[Epidemiology of multiple sclerosis in Germany: regional differences and drug prescription in the claims data of the statutory health insurance]. / Epidemiologie der Multiplen Sklerose in Deutschland : Regionale Unterschiede und Versorgungsstruktur in Abrechnungsdaten der gesetzlichen Krankenversicherung.

BACKGROUND: Nationwide population-based information on the prevalence of multiple sclerosis (MS) in Germany has so far not been available. In this study the prevalence of MS was determined with the help of the claims data of the health insurance funds underlying the morbidity-based risk adjustment scheme (M-RSA). MATERIAL AND METHODS: Health insurance funds reported inpatient and outpatient diagnoses, outpatient prescriptions, costs and enrolment data for all persons insured in the German statutory health insurance (SHI). The data reported for 2010 form the basis of this study which collated data on the 12-month prevalence, prevalence related to age and gender, drug therapy, regional distribution pattern, combinations of diagnoses and hospitalization. RESULTS: Nearly 200,000 people insured in the SHI have been diagnosed with MS. Hence, the prevalence seems to be considerably higher than was previously assumed. In addition, a slight west-east gradient was apparent. On average 49 % of all MS patients (with a slight east-west gradient) received MS-specific inpatient drug therapy. Insured patients living in the east received on average 30 daily doses per year less than patients living in the western part. CONCLUSION: For the first time MS prevalence has been determined nationwide for Germany with the help of SHI data. It appears that previously applied methods have underestimated the prevalence. The regional differences found with respect to prevalence and drug therapy need further clarification. The data underlying the M-RSA do not allow more causal research.

Fear of recurrence and disease progression in long-term (≥ 5 years) cancer survivors--a systematic review of quantitative studies.

BACKGROUND: Increasing proportions of patients diagnosed with cancer will become long-term survivors (≥ 5 years post-diagnosis). However, survivors may continue to experience negative effects of cancer and/or treatment, including fear of recurrence (FoR). This review aims to provide an overview of current knowledge on FoR, including determinants and consequences in long-term cancer survivors, and to outline methodological and conceptual challenges that should be addressed in future research. METHODS: Multiple databases including PUBMED, EMBASE, and PsycINFO were searched to identify relevant articles. Seventeen articles were included. Data were extracted by two reviewers and summarized following a systematic scheme. RESULTS: Even years after initial diagnosis, cancer survivors suffer from FoR. Most studies report low or moderate mean FoR scores, suggesting that FoR is experienced in modest intensity by most survivors. Studies including long-term and short-term survivors indicate no significant change of FoR over time. Lower level of education, lower level of optimism, and being Hispanic or White/Caucasian were found to be associated with higher levels of FoR. Significant negative associations were reported between FoR and quality of life as well as psychosocial well-being. All but three studies were conducted in the USA. General cut-offs for severity/clinical significance have not been defined yet. CONCLUSIONS: FoR at modest intensity is experienced by most long-term cancer survivors. Future studies should address determinants and consequences of FoR in more detail. Validated instruments providing cut-offs for severity/clinical significance of FoR should be developed and utilized. Efficient interventions should be implemented to reduce detrimental effects of FoR.

Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: prevalence, determinants, and associations with quality of life.

BACKGROUND: As research on quality of life of colorectal cancer (CRC) survivors has mainly focused on downsides of cancer survivorship, the aim of this study is to investigate benefit finding (BF) and post-traumatic growth (PTG) in long-term CRC survivors. METHODS: Benefit finding, PTG, and quality of life were assessed 5 years after diagnosis in a population-based cohort of 483 CRC patients using the benefit finding scale, the post-traumatic growth inventory, and the EORTC QLQ-C30. Prevalence of BF and PTG, determinants of moderate-to-high BF and PTG, and the association between BF, PTG, and quality of life were investigated. RESULTS: Moderate to high levels of BF and PTG were experienced by 64% and 46% of the survivors, respectively. Survivors with the highest level of education and with higher depression scores reported less BF and PTG. The PTG increased with increasing stage and self-reported burden of diagnosis. Quality of life only correlated weakly with PTG (Pearson's r=0.1180, P=0.0112) and not with BF (r=0.0537, P=0.2456). CONCLUSION: Many long-term CRC survivors experience BF and PTG. As these constructs were not strongly correlated with quality of life, focusing solely on quality of life after cancer misses an important aspect of survivorship.

Overweight, obesity and risk of work disability: a cohort study of construction workers in Germany.

