A controlled cohort study of sickness absence and disability pension in colorectal cancer survivors.

PURPOSE: To investigate long-term development of sickness absence and disability pension among colorectal cancer (CRC) survivors compared to matched cancer-free controls, and to assess to what degree socio-demographic and disease characteristics influence these outcomes. PATIENTS AND METHODS: In a register-based cohort study with data from the Cancer Registry of Norway and longitudinal data from other national registries, 740 patients with CRC diagnosed 1992-1996 at the age 45-54 years were observed up to 14 years post-diagnosis. Also 740 matched controls were observed over the same time period. RESULTS: During the first year after diagnosis, 85% of the CRC survivors were on sick-leave at some point, compared to 19% of the controls. Among survivors with localized cancer, 21% were on sick-leave 12 months after diagnosis, versus 33% with regional, and 52% with distant cancer. Survivors with rectum cancer were more likely than colon cancer survivors to be on sick-leave the first year after diagnosis (OR 2.53, 95% CI 1.61-3.98). CRC survivors were at higher risk for disability pension (DP) than controls, depending on extent of disease. Hazard ratios for DP were 1.67 (95% CI 1.13-2.46) for survivors with localized cancer, 3.12 (95% CI 2.06-4.72) for regional, and 10.13 (95% CI 4.17-24.62) for distant cancer, respectively. In survivors, distant cancer, low level of education, not having children<18 years in the household, pre-diagnostic sick-leave and not being employed at diagnosis were associated with increased likelihood for DP. CONCLUSION: A considerable proportion of CRC survivors, for years after diagnosis, will experience reduced work ability compared to controls. Rehabilitation and workplace adjustment to reduce sickness absence and improve work ability should be a long-term concern.

A controlled cohort study of long-term income in colorectal cancer patients.

PURPOSE: The study aims to investigate long-term development in annual labor income (ALI) among patients with colorectal cancer (CRC) compared to individually matched cancer-free controls. METHODS: In a register-based cohort study based on data from Norwegian national registries, 752 patients diagnosed with CRC 1992-1996 at the age 45-54 years were observed annually up to 10 years post-diagnosis. Also, 752 individually matched controls were observed correspondingly. The relationship of CRC and ALI development was modeled by linear mixed model statistics. RESULTS: CRC was associated with reduced ALI in females in the year of diagnosis, irrespective of extent of disease. From the year after diagnosis and onwards, ALI decreased in female patients and controls, most strongly in females with distant CRC, and also in males with regional and distant CRC. Five years after diagnosis, mean ALI was reduced by 22 % in females and 6 % in males with localized CRC. Corresponding numbers were 21 % in females and 11 % in males with regional CRC and 6 % reduction in female and less than 1 % reduction in male controls. After adjustment for post-diagnostic disability pension and days of employment, ALI developed similarly in male patients and controls, whereas CRC remained associated with reduced ALI in the year of diagnosis in females and throughout observation in females with distant CRC. CONCLUSION: Except for males with localized cancer, CRC was associated with negative development in ALI in both sexes, varying by extent of disease. The work ability and income status of female CRC patients and males with metastasing disease should be checked during follow-up.

Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study.

OBJECTIVES: This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy. DESIGN: National register-based cohort study. SETTING: Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy. PARTICIPANTS: 7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015-2018. MAIN OUTCOME MEASURES: The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis. RESULTS: Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.Patients aged 75-84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1-2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time. CONCLUSIONS: The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.

Sentinel node mapping does not improve staging of lymph node metastasis in colonic cancer.

PURPOSE: This study was designed to evaluate the reliability of the sentinel node concept in colonic cancer. METHODS: Patent blue was used as tracer. The four blue nodes closest to the tumor were defined as the sentinel node(s) by the pathologist. All nodes were examined by routine microscopy (hematoxylin-eosin staining). If no metastases were detected, all lymph nodes were examined immunohistochemically with antibody to cytokeratin. RESULTS: Two hundred colon specimens were examined. Sentinel node(s) were identified in 93 percent. Sixty contained metastases in hematoxylin-eosin sections. In 32 these were found in sentinel nodes (sensitivity 53 percent). Twenty-eight patients had metastases in nonsentinel nodes only, giving a false-negative rate of 47 percent. Immunostaining revealed 39 (30 percent) micrometastases or submicrometastases in 131 TNM Stages I and II patients, and in 17 of these patients metastases were found in nonsentinel nodes only (false-negative rate 44 percent). CONCLUSIONS: Sentinel lymph node mapping shows low sensitivity for detection of ordinary metastases, micrometastases, and submicrometastases. If only the sentinel nodes had been examined, approximately half of the metastases would have been lost after routine staining, as well as half of the micrometastases and submicrometastases when immunohistochemical examination was added.

A cohort study of permanently reduced work ability in breast cancer patients.

PURPOSE: The aims of this cohort study were to explore various longitudinal aspects of employment and disability pension due to permanently reduced work ability among women with breast cancer and to investigate the impact of breast cancer on income. PATIENTS AND METHODS: In a national register-based controlled cohort study from Norway, 1,548 women diagnosed with breast cancer (all stages) between 1992 and 1996 at the age 45-54 years and 1,548 cancer-free women matched for age, municipality and civil status were followed for up to 14 years. Medical data from the Cancer Registry of Norway were linked with longitudinal data on employment, social security benefits and socio-demography collected from other national official registries. RESULTS: Compared to cancer-free controls, breast cancer patients were significantly more likely to receive disability pension (hazard ratio (HR) 2.7, 95% CI 2.3-3.2) after adjustment for unmatched socio-demographic variables (education, income and children <18 years in the household). Adjusted HR in breast cancer stage I patients was 1.8 (95% CI 1.5-2.3) and 3.0 (95% CI 2.4-3.8) in stage II/III patients compared to controls. The risk increased with mastectomy compared to breast-conserving surgery (HR 1.5, 95% CI 1.2-1.9). At the end of the observation period, employment rates were higher in non-disabled patients than in non-disabled controls (82% vs. 77%, p = 0.008). Working breast cancer patients experienced a temporary negative effect on employment income. CONCLUSION: A considerable proportion of women with breast cancer will over time experience permanently reduced work ability and become disability pension holders. In case of reduced work ability in breast cancer survivors, medical personel caring for them should consider and discuss with them rehabilitation and workplace adjustment in order to prevent early disability pension.