Drug adherence and treatment duration for denosumab and mortality risk among hip fracture patients.

This study aimed to assess the impact of drug adherence and treatment duration for denosumab on mortality risk after hip fracture surgery. Lower all-cause mortality risk was associated with drug intervals of 7 months or less and longer treatment duration. The study highlights the importance of proper denosumab administration. PURPOSE: Prescription of anti-osteoporotic medications (AOMs) after osteoporotic hip fracture may increase bone mineral density (BMD) and decrease mortality risk. However, few studies have been conducted on drug adherence and treatment duration for denosumab, a popular choice among AOMs. This study aimed to assess the impact of denosumab adherence and treatment duration on the mortality risk of hip fracture patients after surgery. METHODS: We conducted a cohort study using nationwide population data from National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with osteoporosis and hip fracture between 2008 and 2019 who used denosumab after surgery were included. We assessed drug adherence, treatment duration, and other parameters associated with patient outcomes. RESULTS: A total of 21,316 patients diagnosed with osteoporotic hip fractures were included. Compared with a > 7-month drug interval for denosumab, an interval of ≤ 7 months led to lower all-cause mortality risk (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.57 ~ 0.64). Patients with denosumab treatment for over 1, 2, and 3 years had lower all-cause mortality risk (HR&CI: 0.68 (0.64 ~ 0.73), 0.48 (0.43 ~ 0.53), 0.29 (0.26 ~ 0.33)) than those with treatment duration < 1 year. Analysis after excluding short-term death yielded similar results. Analysis of causes of death also showed that good adherence and longer duration were associated with reduced mortality due to cancer and cardiovascular disease. CONCLUSION: Better drug adherence and longer duration of denosumab treatment are associated with lower all-cause mortality risk among hip fracture patients after surgery. Our study highlights the benefits of a proper time interval of denosumab administration. These findings provide important insight into management of osteoporotic hip fractures and may inform clinical practice and development of guidelines.

Natural history and survival rate of familial amyloidosis with polyneuropathy: A nationwide databank.

OBJECTIVE: Hereditary amyloid transthyretin (ATTRv) amyloidosis with polyneuropathy, a rare autosomal-dominant disease, has gained attention in recent years owing to treatment improvements. However, epidemiological real-world mega database of nationwide natural history and survival rates, especially with the specific mutation of Ala97Ser, are limited. METHODS: Taiwan National Health Insurance Research Database contains data from over 23 million individuals; Among them, 175 ATTRv amyloidosis patients validated by rare disease registry were enrolled. Multivariable Cox proportional hazard analyses were applied to investigate the association between baseline characteristics and all-cause mortality. FINDINGS: From 2008 to 2020, the annual incidence and prevalence rates of specific mutations (Ala97Ser) leading to ATTRv amyloidosis with polyneuropathy were 0.04-1.14 and 0.04-4.79 per million in Taiwan, respectively. In Taiwan, these patients exhibited male predominance with a mean age at validation of 62.75 years. At the 5th year after validation, patients exhibited a survival rate of approximately 50%, with higher mortality in male patients (hazard ratio [HR]: 2.22, 95% confidence interval [CI]: 1.15-4.31) and patients older at validation (HR: 1.10, 95% CI: 1.06-1.15). The two most common departments in outpatient were neurology and family medicine, and neurology and cardiology in inpatient. The three most common causes of death registered were unspecified amyloidosis (30.6%), organ-limited amyloidosis (20.9%), and neuropathic heredofamilial amyloidosis (9.7%). INTERPRETATION: The annual prevalence rate of specific mutation (Ala97Ser)-dominant ATTRv amyloidosis with polyneuropathy in Taiwan is comparable to the mid- to high-prevalence country level of the research by Schmidt et al. The extraordinarily high mortality, especially among patients older at validation, may reflect the inadequate awareness and the necessity of early intervention with novel disease-modifying regimens.

[Application of Self-Regulation Model in Endometrial Cancer].

Endometrial cancer is the gynecological cancer with the highest incident rate in Taiwan. Compared with other types of gynecological cancers, women generally do not have sufficient information about, and thus pay less attention to, endometrial cancer. For endometrial cancer, early diagnosis is important to achieving a high rate of survival. However, endometrial cancer has negative effects due to insufficient information, leading to women having an unrealistic illness representation that influences their coping behaviors and disease outcomes. Leventhal's self-regulation model indicates that the illness representation of patients is based on received external information and past experiences, and that patients undergo the three stages of illness representation, coping, and appraisal when suffering from disease. In this article, the Leventhal self-regulation model was applied to better understand the correlation between illness representation, coping behaviors, and disease outcomes in patients with endometrial cancer at different disease phases. Clinical health providers may utilize this self-regulation model to help patients with endometrial cancer develop positive illness representation and adopt active coping strategies to realize a better adjustment.