OBJECTIVES: Although obesity and permanent work disability impose a great burden on the individual and are very costly for society, data on the impact of being overweight on occupational disability are sparse, especially in men who work hard physically. The aim of this study was to investigate the association of body mass index (BMI) with work disability among construction workers. METHODS: The association between BMI and work disability was examined during a mean follow-up period of 10.8 years in a cohort of 16,875 male construction workers in Württemberg, Germany, who participated in routine occupational health examinations from 1986 to 1992. Hazard ratios were calculated with normal weight (20.0-22.4 kg/m(2)) as reference using the Cox proportional hazards model, after adjustment for potential confounding factors. RESULTS: Overall, a U-shaped association of BMI with all-cause work disability (total number = 3064 cases) was observed, with the lowest risk of disabilities at BMI levels between 25 and 27.4 kg/m(2). Strong positive associations were observed between BMI and work disability due to osteoarthritis or cardiovascular diseases, whereas BMI was inversely related to work disability due to cancer, even after exclusion of the first 3 years of follow-up. CONCLUSIONS: Moderate overweight is not associated with increased risk of work disability among construction workers, but obesity increases the risk of work disability due to osteoarthritis and cardiovascular disease.

Up-to-date monitoring of childhood cancer long-term survival in Europe: central nervous system tumours.

BACKGROUND: Tumours of the central nervous system (CNS) account for 15-20% of all malignant childhood tumours in developed countries. Steady improvement of survival of children with CNS tumours has been reported for the past decades. However, these results, obtained by cohort analysis of survival, do not reflect the full extent of recent improvement. METHODS: Using selected registries from the database of the Automated Childhood Cancer Information System (ACCIS), we calculated period survival estimates for the years 1995-99 for children diagnosed with a malignant CNS tumour. RESULTS: The overall 10-year period survival estimate for the years 1995-99 was 59% for children with all CNS tumours combined, 73% for children with astrocytoma, 53% for children with ependymoma and 45% for children with primitive neuroectodermal tumours. On average, estimates derived by cohort analysis (pertaining to children diagnosed in 1985-89) were around 4% units lower. Region-specific analysis revealed that recent progress was largest in Eastern Europe, where prognosis nevertheless remained lower than in other European regions. In Northern and Southern Europe, 10-year survival remained essentially unchanged. CONCLUSION: Although period survival of children with CNS tumours is higher than previously reported cohort survival, their long-term prognosis remains modest compared to other childhood malignancies.

Up-to-date monitoring of childhood cancer long-term survival in Europe: tumours of the sympathetic nervous system, retinoblastoma, renal and bone tumours, and soft tissue sarcomas.

BACKGROUND: Prognosis for most types of childhood tumours has improved during the last few decades. In this article we estimate up-to-date period survival for less common, but important childhood malignancies in Europe. METHODS: Using the database of the Automated Childhood Cancer Information System we calculated period estimates of 10-year survival for the 1995-1999 period for children aged 0-14 years diagnosed during 1985-1999 with tumours of the sympathetic nervous system (NS), retinoblastoma, renal tumours, bone tumours and soft tissue sarcomas in four European regions. RESULTS: Ten-year period survival for 1995-1999 was 66% in children with tumours of the sympathetic NS, 96% for retinoblastoma, 87% for renal tumours, 58% for bone tumours and 61% for soft tissue sarcomas. The higher period estimates, as compared with cohort and complete estimates indicate recent improvement in survival for tumours of the sympathetic NS and to a lesser extent for retinoblastoma and renal tumours. Region-specific period survival estimates were lowest for Eastern Europe for renal, bone and soft tissue tumours, but not for the other two tumour groups. CONCLUSION: There have been further improvements in the 1990s in long-term survival of children diagnosed with several malignancies, albeit to a different extent in different European regions.

Reduction of clinically manifest colorectal cancer by endoscopic screening: empirical evaluation and comparison of screening at various ages.

Endoscopic screening (sigmoidoscopy, colonoscopy) with removal of precancerous lesions can prevent a large proportion of colorectal cancers (CRCs). However, there is lack of data regarding optimal age, time intervals and numbers of screening examinations. We developed and applied modified techniques of epidemiological analysis to evaluate the impact of various endoscopy-based screening strategies on prevention of clinically manifest CRCs between the ages of 50 and 79 in a population-based case-control study (294 cases, 254 controls) conducted in Saarland, Germany. We found a strong potential for reduction of CRC occurrence even with a single screening endoscopy. The optimal age for a single screening endoscopy appears to be around 55 (estimated potential for prevention of cases between the ages of 55 and 79 in case of 100% compliance: 77% (95% confidence interval (CI) 46-90%)). A single screening endoscopy at age 50 would have a lower impact due to failure to prevent CRC at higher ages. Similarly, screening at ages 60 or older would have a lower impact because it would fail to prevent CRC at lower ages. Repeated offers of screening examinations could provide substantial additional benefit with the levels of compliance to be expected in practice, but they would have to be weighed against the increased risks and costs.

