Identification of endometrial cancer recurrence - a validated algorithm based on nationwide Danish registries.

INTRODUCTION: Recurrence of endometrial cancer is not routinely registered in the Danish national health registers. The aim of this study was to develop and validate a register-based algorithm to identify women diagnosed with endometrial cancer recurrence in Denmark to facilitate register-based research in this field. MATERIAL AND METHODS: We conducted a cohort study based on data from Danish health registers. The algorithm was designed to identify women with recurrence and estimate the accompanying diagnosis date, which was based on information from the Danish National Patient Registry and the Danish National Pathology Registry. Indicators of recurrence were pathology registrations and procedure or diagnosis codes suggesting recurrence and related treatment. The gold standard for endometrial cancer recurrence originated from a Danish nationwide study of 2612 women diagnosed with endometrial cancer, FIGO stage I-II during 2005-2009. Recurrence was suspected in 308 women based on pathology reports, and recurrence suspicion was confirmed or rejected in the 308 women based on reviews of the medical records. The algorithm was validated by comparing the recurrence status identified by the algorithm and the recurrence status in the gold standard. RESULTS: After relevant exclusions, the final study population consisted of 268 women, hereof 160 (60%) with recurrence according to the gold standard. The algorithm displayed a sensitivity of 91.3% (95% confidence interval (CI): 85.8-95.1), a specificity of 91.7% (95% CI: 84.8-96.1) and a positive predictive value of 94.2% (95% CI: 89.3-97.3). The algorithm estimated the recurrence date within 30 days of the gold standard in 86% and within 60 days of the gold standard in 94% of the identified patients. DISCUSSION: The algorithm demonstrated good performance; it could be a valuable tool for future research in endometrial cancer recurrence and may facilitate studies with potential impact on clinical practice.

How Do We Follow Up Patients With Endometrial Cancer?

PURPOSE OF REVIEW: In this review, we present the existing evidence regarding follow-up care after endometrial cancer, including content of follow-up and type of provider. We furthermore discuss the future perspectives for follow-up care and research in the field. RECENT FINDINGS: Recently published randomized controlled trials show that nurse-led telephone follow-up and patient-initiated follow-up are feasible alternatives to routine hospital-based follow-up. No randomized or prospective study has evaluated the effect of routine follow-up on survival. Hence, current knowledge is derived from retrospective studies with the inherent risk of bias. The most important method for recurrence detection is a review of symptoms. There is no evidence to support a survival benefit from the use of routine physical examinations, additional tests, or imaging. One in three of the women attending hospital-based follow-up experience unmet needs, and alternative models for follow-up focused on survivorship care and empowerment should be tested.

Self-assessment of Goal Achievements Within a Gynecological Cancer Rehabilitation Counseling.

BACKGROUND: There is an increasing focus on patient involvement in cancer rehabilitation. Goal assessment may improve the patient's self-management of life after cancer. OBJECTIVE: The aim of this study was to evaluate whether (1) nurse-led supported goal setting and assessment of goal achievement were feasible in a clinical setting and (2) there was a positive association between women's goal achievement and their self-assessed global health status (GHS). METHODS: Women surgically treated for gynecological cancer were offered rehabilitation counseling consisting of 2 face-to-face sessions and 2 phone calls carried out by a nurse. The Goal Attainment Scale evaluated goal achievement, whereas GHS was assessed with a quality-of-life questionnaire (European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Core 30). RESULTS: One hundred fifty-one women consented to participate; 70% of the women at the first phone call and 72% at the second phone call achieved their goals as "expected" or "more or much more than expected." Endometrial cancer patients more often achieved their goals than ovarian or cervical cancer patients. Approximately 32% of ovarian and 40% of cervical cancer patients scored their goal achievement "below expected." The patients' GHS was not associated with goal attainment measured at each phone call. CONCLUSION: Goal measurement is feasible in cancer rehabilitation, in both goal setting and goal achievement. Goal achievement less than expected levels in women recovering from ovarian or cervical cancer suggests a need for additional support. IMPLICATIONS FOR PRACTICE: This study supports goal setting and goal achievement as a feasible approach to improve cancer rehabilitation and that nursing professionals can facilitate individualized rehabilitation efforts.