[Talk About Psychological Distress and Support in Women With Gynecological Cancer: NOT Just the Disease].

Cervical cancer, uterus cancer, and ovarian cancer are three common gynecological cancers. After diagnosis, the three therapeutic modalities available for treating gynecological cancers include surgery, chemotherapy, and radiotherapy. During the diagnostic and treatment periods, these patients usually suffer from physical and psychologic distresses, including menopausal symptoms, infertility, sexual dysfunction, incontinence, anxiety, depression, and relationship changes, among others. Support from family members and significant others has the potential to buffer the psychological distress perceived by patients with gynecological cancers. However, those patients who undergo invasive treatment modalities or have intimate issues such as brachytherapy, the need to use a vaginal dilator, and sexual dysfunction tend to conceal relevant information from their families or friends, which may increase self-perceived loneliness when facing the impacts of the disease and treatments. Healthcare providers may help alleviate patients' psychological stresses by providing psychological support in a timely manner, initiating discussions of intimate issues, and fulfilling patient needs for related information. In addition, healthcare providers may provide one-on-one counseling and individualized care information to increase patients' understanding of their health status. Furthermore, during the COVID-19 pandemic, patients may self-isolate to avoid becoming infected or to recuperate from a COVID-19 infection, causing social isolation or delays of cancer treatment. Healthcare providers may further place caring phone calls and provide treatment information to increase patients' social support and lessen their psychological distress.

The Impact of Various Anti-Osteoporosis Drugs on All-Cause Mortality After Hip Fractures: A Nationwide Population Study.

Anti-osteoporosis treatment following hip fractures may reduce the overall mortality rate. However, the effects of different drugs on mortality is still unclear. This population-based cohort study aimed to identify the degree of reduced mortality after various anti-osteoporosis regimens following hip fracture surgery. We conducted this cohort study to identify patients with newly diagnosed osteoporosis and hip fractures from 2009 to 2017 using the Taiwan National Health Insurance Research Database (NHIRD). The subsequent use of anti-osteoporosis medication following hip fracture surgery was collected and analyzed. National death registration records were retrieved to determine mortality. A total of 45,226 new cases of osteoporotic hip fracture were identified. Compared with patients who did not receive further treatment, patients who had ever used oral bisphosphonates (alendronate and risedronate, hazard ratio [HR] 0.81; 95% confidence interval [CI], 0.78-0.84), ibandronate (HR 0.76; 95% CI, 0.67-0.86), zoledronic acid (HR 0.70; 95% CI, 0.64-0.76), and denosumab (HR 0.64; 95% CI, 0.60-0.68) showed lower all-cause mortality rates. Patients treated with bisphosphonates had a lower mortality risk than those treated with selective estrogen receptor modulators (HR 0.81; 95% CI, 0.75-0.87). Patients treated with zoledronic acid showed a lower mortality risk than those treated with oral bisphosphonates (HR 0.89; 95% CI, 0.82-0.97). However, patients receiving denosumab and zoledronic acid did not show a significant difference in mortality (HR 0.94; 95% CI, 0.85-1.03). Different anti-osteoporosis treatments for postsurgical patients were associated with different levels of decline in mortality. Generally, longer durations of drug use were associated with lower mortality. © 2022 American Society for Bone and Mineral Research (ASBMR).

The association between osteoporosis medications and lowered all-cause mortality after hip or vertebral fracture in older and oldest-old adults: a nationwide population-based study.

BACKGROUND: Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old). METHODS: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018. RESULTS: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture). CONCLUSIONS: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.

Treatment of osteoporosis after hip fracture is associated with lower all-cause mortality: A nationwide population study.

