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1.
Qual Life Res ; 26(12): 3251-3265, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28766080

RESUMO

PURPOSE: This prospective study aimed to identify the different trajectories of quality of life (QOL) in patients with distal radius fractures (DRF) and ankle fractures (AF). Secondly, it was examined if subgroups could be characterized by sociodemographic, clinical, and psychological variables. METHODS: Patients (n = 543) completed the World Health Organization Quality of Life assessment instrument-Bref (WHOQOL-Bref), the pain, coping, and cognitions questionnaire, NEO-five factor inventory (neuroticism and extraversion), and the state-trait anxiety inventory (short version) a few days after fracture (i.e., pre-injury QOL reported). The WHOQOL-Bref was also completed at three, six, and 12 months post-fracture. Latent class trajectory analysis (i.e., regression model) including the Step 3 method was performed in Latent Gold 5.0. RESULTS: The number of classes ranged from three to five for the WHOQOL-Bref facet and the four domains with a total variance explained ranging from 71.6 to 79.4%. Sex was only significant for physical and psychological QOL (p < 0.05), whereas age showed significance for overall, physical, psychological, and environmental QOL (p < 0.05). Type of treatment or fracture type was not significant (p > 0.05). Percentages of chronic comorbidities were 1.8 (i.e., social QOL) to 4.5 (i.e., physical QOL) higher in the lowest compared to the highest QOL classes. Trait anxiety, neuroticism, extraversion, pain catastrophizing, and internal pain locus of control were significantly different between QOL trajectories (p < 0.05). CONCLUSIONS: The importance of a biopsychosocial model in trauma care was confirmed. The different courses of QOL after fracture were defined by several sociodemographic and clinical variables as well as psychological characteristics. Based on the identified characteristics, patients at risk for lower QOL may be recognized earlier by health care providers offering opportunities for monitoring and intervention.


Assuntos
Adaptação Psicológica/fisiologia , Tornozelo/patologia , Fraturas Ósseas/psicologia , Qualidade de Vida/psicologia , Rádio (Anatomia)/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
2.
Acta Oncol ; 55(9-10): 1161-1167, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27174793

RESUMO

BACKGROUND: We assessed the use of external beam radiotherapy, brachytherapy chemoradiotherapy and chemotherapy in patients with metastatic esophageal cancer and evaluated the effect on overall survival. METHODS: We included all patients diagnosed with synchronous metastatic esophageal cancer in the south of the Netherlands between 1 January 1994 and 31 December 2013. Proportions of patients treated with external beam radiotherapy, brachytherapy, chemoradiotherapy and chemotherapy were described with respect to the period of diagnosis, patient and tumor characteristics. Independent risk factors for death were discriminated. RESULTS: A total of 1020 patients were included, 61.5% of these patients received palliative treatment with external beam radiotherapy, chemoradiotherapy, brachytherapy and/or chemotherapy. The use of external beam radiotherapy decreased from 44.5% in 1994 to 22.2% in 2013 (p = 0.0001), whereas the use of chemoradiotherapy increased from 2.9% in 1994 to 19.1% in 2013 (p < 0.0001). The prescription of systemic chemotherapy as single modality increased from 13.9% to 30.5% (p < 0.0001). The use of brachytherapy decreased from 20.9% in 1994 to 7.4% in 2013 (p = 0.0013). The odds of receiving external beam radiotherapy, brachytherapy, chemoradiotherapy and chemotherapy were influenced by different tumor and patient characteristics, such as age, gender, histologic subtype and number of metastatic sites. The median overall survival in patients with metastatic esophageal cancer significantly improved over time from 18 weeks (one-year survival rate 14.4%) in 1994-1998 to 25 weeks (one-year survival rate 22.4%) in 2009-2013. Patients treated with chemoradiotherapy had the most favorable prognosis, followed by patients treated with chemotherapy as a single modality. CONCLUSION: The median overall survival of patients diagnosed with metastatic esophageal cancer improved from 18 weeks in 1994-1998 to 25 weeks in 2009-2013. Although this increase could be attributed to stage migration, our population-based study suggests that major changes in treatment strategies and appropriate patient selection might have played a role as well.


