Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial.

Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).

Supporting cancer patients with work-related problems through an oncological occupational physician: a feasibility study.

To evaluate the feasibility of an oncological occupational physician (OOP) who is trained in oncological work-related problems, and in providing work-related support to cancer patients within the curative setting. We assessed facilitators and barriers that affect the activities of an OOP, and the satisfaction of the OOPs and patients with this new form of health care. Interviews were held with (1) OOPs (N = 13) to assess facilitators, barriers and their satisfaction with their ability to give supportive care and (2) cancer patients (N = 8) to assess their satisfaction concerning consulting an OOP. The main facilitators were positive feedback from health care providers and patients about the received care and support that the OOP had given, and the additional knowledge of the OOPs about cancer and work-related problems. Major barriers for being active as an OOP were lack of financial support for the OOP and the unfamiliarity of patients and health care providers with the specialised occupational physician. Both OOPs and the specialised knowledge and additional training of the OOPs facilitated providing support to cancer patients and survivors with work-related problems. Familiarity with the specialised occupational physician and financial support should be improved.

Predictors of return to work and employment in cancer survivors: a systematic review.

The objective of this study was to provide an overview of the prognostic factors for return to work and employment of cancer survivors. Cohort studies were selected if the population consisted of cancer patients between 18 and 65 years of age, with return to work, employment or equivalent concepts as main outcome measure, studying at least one prognostic factor. The methodological quality of the included studies and level of evidence for each prognostic factor were assessed. Twenty-eight cohort studies met the inclusion criteria. Heavy work and chemotherapy were negatively associated with return to work. Less invasive surgery was positively associated with return to work. Breast cancer survivors had the greatest chance of return to work. Old age, low education and low income were negatively associated with employment. Moderate evidence was found for extensive disease being negatively associated with both return to work and employment, and for female gender being negatively associated with return to work. The review shows that in cancer survivors, a limited number of prognostic factors of return to work and employment can be identified. Physicians primarily engaged in the process of vocational rehabilitation of cancer survivors should be aware of the potential role these factors exert.

Employment status and work-related problems of gastrointestinal cancer patients at diagnosis: a cross-sectional study.

Objective To assess the employment status of patients with gastrointestinal cancer at diagnosis and to examine work-related problems of employed patients. Design New, consecutive patients were included at the Gastrointestinal Oncology Center Amsterdam, a one-stop, rapid access diagnostic assessment centre. Patients were interviewed on their employment status by a nurse. If (self-) employed, patients were asked to self-report on work-related problems, perceived distress (0-10), cancer-related problems, fatigue (MFI-20, range 4-20) and work ability (three WAI questions, range 0-10). Results Of all 333 included new consecutive patients (age range 32-89 years), 95 patients (28%) were (self-) employed at time of diagnosis, 179 (54%) were pensioners, and 59 were not working (18%). For the assessment of work-related problems, 45 (47%) of these 95 employed patients with cancer participated. Their mean age was 56 years, and patients had oesophageal/stomach (49%), colorectal (18%) or hepatic/pancreatic/biliary cancer (33%). Half of the employed patients (49%) were still at work, while 51% were on sick leave. The main reasons for sick leave were stress (35%), (scheduled) operation (26%), fatigue (17%) and pain (13%). Most patients on sick leave (70%) had no contact with their own occupational physician, although the majority (67%) would like to continue to work. Work-related problems were experienced by 73% of working patients. The mean work ability was 5.4, the mean general fatigue score was 11.5, and the mean distress score was 4.7. Employed patients on sick leave reported a lower work ability, more fatigue and higher distress but no more cancer-related problems compared with those still working. Conclusion A quarter of all patients with gastrointestinal cancer seen at an oncological centre are employed at time of diagnosis, and of these employed patients, 73% experience work-related problems. During diagnosis and treatment, information and support on work-related issues should be offered to patients with cancer as an essential part of high-quality oncological care.

Immunohistochemical detection of p53 and Bcl-2 in colorectal carcinoma: no evidence for prognostic significance.

To evaluate the prognostic significance of immunohistochemically detected p53 and Bcl-2 proteins in colorectal cancer, tissue sections from 238 paraffin-embedded colorectal carcinomas were immunostained for p53 (MAb DO-7 and CM-1 antiserum) and Bcl-2 (MAb Bcl-2:124). Staining patterns were assessed semiquantitatively and correlated with each other and with sex, age, tumour site, Dukes' classification, tumour differentiation, mucinous characteristics, lymphocyte and eosinophilic granulocyte infiltration, and patient survival. In our series, 35% of carcinomas showed no nuclear staining and 34% (DO-7) to 40% (CM-1) showed staining in over 30% of tumour cell nuclei. A majority of carcinomas that had been immunostained with CM-1 showed cytoplasmic staining, but this was not observed with DO-7. With respect to Bcl-2, 51% of tumours were completely negative, 32% displayed weak and 15% moderate staining; only 3% showed strong positive staining. No evidence was found for reciprocity between Bcl-2 expression and nuclear p53 accumulation. From 13 cases containing tumour-associated adenoma, four were Bcl-2 negative in premalignant and malignant cells, in another four cases these cells showed similar staining intensities and in the remaining cases only the malignant colorectal cells were Bcl-2 negative. Therefore, our data indicate that Bcl-2 is dispensable in the progression towards carcinoma. Except for an association between nuclear p53 accumulation and mucinous tumours (P = 0.01), no significant correlation was found between the clinicopathological parameters mentioned above and immunostaining pattern of (nuclear or cytoplasmic) p53 or Bcl-2.

