INTRODUCTION: Studies have suggested a link between placental weight, placental weight-to-birth weight ratio (PW/BW) and adult health. Hyperemesis gravidarum (HG) may also have implications for adult health. No studies on HG and placental characteristics have been identified. We therefore explored the relationship between HG, placental weight and the PW/BW-ratio in a population-based cohort. METHODS: Singleton births to primiparous women between 1999 and 2009 with data on HG, placental weight and birth weight in the Medical Birth Registry of Norway (MBRN) comprised the study base (n = 200,390). HG was defined through ICD-10 code 021.0, 021.1 and 021.9. Gender and gestational age specific percentile curves for placenta weight and PW/BW ratio were used to define those below the 10th and above the 90th percentile of both outcomes. Associations between HG and dichotomous outcomes were studied by multiple logistic regression. Multiple linear regression was applied to study placental weight as a continuous variable. Male and female offspring were analyzed separately. RESULTS: The prevalence of HG was 1.2%. Women with HG and female offspring had significantly higher risk of a PW/BW-ratio above the 90th percentile (OR = 1.17, 95% CI: 1.03-1.34). HG and PW/BW-ratio below the 10th percentile were inversely associated (OR = 0.70, 95% CI: 0.56-0.89). For male offspring no association was observed for HG and PW/BW-ratio below the 10th or above the 90th percentile. DISCUSSION/CONCLUSIONS: We observed positive associations between HG and high PW/BW ratio limited to female offspring only. The high PW/BW-ratio suggests that there may be a possible link between HG and adult health.

Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry.

OBJECTIVE: To study associations between hyperemesis gravidarum (HG) and birth outcomes. DESIGN: Population-based cohort study. SETTING: Norway. SAMPLE: Singleton births in the Norwegian Birth Registry, 1967-2009 (n = 2 270 363). METHODS: Multiple logistic regression was applied to study associations between HG and dichotomous outcomes; multiple linear regression to study associations between HG, birthweight and gestational length. Generalised estimating equations were applied to obtain valid standard errors. Sub-analysis on data with available information on smoking was conducted (1999-2009). MAIN OUTCOME MEASURES: Small and large for gestational age (SGA/LGA), Apgar score after 5 minutes, very preterm and preterm birth (VPTB/PTB), perinatal death, stillbirth, neonatal death, birthweight and gestational length. RESULTS: No associations between HG and adverse pregnancy outcomes were observed in crude analyses, except for VPTB (odds ratio [OR] 0.79, 95% CI 0.67-0.93). In adjusted analysis, HG was associated with perinatal death (OR 1.27, 95% CI 1.08-1.48). Inverse associations were observed between HG and VPTB (OR 0.80, 95% CI 0.68-0.94) and LGA (OR 0.95, 95% CI 0.90-0.99). Sub-analyses showed no associations between HG and perinatal death (OR 1.29, 95% CI 0.91-1.83). The inverse associations between HG, VPTB and LGA were strengthened (OR 0.66, 95% CI, 0.48-0.91 and OR 0.86, 95% CI 0.79-0.93, respectively). Exposed babies had reduced birthweight and gestational length compared with unexposed, adjusted difference - 21.4 g and - 0.5 days, respectively. Adjustment for smoking slightly strengthened the impact of HG on birthweight. CONCLUSIONS: Inverse associations for HG and VPTB and LGA were observed. HG was associated with slight reductions in birthweight and gestational age.