PURPOSE: Mortality after osteoporotic hip fractures is high. Postoperative care is as important as surgery itself to prevent a second fracture and improve outcomes, and the effect of anti-osteoporosis treatment after hip fractures on overall mortality is controversial. This nationwide population study aimed to determine whether anti-osteoporosis treatment might reduce overall mortality after hip fracture surgery. METHODS: We conducted this cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients admitted for surgery due to hip fractures from 2008 to 2018. The subsequent use and duration of anti-osteoporotic medication and other parameters were analyzed, and national death registration records were retrieved to investigate mortality. RESULTS: A total of 59,943 patients admitted for hip fracture surgery were identified. The 22,494 patients (37.5%) who received anti-osteoporotic medication showed a lower all-cause mortality rate compared with the 37,449 patients (62.5%) who did not receive further treatment (hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.67-0.70, p < 0.0001). Patients who received anti-osteoporotic medication for more than 1, 2, and 3 years exhibited propotional reductions in all-cause mortality (HR & 95%CI: 0.57 (0.54-0.60), 0.42 (0.38-0.46), and 0.29 (0.26-0.33) respectively). CONCLUSION: Anti-osteoporosis treatment was associated with lower all-cause mortality after hip fracture surgery. A longer duration of treatment was also associated with lower mortality. Postoperative treatment for osteoporosis is crucial for patients with hip fracture.

Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan.

Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care and cost. Taiwan launched its universal health insurance coverage in 1995, which largely removes financial barriers to health care. This study aims to investigate whether socioeconomic inequality in one-year mortality exists among Taiwanese elderly people. This population-based cohort study included 193,158 elderly patients (≥65 years) admitted for hip fracture between 2000 and 2012. With over a one-year follow-up, 10.52% of the participants died from all causes. The mortality rate was low in the northern part of Taiwan and in urban and high-family-income areas. Multiple Poisson regression models further suggested that the level of >Q1-Q3 and >Q3-Max showed significantly reduced odds ratio of one-year mortality at 0.90 (95% confidence interval (CI), 0.87-0.93) and 0.77 (95% CI, 0.74-0.81), respectively, compared with that of the lowest family income level (i.e., Min.-Q1). Despite a monotonic decline in overall one-year mortality during the study period, socioeconomic inequality in one-year mortality rate remained evident. The annual percentage change in one-year mortality was higher (-2.86) in elderly people from families with high income (>Q3-Max.) than that for elderly patients from family with low income (Min.-Q1, -1.94). Accessibility, rather than affordability, to health care for hip fracture is probably responsible for the observed socioeconomic inequality.

Quality of life among survivors of early-stage cervical cancer in Taiwan: an exploration of treatment modality differences.

PURPOSE: Women with early-stage cervical cancer may experience changes in their quality of life (QoL) due to treatment or to the effects of the cancer. In this study, we examined differences in QoL by treatment modality between women who underwent surgery only and those treated with concurrent chemoradiation (CCRT). METHODS: The sample of 290 women had been diagnosed with stage I-II cervical cancer. Data were collected on these women's demographic and disease characteristics, general QoL, and cancer-specific QoL using an author-designed demographic-disease survey, the European Organization for Research and Treatment of Cancer QoL questionnaire, and the Taiwanese-version Cervical Cancer Module 24 questionnaire, respectively. Data were analyzed by descriptive statistics and analysis of covariance. RESULTS: Women with cervical cancer who underwent surgery only had significantly worse constipation and body image than those treated with CCRT. Women who underwent CCRT had worse physical and role functioning than those who underwent surgery only. Women who had CCRT also reported worse symptoms, such as fatigue, appetite loss, diarrhea, financial difficulties, sexual enjoyment, and sexual/vaginal functioning, than those who had only surgery. CONCLUSIONS: Our results add knowledge about QoL in women with early-stage cervical cancer who receive different treatment modalities. When suggesting treatment modalities for women with cervical cancer, health professionals should also consider changes in women's QoL after cancer treatment. To improve women's QoL after treatment, professionals should also offer timely and individualized interventions based on women's cervical cancer treatment.

Associations among menopausal symptoms, sleep and fatigue in Taiwanese women with endometrial cancer.

The purpose of this study was to explore the relationships among menopausal symptoms, sleep quality and fatigue in women with endometrial cancer. Participants were 95 women (mean age = 57.44 ± 10.15 years) diagnosed with endometrial cancer and who had completed their treatment before data collection. Each woman completed three structured questionnaires: the Functional Assessment of Cancer Therapy-Endocrine Symptoms (endocrine symptom subscale), the Pittsburgh Sleep Quality Index and the Functional Assessment of Chronic Illness Therapy-Fatigue. Participants' worst menopausal symptom was sexual pain. In addition, menopausal symptoms were worse in women with surgical menopause than with natural menopause. The majority of women had poor sleep quality (55%), and women with fatigue reported worse sleep quality and menopausal symptoms than those without fatigue. However, higher fatigue was significantly related to shorter time since diagnosis. Together, three variables (time since diagnosis, menopausal symptoms and sleep quality) explained 39% of the variance in fatigue, with menopausal symptoms being the strongest predictor. Healthcare providers can assess menopausal symptoms and sleep quality during and after treatment of women with endometrial cancer. Such assessments would allow timely interventions to alleviate fatigue and menopausal symptoms in this population, thus improving their quality of life.