Assuntos
Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/terapia , Sistema de Registros/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Braquiterapia/estatística & dados numéricos , Braquiterapia/tendências , Quimiorradioterapia/estatística & dados numéricos , Quimiorradioterapia/tendências , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Países Baixos/epidemiologia , Fatores Sexuais , Análise de Sobrevida , Taxa de Sobrevida
3.
Colorectal Dis ; 18(6): 594-602, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26682705

RESUMO

AIM: This prospective cohort study was performed to evaluate the impact of complications on quality of life (QOL) in colorectal surgery. The Clavien-Dindo complication classification (CDCC) is promising, but has not been evaluated by relating the classification to patient-reported outcome measures. METHOD: Patients undergoing colorectal surgery were evaluated prospectively 12 months postoperatively using the WHOQOL-BREF questionnaire. Patient data were prospectively recorded and complications were classified using the CDCC. Postoperative QOL in patients with minor and severe complications and patients without complications was compared using a general linear model. Relationships between CDCC and QOL were examined using correlations and multivariate regression. RESULTS: Of 218 patients, 130 (59.6%) had complications. In patients with severe complications there was a greater decrease in overall QOL (P = 0.043), QOL-physical (P < 0.001) and QOL-psychological (P = 0.013) domains in the first six postoperative weeks, whereas patients with minor complications had QOL scores comparable to those of patients without complications. QOL recovered to preoperative levels in all groups at 12 months. Change in QOL at 6 weeks was significantly correlated with CDCC grade, especially in the physical domain (Spearman's rho -0.287, P < 0.001). The presence of severe complications was an independent predictor of overall QOL, QOL-physical and QOL-psychological at 6 weeks. CONCLUSION: Severe complications are associated with reduced postoperative QOL at 6 weeks, but QOL recovers after 12 months. CDCC grade negatively correlates with change in QOL in the early postoperative period. These findings support the theoretical framework of the CDCC.


Assuntos
Doenças do Colo/cirurgia , Complicações Pós-Operatórias/classificação , Qualidade de Vida , Doenças Retais/cirurgia , Idoso , Colectomia/efeitos adversos , Colectomia/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Inquéritos e Questionários
4.
Support Care Cancer ; 24(10): 4113-21, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27146392

RESUMO

BACKGROUND: Couples coping with colorectal cancer were monitored during the first year after diagnosis to evaluate the following: (i) levels of patients' and partners' fatigue-hereby comparing their scores to each other and a normative population, (ii) association between patients' and partners' fatigue, (iii) the course of partners' fatigue, and (iv) biopsychosocial predictors of the partners' fatigue, including the patients' level of fatigue. METHOD: Couples (n = 171) preoperatively completed questions regarding age and sex as well as questionnaires assessing neuroticism and trait anxiety. Questionnaires assessing fatigue, anxiety, and depressive symptoms were measured preoperative (time-0) and 3 (time-1), 6 (time-2), and 12 months (time-3) postoperative. Patients' clinical characteristics were retrieved from the Eindhoven Cancer Registry. Descriptive statistics, correlations, and linear mixed effect models were used. RESULTS: Compared with a normative population, partners' fatigue was similar (p > .05), while patients' fatigue was higher at Time-2 and Time-3 (p values <.001). At each time point, correlations between patients' and partners' fatigue were small (r < .30). Partner's course of fatigue was as follows: 18.2 at time-0, 19.0 at time-1, 19.4 at time-2, and 19.2 at time-3 (p = 0.64). Scoring higher on neuroticism (ß = .12) and trait anxiety (ß = .23), and more depressive symptoms (ß = .30) significantly contributed to higher partners' fatigue. CONCLUSION: Trait anxiety, neuroticism, and depressive symptoms predicted higher levels of partners' fatigue, while demographic factors, patients' fatigue, and clinical factors did not. Health professionals are advised to be alert for partners with a vulnerable personality and depressive symptoms. If needed, they can for instance refer to a psychologist for treatment.


Assuntos
Neoplasias Colorretais/psicologia , Fadiga/psicologia , Cônjuges/psicologia , Adaptação Psicológica , Neoplasias Colorretais/complicações , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários
5.
Qual Life Res ; 25(5): 1285-94, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26537977