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers.

AIMS: Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers. METHODS: A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references. RESULTS: In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16). CONCLUSIONS: Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Age-specific detriments to quality of life among breast cancer patients one year after diagnosis.

The aim of our study was to identify any differences in the quality of life (QOL) of breast cancer survivors one year after diagnosis when the acute treatment effects should not longer be apparent. QOL was assessed in a population-based cohort of 387 women with breast cancer from Saarland (Germany) using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLC30). Functional and symptom QOL-scores were compared with published reference data from the general population. Breast cancer survivors and women from the general population reported similar scores of global health/QOL. However, major deficits among women with breast cancer were found, for emotional, social, role and cognitive functioning. Age-specific comparisons between breast cancer patients and the reference population revealed that these deficits are predominantly found in younger age groups. The overall QOL of life of breast cancer survivors one year after diagnosis is comparable to women from the general population. However, some differences exist that seem to predominantly affect younger women who show a poorer QOL in certain domains.

Ablation characteristics of arterial vessel walls irradiated with the pulsed dye laser--an analysis of variance.

BACKGROUND AND OBJECTIVE: Since most clinical laser angioplasties require the use of over-the-wire delivery systems, we studied the effects of pulsed dye laser energy (504 nm, 1.4 microseconds on arterial vessel walls in combination with a multifiber catheter system. MATERIAL AND METHODS: Postmortem arterial segments (n = 368) were exposed under blood or saline. Laser pulses (n = 100-800) were transmitted via 9F-multifiber-catheters, at energy densities of 3-16 J/cm2. Ablation characteristics revealed by histologic examination and morphometry were analyzed by multiple analysis of variance. RESULTS: Ablation occurred more frequently in saline compared to blood. Below an energy density of 10 J/cm2 ablation occurred in saline only. Specimens irradiated under blood showed only thermal changes at 10 J/cm2. In saline, 92% of normal, 88% of fibro-fatty and 60% of calcified tissue showed ablation at 13 J/cm2. The average ablation threshold in saline was about 3-4 J/cm2 per pulse for normal tissue, 5 J/cm2 for fatty plaques, and 8-9 J/cm2 for calcified plaques. In blood, the average ablation thresholds did not differ significantly between the different stages of arteriosclerosis (12 J/cm2 for normal tissue, 11 J/cm2 for fatty plaque, and 10 J/cm2 for calcified tissue). Carbonization and vacuolization were seen regularly at energy levels > or = 13.4 J/cm2. CONCLUSIONS: Selective ablation of arteriosclerotic tissue with the pulsed dye laser could not be found. Further investigation is needed before an effective ablation of arteriosclerotic arterial tissue can be expected.

Environmental chemical exposures and risk of herpes zoster.

This study investigated whether residence in Aberdeen, North Carolina, the location of the Aberdeen pesticides dumps site (a national priority list Superfund site containing organochlorine pesticides, volatile organic compounds, and metals), is associated with immune suppression as indicated by a higher incidence of herpes zoster and recent occurrences of other common infectious diseases. Study participants included 1,642 residents, 18-64 years of age, who responded to a telephone survey concerning potential occupational and recreational exposures to pesticides and other chemicals, lifetime history of herpes zoster (shingles), and the recent occurrence of other common infectious diseases. Stratified and logistic regression analyses were used to compare the cumulative incidence of herpes zoster among Aberdeen residents and residents of nearby communities. There was little evidence of an overall increased risk of herpes zoster among Aberdeen residents during the period 1951-1994 [relative risk (RR), 1.3; 95% confidence interval (CI), 0.8-2.1]. However, an elevated risk of herpes zoster was noted consistently among Aberdeen residents of younger ages as compared to residents of the nearby communities. The RR was 2.0 (CI, 1.0-4.0) among those 18-40 years of age and was not affected by controlling for potential confounders. The RR of herpes zoster was also consistently elevated in all age groups for the period before 1985. No differences were noted between residents of Aberdeen and those of the nearby communities with respect to the recent occurrence of other common infectious diseases. These results support the plausibility of an association between exposure to the Aberdeen pesticides dumps site and immune suppression and the potential use of herpes zoster as a marker of immune suppression in studies of environmental chemical exposures.

