Psychosocial well-being in testicular cancer patients.

149 testicular cancer patients with no evidence of disease for 3 or more years filled in a questionnaire which covered the following subjects: psychosocial well-being, working ability and use of analgesics/tranquilisers. The questions were chosen to compare cancer patients' morbidity with that of age-matched controls. The patients had been treated with surgery (32 patients), radiotherapy (39 patients), cisplatin-based chemotherapy plus surgery (46 patients) or chemotherapy plus radiotherapy with or without surgery (32 patients). Since no systematic differences between the treatment groups were found, the analyses were undertaken with all patients combined. The patients felt significantly less exhausted after a working day, were more satisfied with life and felt stronger and more fit than the controls. On the other hand, the patients reported a significantly higher incidence of anxiety and depression than the normal population. The results indicate that patients treated for a malignant disease may have greater fluctuations in mood and affect than the general population.

Quality of life in patients treated for head and neck cancer: a follow-up study 7 to 11 years after radiotherapy.

PURPOSE: To compare health-related quality of life factors in 845 head and neck cancer patients randomized to receive either conventional radiotherapy (2 Gy, 5 days-a-week) or a hypofractionated regimen (2.35 Gy, 4 days-a-week), a follow-up study was carried out 7 to 11 years after treatment in the surviving patients, representing 30% of the original patient number. METHODS AND MATERIALS: The cancer-specific EORTC Core Quality of Life Questionnaire (30 item version; the EORTC QLQ-C30) and a 19 item head and neck cancer-specific questionnaire were mailed to the 245 surviving patients of the trial. The EORTC QLQ-C30 is comprised of six multi-item function scales, three symptom scales, and six single items which assess both symptoms and economic consequences of the disease. Two hundred and four patients (83%) completed the questionnaire. The two groups of patients (N = 103 and N = 101) treated by different fractionating schedules, were comparable with regard to sociodemographic variables, tumor site, treatment variables (including different types of surgical treatment), and secondary primary cancers. Patients in the conventional group had more advanced disease and a higher recurrence rate compared to patients in the hypofractionated group. RESULTS: Unexpectedly, patients in the hypofractionated group, reported similar or better quality of life compared to patients in the conventional fractionated group. Patients in both groups described a high level of symptoms, like dryness in the mouth and mucus production. Clinical and sociodemographic variables did not explain variance in social function, emotional function or fatigue, except for the type of surgery performed, which significantly influenced the patients' emotional function. CONCLUSION: Long-term survivors of head and neck cancer reported a high level of disease and treatment related symptoms. Emotional function was significantly influenced by the type of surgical procedure. Strategies for future trials in head and neck cancer should continue to attempt to stress conservative surgical approaches and coordinated adjuvant therapy to maximize local regional control and quality of life. Functional and emotional outcome are important parameters which should prospectively be evaluated in future clinical trials in head and neck cancer.

Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease. The importance of patients' subjective experience of disease and psychosocial well-being.

In a prospective controlled clinical trial, 102 patients with inoperable non-small cell lung cancer (NSCLC), limited disease, stage II and III were treated with combination chemotherapy, cisplatin 70 mg/m2 i.v. on day one and etoposide 100 mg/m2 i.v. on day one, and etoposide 200 mg/m2 orally on days 2 and 3, or radiotherapy given in 15 fractions of 2.8 Gy with two anterior/posterior fields during a period of three weeks. The patients completed a validated self-administered questionnaire before the start of treatment that assessed their psychosocial well-being, disease-related symptoms, personal functioning, and everyday activity. These subjective variables were evaluated together with treatment modality, WHO performance status, weight loss, and stage of disease, with regard to their value in predicting survival. Univariate survival analyses were undertaken for each individual factor, median survival was calculated according to life-table analyses. A step-wise multiple regression analysis was used to measure the prognostic value of the various factors. In the univariate analysis, general symptoms (p = 0.0006) psycho-social well-being (p = 0.0002) and stage of disease (p = 0.007) were the best predictive factors. In the multiple regression analyses the subjective variables, general symptoms (p less than 0.01) and psychosocial well-being (p less than 0.05) were shown to have the best predictive value for the patients' survival.