Follow-up after colorectal cancer: current practice in The Netherlands.

OBJECTIVE: To assess the current practice of follow-up after operations for colorectal cancer in The Netherlands in comparison with other countries. DESIGN: Postal survey. SETTING: All surgical departments in The Netherlands. MAIN OUTCOME MEASURES: Attitudes of surgeons towards detection and treatment of recurrences after colorectal cancer. RESULTS: Of the 139 questionnaires sent out, 136 (98%) were returned. History taking, physical examination, and colonoscopy for local recurrence and metachronous tumours were used by 90% of the hospitals. Attitudes towards screening for hepatic and pulmonary metastases and regional recurrence varied considerably between hospitals. Similar findings were found in seven surveys from other countries. CONCLUSION: There is no consensus among surgeons regarding the follow-up of patients with colorectal cancer. Randomised controlled trials comparing different follow-up strategies and cost-effectiveness analyses are needed to identify groups of patients that will benefit most from follow-up. Identification of these patients may lead to more agreement between surgeons.

Detection of recurrence after surgery for colorectal cancer.

Of all patients operated for colorectal cancer, 1 in 3 will suffer from cancer recurrence, and most of these patients will die from disseminated disease. Postoperative follow-up aims at improving these grim figures. This sound idea has not been supported by any empirical data. In the current article, we discuss some theoretical issues concerning colorectal cancer follow-up, and present results of a cost-effectiveness analysis, used to model the natural history of colorectal cancer recurrence and the costs and effects of follow-up and re-operation. The expected results of three policies were calculated: no follow-up, selective follow-up and intensive follow-up. For most patients, follow-up will only lead to a significant increase in costs, without increase in (quality-adjusted) life expectancy. Colorectal cancer follow-up is not "evidence-based medicine".

Follow-up of patients with colorectal cancer. A meta-analysis.

OBJECTIVE: The authors sought to determine whether intensive follow-up improves 5-year survival rates in patients with colorectal cancer who were operated on for cure. SUMMARY BACKGROUND DATA: Intensive follow-up of patients with colorectal cancer is still controversial. The present uncertainty in regard to the value of intensive follow-up could be the result of the absence of prospective randomized studies comparing patients with and without follow-up. METHODS: Studies comparing two follow-up programs of different intensities were identified in the medical literature and were aggregated in a meta-analysis using the "random effects method." Seven nonrandomized studies describing 3283 patients were analyzed. RESULTS: Patients with intensive follow-up did have 9% better 5-year survival rates than did those with minimal or no follow-up, only when intensive follow-up included carcinoembryonic antigen (CEA) assays. In addition, more asymptomatic recurrences were detected and more recurrences were resected in patients with intensive follow-up. CONCLUSIONS: This meta-analysis indicated that intensive follow-up using CEA assays can identify treatable recurrences at a relatively early stage. Treatment of these recurrences appears to be associated with improved 5-year survival rates. However, not all intensive follow-up strategies will be equally effective. Follow-up may yield the best results if diagnostic tests are used only to detect those recurrences that can be operated on with curative intent and when follow-up is "individualized," according to patient characteristics.

Attitudes towards detection and management of hepatic metastases of colorectal origin: a second look.

In the present study we undertook an international postal survey to assess the current attitudes towards the detection and management of hepatic metastases in colorectal cancer patients, who have been operated on with curative intent. Results of this survey were compared to results of an earlier survey, held in 1985. Both surveys indicate that there is no consensus on the follow-up of patients at risk of hepatic metastases. Especially the interpretation of unexplained rises in carcinoembryonic antigen (CEA) levels leads to much controversy. Only 37% of the hospitals performing liver surgery were willing to perform second-look laparotomies based on CEA only. Also there is no agreement on the maximum number of liver metastases that will justify partial liver resection for cure. Clearly, there is a need for prospective randomized trials on which a more rational policy regarding hepatic metastases in colorectal cancer patients can be based.

Frequency of the delta F508 mutation and XV2c,KM19 haplotypes in cystic fibrosis families from The Netherlands: haplotypes without delta F508 still in disequilibrium.

We have determined the frequency of the major cystic fibrosis (CF) three base pair deletion (delta F508) mutation in 152 CF chromosomes from patients originating from the northern part of The Netherlands. In these patients, the deletion represents approximately 76% of CF mutations. Meconium ileus is strongly associated with homozygosity for the delta F508 mutation. The XV2c,KM19 haplotypes on the CF chromosomes without the delta F508 mutation are in disequilibrium with the population frequency, although showing an increased frequency of the 1 2 haplotype. The surplus of this haplotype is almost entirely made up by the pancreatic insufficient patients.