General practitioners' experience of using a questionnaire when assessing cancer patients' needs: a qualitative study.

BACKGROUND: International guidelines recommend health care professionals to use supportive tools like questionnaires when assessing cancer patients' needs. Little is known about GPs' perspectives and experience in this regard. OBJECTIVE: To examine how GPs experience to involve a short questionnaire, completed by patients' prior to a consultation, when addressing the patients' problems and needs. The aim is to contribute to the knowledge concerning the use of questionnaires as part of clinical cancer care in general practice. METHODS: Semi-structured individual interviews with 11 GPs in the Region of Southern Denmark purposefully sampled with regard to gender, years working in general practice and practice form. Interviews were analyzed using systematic text condensation. RESULTS: Most GPs found that using the questionnaire provided a supportive structure to the consultation. The questionnaire helped to bring forward issues of importance to the patients, which might otherwise not have been mentioned and enhanced a patient-centered approach. A few GPs found the use of the questionnaire to be restraining, detracting focus from the patient and impede usual practice. CONCLUSIONS: This study shows that using questionnaires may have the potential to improve clinical cancer care in general practice in relation to needs assessment of cancer patients and the results support current recommendations.

Goal setting in cancer rehabilitation and relation to quality of life among women with gynaecological cancer.

BACKGROUND: Rehabilitation should be integrated in the routine cancer care of women treated for gynaecological cancers. Goal setting is expected to facilitate the process through patient involvement and motivation. Our knowledge about goal setting in cancer rehabilitation is, however, sparse. OBJECTIVES: This study aimed to: 1) analyse rehabilitation goals defined during hospital-based rehabilitation in patients with gynaecological cancer, with regard to number, category, changes over time, and differences between cancer diagnosis, and 2) analyse the association between health-related quality of life and goals defined for rehabilitation. MATERIAL AND METHODS: Consecutively, all patients treated surgically for endometrial, ovarian, and cervical cancer were invited for hospital-based rehabilitation at Odense University Hospital, Denmark, including two sessions at the hospital one and three months following surgery and two phone calls for follow-up. Questionnaires from the EORTC were used to prepare patients and facilitate individual goal setting with definitions of up to three goals. All goals were grouped into six categories. RESULTS: A total of 151 (63%) patients accepted the invitation including 50 endometrial, 65 ovarian, and 36 cervical cancers patients. All patients defined goals at the first session, 76.4% defined three goals, 21.9% two, and 1.6% had one goal. Physical goals decreased over time but were the most frequent at both sessions (98% and 89%). At both sessions, the social and emotional categories were the second and third most frequent among patients with endometrial and ovarian cancer. Sexual issues were dominant among the cervical cancer patients. Regression analysis showed significant association between quality of life scores and goal setting within the social and emotional domains. CONCLUSION: Goal setting seemed feasible in all problem areas. The EORTC questionnaires were helpful during the process although expectations of the sub-scores being predictive of which areas to address were not convincing.

Attachment-oriented psychological intervention for couples facing breast cancer: protocol of a randomised controlled trial.