Conduct problems and early cannabis initiation: a longitudinal study of gender differences.

AIM: To investigate the relationship between early conduct problems and early onset of cannabis use, with special emphasis on possible gender differences. DESIGN: A prospective longitudinal study of a national sample of 2436 adolescents. The sample was followed up over a year and a half, when the adolescents were in their early teens. SETTING: Norway. MEASUREMENTS: On the basis of an earlier study, conduct problems (CP) closely related to the criteria for conduct disorder (CD) in DSM-III-R were decomposed into three dimensions, labelled serious, aggressive and covert. Further, information was collected about alcohol intoxication, daily smoking and use of cannabis. A number of questions were posed about sexual interactions and perceived puberty development. Parental socio-economic status was measured according to the ISCO-88. Separate information was collected as to whether the parents were on social welfare or unemployed. A parental bonding measure (PBI) was used to measure the emotional relationship between respondents and parents. Further, a measure of parental monitoring was used, and information was also collected on other aspects of the family milieu, and on the adolescents' peers. Statistical models. Logistic regression analysis was employed. As the sample consisted of pupils clustered within classes within schools, a three-level error structure for the logistic regression model was estimated. FINDINGS: There was a strong association between early conduct problems and subsequent cannabis initiation. Also conduct problems at a potential subclinical level seemed to have great impact. The effect was significantly stronger in girls than in boys. Serious CP was found to have a moderate effect upon cannabis initiation in boys, whereas aggressive and covert CP had strong effects in girls. Early onset of puberty and early sexual involvement had no impact, whereas early use of cigarettes proved an important precursor to cannabis use. CONCLUSIONS: Conduct problems are important precursors of early onset cannabis use, but probably represent gender-specific aetiologies. There might be an important potential for prevention of early onset drug use in the prevention of early conduct problems, in particular for girls.

Parenthood, gender and sickness absence.

It is well documented that women have generally higher morbidity rates than men. In line with this women are also more absent from work due to sickness. This paper considers one popular explanation of the morbidity difference in general and of the difference in sickness absence in particular, viz. that women to a greater extent than men are exposed to the 'double burden' of combining paid work with family obligations. We discuss theories of role overload and role conflict, which both assume that the combination of multiple roles may have negative health effects, as well theories of role enhancement, which assume positive health effects of multiple roles. Using two large Norwegian data sets, the relationship between the number of and the age of children on the one hand and sickness absence on the other is examined separately for men and women and for a number of theoretically interesting subpopulations of women defined in terms of marital status (also taking account of unmarried cohabitation), level of education, and working hours. Generally speaking the association between children and sickness absence is weak, particularly for married people of both genders. To the extent that married persons with children are more absent than married persons without children, this is largely due to respiratory conditions. The relationship between children and sickness absence is somewhat stronger for single, never married mothers, but not for single mothers who have been previously married or for women living in unmarried cohabitation. The findings thus provide little support for either role overload/conflict or role enhancement theories. The possibility that these effects are both present and counterbalancing each other or that they are confounded with uncontrolled selection effects can not, however, be ruled out.

Psychosocial well-being of patients with inoperable non-small cell lung cancer. The importance of treatment- and disease-related factors.

Patients with inoperable non-small cell lung cancer, limited disease, were randomized to either chemotherapy (cisplatin and etoposide) or radiotherapy of the thorax. A set of questionnaires, covering 4 areas: psychosocial well-being, medical side effects, physical function, and everyday activity was filled out by 101 patients. The correlations between psychosocial well-being (dependent variable) on the one hand, and medical side effects, physical function, and everyday activity (independent variables) on the other were subjected to multiple regression analysis. No significant correlation was found between psychosocial well-being and chemotherapy- or radiotherapy-related subjective side effects. The disease-related symptoms correlated highly with psychosocial well-being during the observation period. Psychosocial well-being and the independent variables tended to be more strongly correlated during the follow-up period (14-52 weeks) than during the treatment period.