[Overview of Endometrial Cancer].

Endometrial cancer is the most common gynecological cancer and the sixth most common cancer among women in Taiwan. Risk factors for endometrial cancer include obesity, long-term estrogen replacement therapy, diabetes mellitus, hypertension, nulliparty, early age at menarche, late age at menopause, and tamoxifen therapy. Most women with endometrial cancer exhibit abnormal uterine bleeding. Endometrial cancer is often diagnosed at stage I. Surgery alone is the primary treatment for stage I endometrial cancer. Fortunately, mortality rates for endometrial cancer are relatively low, with a 5-year survival rate of 81% among women who are diagnosed with endometrial cancer in Taiwan. However, the common side effects of treatment, including infertility, surgical menopause, lymphedema of the lower extremities, sexual dysfunction, distress, and fatigue, impact significantly on the quality of life of patients. Lifestyle changes such as keeping physically active and eating a diet that is high in fruit and vegetables may alleviate symptoms and improve quality of life in women who have undergone treatment for endometrial cancer.

Social support buffers the effect of self-esteem on quality of life of early-stage cervical cancer survivors in Taiwan.

PURPOSE: The purpose of this study was to examine the effects of self-esteem and social support on quality of life (QoL) in stage I and II cervical cancer survivors. METHOD: The sample consisted of 110 participants who had been diagnosed with stage I-II cervical cancer and had completed their treatment 5 years or more before data collection. Each participant completed four structured questionnaires: a demographic-disease survey, the Rosenberg Self-Esteem Scale, Medical Outcomes Study Social Support Survey, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30. Data were analyzed using descriptive statistics, independent sample t-test, one-way ANOVA, and hierarchical multiple linear regression analyses. RESULTS: The participants' mean age was 60.74 ± 10.69 years. Better QoL was significantly associated with younger age, higher self-esteem, and stronger social support; in addition, social support buffered the effect of self-esteem on global QoL. Together, five variables (age, time since treatment, self-esteem, social support, and the interaction term of self-esteem and social support) explained 36% of the variance in global QoL, with self-esteem being the strongest predictor. CONCLUSIONS: The results of this study advance current knowledge of QoL in cervical cancer survivors by demonstrating that survivors with low self-esteem and social support tend to have lower QoL than those with low self-esteem but high social support. Health professionals should help survivors seek support and provide appropriate strategies to expand their social networks and enhance their self-esteem to improve their global QoL after cervical cancer.

Factors affecting sexual function: A comparison between women with gynecological or rectal cancer and healthy controls.

This study had two purposes: (i) to explore differences in sexual function between women with gynecological or rectal cancer after related pelvic-area treatments and women without cancer; and (ii) to investigate the relationships among body image, anxiety and depression, sexual relationship power, sexual self-schema, and female sexual function. The participants (n = 139) were recruited through Internet cancer support groups and women's health organizations in the USA. Six structured questionnaires were mailed, and the data were analyzed using descriptive and inferential statistics. The results showed that women with gynecological or rectal cancer had significantly worse sexual function than women without cancer. Having gynecological/rectal cancer and a negative sexual self-schema were significantly related to poor sexual function. Furthermore, sexual self-schema moderated the relationship between sexual relationship power and female sexual function. Healthcare providers could give more attention to sexual issues in women who have undergone treatment for gynecological or rectal cancer, especially for those with a negative sexual self-schema and high sexual relationship power, which might improve these women's quality of life.

Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy.