RESUMO

PURPOSE: The aim of this prospective study was to describe the course of health status (HS), health-related quality of life, and quality of life (QOL) in patients with lower extremity fractures (LEF) up to 6 months post-fracture. METHODS: Patients (n = 171; age range 18-100 years) completed the World Health Organization Quality of Life assessment instrument-Bref (WHOQOL-Bref) and the Short Musculoskeletal Function Assessment questionnaire (SMFA) at time of diagnosis (i.e., pre-injury status), 1 week, and 6 months post-fracture. Linear mixed modeling was performed. RESULTS: Interaction effects of time with treatment were detected for the WHOQOL-Bref facet Overall QOL and General health (p = .002) and Physical health (p = .003). Patients did not return to their pre-injury Physical health, Psychological health, and Environment 6 months post-fracture (p < .05). No effects were found for Social relationships. The SMFA subscale Lower extremity dysfunction showed main effects for time and treatment (p < .0001) with full recovery at 6 months (p = .998). An interaction effect of time with treatment was found for Daily life consequences (p < .0001) with nonoperatively treated patients showing full recovery (p = 1.00), whereas surgically treated patients did not (p = .002). CONCLUSIONS: Six months after LEF, patients still experienced impaired physical and psychological health on the WHOQOL-Bref compared to their pre-injury status. However, patients showed full recovery on SMFA Lower extremity dysfunction, indicating that the choice of the questionnaire influences the derived conclusions. LEF did not affect satisfaction with social relationships.


Assuntos
Fraturas Ósseas/psicologia , Fraturas Ósseas/terapia , Nível de Saúde , Extremidade Inferior/lesões , Qualidade de Vida/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Estudos Prospectivos , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto Jovem
6.
BMC Surg ; 16(1): 46, 2016 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-27411788

RESUMO

BACKGROUND: Five to 22 % of the adult Western population has gallstones. Among them, 13 to 22 % become symptomatic during their lifetime. Cholecystectomy is the preferred treatment for symptomatic cholecystolithiasis. Remarkably, cholecystectomy provides symptom relief in only 60-70 % of patients. The objective of this trial is to compare the effectiveness of usual (operative) care with a restrictive strategy using a standardized work-up with stepwise selection for cholecystectomy in patients with gallstones and abdominal complaints. DESIGN AND METHODS: The SECURE-trial is designed as a multicenter, randomized, parallel-arm, non-inferiority trial in patients with abdominal symptoms and ultrasound proven gallstones or sludge. If patients meet the inclusion criteria they will be randomized to either usual care or the restrictive strategy. Patients in the usual care group will be treated according to the physician's knowledge and preference. Patients in the restrictive care group will be treated with interval evaluation and stepwise selection for laparoscopic cholecystectomy. In this stepwise selection, patients strictly meeting the preselected criteria for symptomatic cholecystolithiasis will be offered a cholecystectomy. Patients not meeting these criteria will be assessed for other diagnoses and re-evaluated at 3-monthly intervals. Follow-up consists of web-based questionnaires at 3, 6, 9 and 12 months. The main end point of this trial is defined as the proportion of patients being pain-free at 12 months follow-up. Pain will be assessed with the Izbicki Pain Score and Gallstone Symptom Score. Secondary endpoints will be the proportion of patients with complications due to gallstones or cholecystectomy, the association between the patients' symptoms and treatment and work performance, and ultimately, cost-effectiveness. DISCUSSION: The SECURE trial is the first randomized controlled trial examining the effectiveness of usual care versus restrictive care in patients with symptomatic gallstones. The outcome of this trial will inform clinicians whether a more restrictive strategy can minimize persistent pain in post-operative patients at least as good as usual care does, but at a lower cholecystectomy rate. (The Netherlands National Trial Register NTR4022, 17th December 2012) TRIAL REGISTRATION: The Netherlands National Trial Register NTR4022 http://www.zonmw.nl/nl/projecten/project-detail/scrutinizing-inefficient-use-of-cholecystectomy-a-randomized-trial-concerning-variation-in-practi/samenvatting/.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Análise Custo-Benefício , Feminino , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Seleção de Pacientes , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Arch Orthop Trauma Surg ; 136(2): 185-93, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26690070