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study.

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.

Body weight, pre-existing disease, and all-cause mortality in a cohort of male employees in the German construction industry.

The impact of body weight on all-cause mortality is subject to ongoing debate. We assessed the relation between body mass index (BMI) and all-cause mortality in a cohort of 8043 male employees in the German construction industry who underwent detailed occupational health examinations at ages 25-64 and who were followed for all cause mortality over an average period of 4.5 years. Overall, there was a negative, graded relation between BMI and all-cause mortality, which persisted after controlling for multiple covariates including age and cigarette smoking, and after excluding the initial two years of follow-up. There was a strong positive cross-sectional relationship between BMI and a medical diagnosis of diabetes, hypertension, and ischemic heart disease at the baseline examination. While BMI showed a strong negative relation with all-cause mortality among men with such diseases, the association was much weaker and non-monotonic for mean free of these diseases. Our results underline the importance of preexisting diseases for the prognostic value of body weight.

The association between alcohol consumption and all-cause mortality in a cohort of male employees in the German construction industry.

BACKGROUND: Many epidemiological studies have shown a J- or U-shaped association between alcohol consumption and total mortality. It has been argued that the higher mortality among abstainers than among moderate drinkers might result from misreporting of alcohol consumption, confounding or inclusion of a high proportion of ex-drinkers or individuals with pre-existing diseases among abstainers. METHODS: These concerns were addressed in a cohort study among 8043 construction workers aged 25-64 years who underwent occupational health examinations at six centres in South West Germany during 1986 to 1988. Abstainers were compared with alcohol users with respect to biological markers of alcohol consumption, prevalence of pre-existing diseases and other covariates. Study participants were followed for all-cause mortality until 1994. RESULTS: There was a clear monotonic dose-response relationship of biological markers with self-reported alcohol consumption. Prevalence of pre-existing diseases was highest among heavy drinkers, while no major differences were observed between abstainers and men who consumed 1-49 g of alcohol per day. Overall, 172 men died during the follow-up period. There was a strong U-shaped relationship between alcohol consumption and total mortality. Mortality was 2.8 times higher (95% confidence interval [CI]: 1.5-5.4) among non-drinkers than among men who consumed 1-49 g of alcohol per day after control for potential confounders in multivariable analyses. Strongly increased mortality was also found among heavy drinkers. Exclusion of non-drinkers with pre-existing diseases did not change the U-shaped association. CONCLUSIONS: We found a strong U-shaped association between alcohol consumption and all-cause mortality which is unlikely to be explained by misreporting, confounding or pre-existing disease.

All-cause and cause specific mortality in a cohort of 20 000 construction workers; results from a 10 year follow up.

BACKGROUND: Construction workers are potentially exposed to many health hazards, including human carcinogens such as asbestos, silica, and other so-called "bystander" exposures from shared work places. The construction industry is also a high risk trade with respect to accidents. METHODS: A total of 19 943 male employees from the German construction industry who underwent occupational health examinations between 1986 and 1992 were followed up until 1999/2000. RESULTS: A total of 818 deaths occurred during the 10 year follow up (SMR 0.71; 95% CI 0.66 to 0.76). Among those were 299 deaths due to cancer (SMR 0.89; 95% CI 0.79 to 1.00) and 312 deaths due to cardiovascular diseases (SMR 0.59; 95% CI 0.51 to 0.68). Increased risk of mortality was found for non-transport accidents (SMR 1.61; 95% CI 1.15 to 2.27), especially due to falls (SMR 1.87; 95% CI 1.18 to 2.92) and being struck by falling objects (SMR 1.90; 95% CI 0.88 to 3.64). Excess mortality due to non-transport accidents was highest among labourers and young and middle-aged workers. Risk of getting killed by falling objects was especially high for foreign workers (SMR 4.28; 95% CI 1.17 to 11.01) and labourers (SMR 6.01; 95% CI 1.63 to 15.29). CONCLUSION: Fatal injuries due to falls and being struck by falling objects pose particular health hazards among construction workers. Further efforts are necessary to reduce the number of fatal accidents and should address young and middle-aged, semi-skilled and foreign workers, in particular. The lower than expected cancer mortality deserves careful interpretation and further follow up of the cohort.

Early retirement due to permanent disability in relation to smoking in workers of the construction industry.