AIMS: This study was designed to evaluate the efficacy of an aerobic exercise programme on fatigue for Taiwanese breast cancer women under radiotherapy (RT). BACKGROUND: Cancer-related fatigue has been widely reported by patients undergoing radiotherapy as strongly and profoundly interfering with their quality of life. Evidence has shown that exercise can be beneficial to patients with breast cancer. DESIGN: A quasi-experimental design was used. METHODS: Patients with early-stage breast cancer scheduled for radiotherapy were invited to participate. The first 28 women who agreed to participate were assigned to the intervention group with a six-week mild- to moderate-intensity aerobic exercise training programme during their radiotherapy. The next 30 women were assigned to the routine care control group without special exercise intervention. Fatigue was measured at pre-radiotherapy and weekly after starting radiotherapy for six weeks using the Taiwanese version of the Brief Fatigue Inventory. RESULTS: The mean age of these 47 women was 50·3 years (standard deviation = 9·5). The baseline fatigue severity for the intervention group and control group were 3·04 and 2·95 respectively; and the baseline fatigue interference for the intervention group and the control group were 3·48 and 3·55 respectively. The student t-test showed no group differences in baseline fatigue severity, fatigue interference, or haemoglobin levels. Multivariate analyses showed a significant group-by-time-interaction effect for fatigue severity and interference (p ≦ 0·001); the fatigue severity and interference decreased significantly over time for women in the intervention group but increased over time for women in the control group. CONCLUSIONS: The mild- to moderate-intensity aerobic exercise programme reduces the fatigue of Taiwanese women with breast cancer undergoing radiotherapy. The issues of cancer-related fatigue should also be discussed as they relate to other treatment modalities. RELEVANCE TO CLINICAL PRACTICE: Aerobic exercise intervention should be offered as an option for women with breast cancer to alleviate cancer-related fatigue when undergoing radiotherapy.

The relationship between spiritual well-being and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy.

PURPOSE: We examined relationships among demographic and clinical characteristics, spiritual well-being, and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. DESIGN: A descriptive, cross-sectional, exploratory study design was used to answer research questions. SUBJECTS AND SETTING: Participants were recruited from the outpatient ambulatory clinic in the gastrointestinal surgical department at the medical center of National Taiwan University. Forty-five Taiwanese patients aged 42 to 83 years who were diagnosed with colorectal cancer and underwent colostomy surgery participated in the study. METHODS: Participants completed a personal data questionnaire designed for this study, along with 2 validated instruments, the Spiritual Well-Being Scale and the Psychosocial Adjustment to Illness Scale-Self Report. FINDINGS: Forty-five persons participated in the study; 69% reported a moderate level of spiritual well-being. Participants reported strong adjustment to extended family relationships, but poor adjustment in sexual relationships. Spiritual well-being was significantly associated with psychosocial adjustment (r = -0.52, P < .01), and 4 predictors (income change after surgery, self-rated disease severity, time since surgery, and spiritual well-being) accounted for 53% of the variance in psychosocial adjustment. CONCLUSIONS: Spiritual well-being plays an important role for Taiwanese patients when faced with psychosocial adjustment related to life with colorectal cancer and a colostomy.

Early and risky sexual behavior in a sample of rural adolescents.

INTRODUCTION: Early and risky sexual behavior has been studied primarily in urban adolescents. METHOD: The purpose of this analysis was to identify psychosocial variables associated with sexual-risk behaviors in a sample of mostly rural adolescents. Six hypotheses were tested, using a resilience framework and data from an ongoing longitudinal study of 255 adolescents. RESULTS: Sexual-risk status did not differ statistically by gender (p=.654) or socioeconomic status (p=.590). However, adolescents who engaged in sexual-risk behaviors reported significantly lower religiosity (p<.003), lower parental monitoring (p=.002), lower social connectedness (p=.007), and higher levels of peer influence (p<.001) than those engaged in no sexual-risk behaviors. Adolescents engaged in sexual-risk behaviors were also engaged in significantly more other health-risk behaviors such as smoking and drinking (p<.001). DISCUSSION: Findings may be useful for developing interventions that focus on the social influences of peers and parents on rural youth.

A feminist perspective on sexuality and body image in females with colorectal cancer: an integrative review.

Women often experience sexual dysfunction following colorectal cancer surgery. The purpose of this integrative review is to explore changes in body image and sexuality associated with colorectal cancer and its treatment in women. We used a feminist perspective to explore differences in gender role, in body image, and sexuality in the context of women who are treated for colorectal cancer. Results of our review suggest that additional studies and interventions are needed to better understand and assist women with sexual dysfunction associated with colorectal cancer. Research should focus on how age, physical, psychosocial factors influence sexual function in particular.

Sexuality among patients with a colostomy: an exploration of the influences of gender, sexual orientation, and Asian heritage.

A large number of patients undergoing surgery for rectal cancer experience construction of a colostomy and subsequent sexual dysfunction. However, sexual problems are easily neglected or concealed by patients, partners, and medical staff. This literature review explores sexual concerns, dysfunctions, and related factors that directly or indirectly influence sexuality after rectal cancer surgery, including gender differences, sexual orientation, sexual partners, and cultural beliefs. Results of this literature review suggest that additional research is needed that focuses on both anatomical and physiological changes after creation of a colostomy as well as psychological, gender based, and sociocultural factors affecting sexuality.