RESUMO

INTRODUCTION: Adverse events and associated morbidity and subsequent costs receive increasing attention in clinical practice and research. As opposed to complications, errors are not described or analysed in literature on fracture surgery. The aim of this study was to provide a description of errors and complications in relation to fracture surgery, as well as the circumstances in which they occur, for example urgency, type of surgeon, and type of fracture. METHODS: All errors and complications were recorded prospectively in our hospital's complication registry, which forms an integral part of the electronic medical patient file. All recorded errors and complications in the complication registry linked to fracture surgery between 1 January, 2000 and 31 December, 2010 were analysed. RESULTS: During the study period 4310 osteosynthesis procedures were performed. In 78 (1.8 %) procedures an error in osteosynthesis was registered. The number of procedures in which an error occurred was significantly lower (OR = 0.53; p = 0.007) when an orthopaedic trauma surgeon was part of the operating team. Of all 3758 patients who were admitted to the surgical ward for osteosynthesis, 745 (19.8 %) had one or more postoperative complications registered. There was no significant difference in the number of postoperative complications after osteosynthesis procedures in which an orthopaedic trauma surgeon was present or absent (16.7 vs. 19.1 %; p = 0.088; OR 0.85). DISCUSSION: In the present study the true error rate after osteosynthesis may have been higher than the rate found. Errors that had no significant consequence may be especially susceptible to underreporting. CONCLUSION: The present study suggests that an osteosynthesis procedure performed by or actively assisted by an orthopaedic trauma surgeon decreases the probability of an error in osteosynthesis. Apart from errors in osteosynthesis, the involvement of an orthopaedic trauma surgeon did not lead to a significant reduction in the number of postoperative complications.


Assuntos
Fixação Interna de Fraturas/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Equipe de Assistência ao Paciente , Estudos Prospectivos , Sistema de Registros , Centros de Traumatologia
8.
Br J Surg ; 102(11): 1402-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26201942

RESUMO

BACKGROUND: Up to 33 per cent of patients with uncomplicated symptomatic cholecystolithiasis report persistent pain after cholecystectomy. The aim of this study was to determine characteristics associated with patient-reported absence of abdominal pain after cholecystectomy, improved abdominal symptoms, and patient-reported positive cholecystectomy results in a prospective cohort multicentre study. METHODS: Patients aged 18 years or more with symptomatic cholecystolithiasis who had a cholecystectomy between June 2012 and June 2014 in one of three hospitals were included. Before surgery all patients were sent the Gastrointestinal Quality of Life Index (GIQLI) questionnaire and the McGill Pain Questionnaire (MPQ). At 12 weeks after surgery, patients were invited to complete the GIQLI and Patients' Experience of Surgery Questionnaire (PESQ). Logistic regression analyses were performed to determine associations. RESULTS: Questionnaires were sent to 552 patients and returned by 342 before and after surgery. Postoperative absence of abdominal pain was reported by 60·5 per cent of patients. A high preoperative GIQLI score, episodic pain, and duration of pain of 1 year or less were associated with postoperative absence of pain. These factors showed no association with improved abdominal symptoms (reported by 91·5 per cent of patients) or a positive surgery result (reported by 92·4 per cent). CONCLUSION: Preoperative characteristics determine the odds for relief of abdominal pain after cholecystectomy. However, these factors were not associated with patient-reported improvement of abdominal symptoms or patient-reported positive cholecystectomy results, highlighting the variation of internal standards and expectations of patients before cholecystectomy.


Assuntos
Dor Abdominal/etiologia , Colecistectomia , Colecistolitíase/cirurgia , Dor Pós-Operatória/etiologia , Dor Abdominal/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistolitíase/complicações , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
9.
Qual Life Res ; 23(3): 917-26, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24142236

RESUMO

PURPOSE: This prospective study examined the psychometric properties of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with isolated unilateral lower fracture (LEF) or upper extremity fracture (UEF). METHODS: Patients (N = 458) completed the SMFA, WHOQOL-BREF, and the RAND-36 at time of diagnosis (i.e. pre-injury status), 1, and 2 weeks post-fracture. Principal axis factoring was performed, and Cronbach's alpha coefficients (α) and intra-class correlation coefficients (ICC) were calculated. Furthermore, Pearson's product-moment correlations (r), paired t tests, and standardized response means (SRM) were calculated. RESULTS: A three-factor structure was found: Lower extremity dysfunction, Upper extremity dysfunction, and Daily life consequences. This structure was different for patients with LEF versus UEF. ICCs ranged from .68 to .90, and α varied from .81 to .95. The correlations between the SMFA and, respectively, the RAND-36 and WHOQOL-BREF were small to large depending on the SMFA factor combined with fracture location. Responsiveness was confirmed (p < .0001; SRM ranging from .28 to 1.71). CONCLUSIONS: The SMFA has good psychometric properties in patients with fractures. Patients with UEF and LEF could not be regarded as a homogenous group. The development of separate SMFA modules should be considered.