Little is known about the relation of cigarette smoking and early retirement due to permanent disability. We conducted a cohort study among 4796 construction workers aged 40 to 59 who underwent occupational health examinations in 1986-1988 in occupational health centers located in the southern region of Germany. They were followed up with respect to working status until July 1994. The effect of smoking on early retirement due to permanent disability was assessed using the Cox proportional hazard model. Overall, smoking prevalence at baseline was 52%. The relative rate (RR) for permanent disability was 1.3 (95% CI 1.0-1.8) for all current smokers, compared with never-smokers. A positive dose-response relationship between smoking and the rate of early retirement due to permanent disability was found after adjustment for covariates. RR ranged from 1.3 in persons who reported smoking 1-19 cigarettes a day to 1.6 in persons who reported smoking > or = 30 cigarettes a day (P value for trend = 0.02). These findings underline the need for comprehensive efforts at the workplace to reduce smoking and its negative consequences for the individual, as well as to limit the associated social burden for society.

Disorders of the back and spine in construction workers. Prevalence and prognostic value for disability.

STUDY DESIGN: A cohort study on back-related morbidity and its impact on early retirement resulting from disability among employees in the construction industry. OBJECTIVE: To describe the prevalence of back-related morbidity according to different measures in various occupational groups and to assess the prognostic value of these measures for early retirement resulting from disability. METHODS: The results of occupational health examinations conducted in 1986-1988 among 4,958 employees of the German construction industry aged 40-64 years were analyzed. Active follow-up evaluation was carried out between October 1992 and July 1994 to ascertain employment status. RESULTS: Compared with that of white-collar employees, no excess risk for self-reported back pain or sciatica was seen for any of the manual professions. In contrast, the age-adjusted prevalence of clinical findings of the spine was elevated among all employees in manual professions, and the prevalence of a recorded diagnosis related to disorders of the back and spine (ICD-9 position 720-724) was elevated among bricklayers compared with white-collar employees. The relative risk of being granted a disability pension in the follow-up period was 1.6 (95% Confidence Interval [Cl], 1.3-2.1) for persons reporting back pain or sciatica, 1.8 (95% Cl, 1.4-2.2) for persons with an abnormal clinical finding of the spine, and 1.5 (95% Cl, 1.2-1.8) for persons with a recorded medical diagnosis related to disorders of the back or spine (ICD-9 720-724). CONCLUSION: Patterns of morbidity varied according to the evaluated morbidity measure. All three measures qualified as significant predictors of disability and helped to identify high-risk occupations and high-risk employees.

Creutzfeldt-Jakob disease and mad cows: lessons learnt from yeast cells.

Transmissible spongiform encephalopathies are fatal neurodegenerative diseases that affect mammals including humans. The proteinaceous nature of the infectious agent, the prion, and its propagation, challenge established dogmas in biology. It is now widely accepted that prion diseases are caused by unconventional agents principally composed of a misfolded host-encoded protein, PrP. Surprisingly, major break-throughs in prion research came from studies on functionally unrelated proteins in yeast and filamentous fungi. Aggregates composed of these proteins act as epigenetic elements of inheritance that can propagate their alternative states by a conformational switch into an ordered ß-sheet rich polymer just like mammalian prions. Since their discovery prions of lower eukaryotes have provided invaluable insights into all aspects of prion biogenesis. Importantly, yeast prions provide proof-of-principle that distinct protein conformers can be infectious and can serve as genetic elements that have the capacity to encipher strain specific information. As a powerful and tractable model system, yeast prions will continue to increase our understanding of prion-host cell interaction and potential mechanisms of protein-based epigenetic inheritance.

Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review.

BACKGROUND: Due to the growing number of long-term (≥5 years) colorectal cancer survivors, investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients' needs. METHOD: To summarise current research results, multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long-term QoL of colorectal cancer survivors. The content of 10 included studies was independently extracted by two reviewers. RESULTS: Colorectal cancer survivors indicated a good overall QoL, but may have slightly lower physical QoL than the general population. Furthermore, survivors had worse depression scores and reported to suffer from long-term symptoms such as bowel problems and distress regarding cancer. Apart from stoma and recurrence of the disease, mainly general and health-related factors such as age, social network size, income, education, BMI and number of comorbidities were associated with QoL. Studies were mainly conducted in the United States (US) (n=7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates. QoL assessment was cross-sectional in all studies. CONCLUSION: Despite an overall good QoL, colorectal cancer survivors have specific physical and psychological problems. The reported determinants of QoL may serve to identify survivors with special needs. But further studies are needed that focus on problems like distress, depression and bowel problems of long-term colorectal cancer survivors.