BACKGROUND: There is evidence that both breast cancer patients and their partners are affected emotionally, when facing a breast cancer diagnosis. Several couple interventions have been evaluated, but there is a need for couple intervention studies with a clear theoretical basis and a strong design. The Hand in Hand intervention is designed to enhance interdependent coping in the couples and to address patients and partners that are both initially distressed and non-distressed. METHODS: The Hand in Hand study is a randomised controlled trial among 199 breast cancer patients and their partners. Couples were randomised to 4-8 couple sessions with a psychologist in addition to usual care, or to usual care only, approximately 2 months after the patients' primary surgery date. The intervention was delivered within 3 months, and outcomes were assessed prior to randomisation and 5 and 10 months after primary surgery date. The primary outcome is patients' cancer-specific distress at the 5-month follow-up measured by the Impact of Event Scale. Secondary outcomes are assessed for both breast cancer patients and partners. These outcomes are: general distress, symptoms of anxiety and depression, health-related quality of life and measures of dyadic adjustment, intimacy and partner involvement. Cancer-specific distress is also assessed for partners. Eligible patients were women ≥ 18 years newly diagnosed with primary breast cancer, cohabiting with a male partner, having no previous cancer diagnoses, receiving no neo-adjuvant treatment, having no history of hospitalisation due to psychosis, and able to read and speak Danish. Partners were eligible if they could read and speak Danish and were ≥ 18 years. DISCUSSION: This study investigates the effect of an attachment-oriented psychological intervention for breast cancer patients and their partners. The intervention has a theoretical framework and a strong design. If proven effective, this intervention would be helpful in optimising psychosocial care and rehabilitation of couples coping with breast cancer. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01368380.

Increasing prevalence of coeliac disease in Denmark: a linkage study combining national registries.

AIM: To determine the prevalence and incidence of diagnosed coeliac disease (CD) in Danish children and adolescents and to describe trends over time. METHODS: All children with a CD diagnosis registered in the Danish National Patient Registry (DNPR) were included in the study. Data were validated by combining this information with registrations of small-bowel biopsies in the National Registry of Pathology (NRP) and with a selected sample of hospital records. RESULTS: Data were obtained from 1996 to 2010. The prevalence of CD registered in DNPR increased from 43.2 [95% CI 39.3-47.1] to 83.6 [95% CI 78.4-88.7] per 100,000, and the incidence increased from 2.8 [95% CI 1.9-3.9] to 10.0 [95% CI 8.4-12.0] per 100,000; 56% of the children had at least one biopsy compatible with CD registered in NRP. The incidence of biopsy-verified CD increased from 0.8 [95% CI 0.3-1.4] to 6.9 [95% CI 5.4-8.4] per 100,000. The mean age at diagnosis increased from 5.1 [95% CI 3.5-6.6] to 8.1 [95% CI 7.2-9.0] years of age. The proportion of children with associated diseases did not change over time. CONCLUSION: The prevalence of diagnosed CD in Danish children and adolescents has increased over the last 15 years.

Can differences in medical drug compliance between European countries be explained by social factors: analyses based on data from the European Social Survey, round 2.

BACKGROUND: Non-compliance with medication is a major health problem. Cultural differences may explain different compliance patterns. The size of the compliance burden and the impact of socio-demographic and socio-economic status within and across countries in Europe have, however, never been analysed in one survey. The aim of this study was to analyse 1) medical drug compliance in different European countries with respect to socio-demographic and socio-economic factors, and to examine 2) whether cross-national differences could be explained by these factors. METHODS: A multi-country interview survey European Social Survey, Round 2 was conducted in 2004/05 comprising questions about compliance with last prescribed drug. Non-compliance was classified as primary and secondary, depending whether the drug was purchased or not. Statistical weighting allowed for adjustment for national differences in sample mechanisms. A multiple imputation strategy was used to compensate for missing values. The analytical approach included multivariate and multilevel analyses. RESULTS: The survey comprised 45,678 participants. Response rate was 62.5% (range 43.6-79.1%). Reported compliance was generally high (82%) but the pattern of non-compliance showed large variation between countries. Some 3.2% did not purchase the most recently prescribed medicine, and 13.6% did not take the medicine as prescribed. Multiple regression analyses showed that each variable had very different and in some cases opposite impact on compliance within countries. The multilevel analysis showed that the variation between countries did not change significantly when adjusted for increasing numbers of covariates. CONCLUSION: Reported compliance was generally high but showed wide variation between countries. Cross-national differences could, however, not be explained by the socio-demographic and socio-economic variables measured.