Assuntos
Ossos da Extremidade Inferior/lesões , Ossos da Extremidade Superior/lesões , Fraturas Ósseas/psicologia , Doenças Musculoesqueléticas/psicologia , Psicometria , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Comorbidade , Comparação Transcultural , Avaliação da Deficiência , Análise Fatorial , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/epidemiologia , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Países Baixos/epidemiologia , Estudos Prospectivos , Perfil de Impacto da Doença , Traduções , Avaliação da Capacidade de Trabalho
10.
Breast Cancer Res Treat ; 139(3): 811-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23760860

RESUMO

To compare overall survival between women with unilateral breast cancer (UBC) and contralateral breast cancer (CBC). Women with UBC (N = 182,562; 95 %) and CBC (N = 8,912; 5 %) recorded in the Netherlands Cancer Registry between 1989 and 2008 were included and followed until 2010. We incorporated CBC as a time-dependent covariate to compute the overall mortality rate ratio between women with CBC and UBC. Prognostic factors for overall death were examined according to age at first breast cancer. Women with CBC exhibited a 30 % increase in overall mortality (Hazard Ratio (HR), 95 % Confidence Interval: 1.3, 1.3-1.4) compared with UBC, decreasing with rising age at diagnosis of first breast cancer (<50 years: 2.3, 2.2-2.5 vs. ≥70 years: 1.1, 1.0-1.1). Women older than 50 years at CBC diagnosis and diagnosed 2-5 years after their first breast cancer exhibited a 20 % higher death risk (1.2, 1.0-1.3) compared to those diagnosed within the first 2 years. In women younger than 50 years, the HR was significantly lower if the CBC was diagnosed >5 years after the first breast cancer (0.7, 0.5-0.9). The prognosis for women with CBC significantly improved over time (2004-2008: 0.6, 0.5-0.7 vs. 1989-1993). Women with CBC had a lower survival compared to women with UBC, especially those younger than 50 years at first breast cancer diagnosis. A tailored follow-up strategy beyond current recommendations is needed for these patients who, because of their age and absence of known familial risk, are currently not invited for population-based screening.


Assuntos
Neoplasias da Mama/mortalidade , Fatores Etários , Idoso , Neoplasias da Mama/patologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Segunda Neoplasia Primária/mortalidade , Países Baixos/epidemiologia , Prognóstico
11.
Qual Life Res ; 22(9): 2399-416, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23519976

RESUMO

PURPOSE: Distal radius fractures (DRF) cause long-term functional limitations. A subgroup (21.2 %) will never fully recover after DRF. Therefore, it is important to consider the health status (HS) and (health-related) quality of life (HR)QOL of these patients. The aim of this systematic review was to describe (1) the HS and (HR)QOL outcomes following DRF, (2) sociodemographic, clinical, and psychosocial factors associated with HS and (HR)QOL, and to (3) evaluate the conceptualization of HS and (HR)QOL in these studies. METHODS: A systematic literature search was conducted in Pubmed, Embase, The Cochrane Library, and PsycINFO (January 1976-July 2012). A criteria list was used to assess the methodological quality of the studies. RESULTS: Twenty-six studies were included with a mean quality score of 7.7 (SD = 1.7). The majority of studies had a low methodological quality. Twenty-three studies (88.5 %) focused exclusively on HS and only three studies examined (HR)QOL. However, 34.8 % of the outcomes were labeled as (HR)QOL by the authors, while in fact, HS was assessed. Sex, age, educational level, living situation, and radiocarpal arthritis were associated with HS. In general, no differences were found in HS and (HR)QOL when comparing different treatment modalities. CONCLUSIONS: The focus of outcome research in DRF is mainly on HS instead of (HR)QOL. HS instruments were often mislabeled as (HR)QOL instruments. With inconclusive results of mostly low-quality studies, there is a need for high-quality prospective follow-up studies measuring HS and/or (HR)QOL while using the correct terminology.