Quality of life of lung cancer patients in a randomized clinical trial evaluated by a psychosocial well-being questionnaire.

The quality of life of patients treated with radiotherapy and chemotherapy for non-small cell lung cancer is compared in a randomized study. A standardized questionnaire composed of 12 questions covering psychosocial well-being (10 question index), and global quality of life evaluation (2 questions) was used to evaluate the patient's quality of life. Data were collected before treatment was started and at 7 different occasions up to 52 weeks after the beginning of the first treatment. The psychosocial well-being index and the 2 global questions were found to have a high degree of validity in a previous study. Two weeks after the start of treatment, the psychosocial well-being index for patients receiving radiotherapy was significantly higher than for patients treated by cytostatic drugs. This observation was confirmed by the 2 global questions. No differences in the quality of life were detected in the follow-up period (6-52 weeks).

Toxicity, physical function and everyday activity reported by patients with inoperable non-small cell lung cancer in a randomized trial (chemotherapy versus radiotherapy).

In a randomized trial, patients with inoperable non-small cell lung cancer with limited disease were randomly given either radiotherapy (42 Gy) or combination chemotherapy with cisplatin, 70 mg/m2, and etoposide, 100 mg/m2, given every third week with a maximum of 4 cycles. The patients were asked to fill in a questionnaire concerning psychosocial well-being, medical and treatment related symptoms, physical function and everyday activity. Of the chemotherapy patients 61% reported nausea 5 weeks after their last chemotherapy session and 44% had spells of vomiting. Only 14% of the radiotherapy patients had nausea and 5% vomited 14 weeks after start of treatment. Of the radiotherapy patients 64% experienced dysphagia compared to 8% of the chemotherapy patients 6 weeks after the start of treatment.

Self-reported satisfaction with life and physical health in long-term cancer survivors and a matched control group.

The response to two validated questions assessing self-reported satisfaction with life and physical health were compared between 204 long-term head and neck cancer survivors from a randomised radiotherapy trial and 766 matched controls. The control group, participants in a large population health survey in a county in the middle of Norway, was matched to the patients with regard to age, gender, marital status/family type and education. Compared with the controls, the patients reported significantly lower satisfaction with life and physical health. Sixty-four per cent of the patients were satisfied with life and 44% felt strong and healthy while the percentages of the controls were 82% and 52%, respectively. Clinical and sociodemographic variables were poor predictors of the patients' responses. Clinicians must be aware of the psychosocial morbidity in the growing population of cured cancer patients, and intervention studies are needed in patients at risk, in order to determine whether this morbidity can be prevented, reduced, or treated.

Validation of a quality of life questionnaire for use in clinical trials for treatment of patients with inoperable lung cancer.

In order to assess the quality of life of patients with inoperable lung cancer, a questionnaire for patient self-administration with 29 variables was designed including the following subjects: psychosocial well-being, medical side-effects, activities of daily living and physical performance. The questionnaire was validated by using a semistructured interview. Thirty-one patients treated for inoperable lung cancer with either radiotherapy (42%), chemotherapy (42%) or a combination of these two treatment modalities (16%) were included in the study. The multitrait-multimethod matrix (MTMM) was used in the analysis of the construct validity. The present validation study showed a high degree of validity for the majority of the items studied. Some of the items showed a low degree of validity, and are subject to future analysis in large scale studies.

Neuropsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy or radiotherapy.

Neuropsychological tests were used to evaluate possible central nervous system dysfunction in patients treated with chemotherapy. Ninety-five patients with non-small cell lung cancer limited disease were randomized to either radiotherapy (2.8 Gy x 15) or combination chemotherapy with cisplatin and etoposide. In order to evaluate cognitive functions three neuropsychological tests were applied: Trail Making, Benton Visual Retention Test and Verbal Learning. Changes in the patients' test scores before and after treatment were compared. The chemotherapy patients showed reduced performance on some of the neuropsychological tests compared to the radiotherapy group. This indicates a treatment related effect on the central nervous system, possibly caused by the combination chemotherapy.