Assuntos
Nível de Saúde , Qualidade de Vida , Fraturas do Rádio/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Fraturas do Rádio/complicações , Resultado do Tratamento
12.
Br J Cancer ; 107(3): 549-55, 2012 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-22713658

RESUMO

BACKGROUND: This study examined the risk of third cancer of non-breast origin (TNBC) among women with bilateral breast cancer (BBC; either synchronous or metachronous), focussing on the relation with breast cancer treatment. METHODS: Risk was assessed, among 8752 Dutch women diagnosed with BBC between 1989 and 2008, using standardised incidence ratios (SIR) and Cox regression analyses to estimate the hazard ratio (HR) of TNBC for different treatment modalities. RESULTS: Significant increased SIRs were observed for all TNBCs combined, haematological malignancies, stomach, colorectal, non-melanoma skin, lung, head and neck, endometrial, and ovarian cancer. A 10-fold increased risk was found for ovarian cancer among women younger than 50 years (SIR=10.0, 95% confidence interval (CI)=5.3-17.4). Radiotherapy was associated with increased risks of all TNBCs combined (HR=1.3; 95%CI=1.1-1.6, respectively). Endocrine therapy was associated with increased risks of all TNBCs combined (HR=1.2; 95%CI=1.0-1.5), haematological malignancies (HR=2.0; 95%CI=1.1-3.9), and head and neck cancer (HR=3.3; 95%CI=1.1-10.4). After chemotherapy decreased risks were found for all TNBCs combined (HR=0.63; 95%CI=0.5-0.87). CONCLUSION: Increased risk of TNBC could be influenced by genetic factors (ovarian cancer) or an effect of treatment (radiotherapy and endocrine therapy). More insight in the TNBC risk should further optimise and individualise treatment and surveillance protocols in (young) women with BBC.


Assuntos
Neoplasias da Mama/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Idoso , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Segunda Neoplasia Primária/genética , Segunda Neoplasia Primária/patologia , Países Baixos/epidemiologia , Risco , Fatores de Risco , Resultado do Tratamento
13.
Ann Oncol ; 23(1): 19-27, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21508174

RESUMO

BACKGROUND: To determine (i) the prevalence of sexual (dys)function in patients with colorectal cancer and (ii) treatment-related and sociodemographic aspects in relation to sexual (dys)function and the quality of sexual life. Recommendations for future studies are provided. METHODS: A systematic search was conducted during the period 1990 to July 2010 that used the databases PubMed, PsychINFO, The Cochrane Library, EMBASE, and OVID Medline. RESULTS: Eighty-two studies were included. The mean quality score was 7.2. The percentage of preoperatively potent men that experienced sexual dysfunction postoperatively varied from 5% to 88%. Approximately half of the women reported sexual dysfunction. Preoperative radiotherapy, a stoma, complications during or after surgery, and a higher age predicted more sexual dysfunction with a strong level of evidence. Type of surgery and a lower tumor location predicted more sexual dysfunction with a moderate level of evidence. Insufficient evidence existed for predictors of the quality of sexual life. Current studies mainly focus on biological aspects of sexual (dys)function. Furthermore, existing studies suffer from methodological shortcomings such as a cross-sectional design, a small sample size, and the use of nonstandardized measurements. CONCLUSION: Sexuality should be investigated prospectively from a biopsychosocial model, hereby including the quality of sexual life.


Assuntos
Neoplasias Colorretais/complicações , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Feminino , Humanos , Masculino , Prevalência
14.
Breast Cancer Res Treat ; 134(1): 253-8, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22434527

RESUMO

Being recalled for further diagnostic procedures after an abnormal screening mammogram (ASM) can evoke a high state anxiety with lowered quality of life (QoL). We examined whether these adverse psychological consequences are found in all women with benign breast disease (BBD) or are particular to women referred after ASM. In addition, the influence of the anxiety as a personality characteristic (trait anxiety) was studied. Between September 2002 and February 2010 we performed a prospective longitudinal study in six Dutch hospitals. Women referred after ASM or with a palpable lump in the breast (PL), who were subsequently diagnosed with BBD, were included. Before diagnosis (at referral) and during follow-up, questionnaires were completed examining trait anxiety (at referral), state anxiety, depressive symptoms (at referral, one, three and 6 months after diagnosis), and QoL (at referral and 12 months). Women referred after ASM (N=363) were compared with women with PL (N=401). A similar state anxiety score was found in both groups, but a lower psychological QoL score at 12 months was seen in the ASM group. In women with not-high trait anxiety those in the ASM group were more anxious with more depressive symptoms at referral, and reported impaired psychological QoL at referral and at 12 months compared with the PL group. No differences were found between ASM and PL in women with high trait anxiety, but this group scored unfavorably on anxiety, depressive symptoms and QoL compared with women with not-high trait anxiety. ASM evokes more anxiety and depressive symptoms and lowered QoL compared with women referred with PL, especially in women who are not prone to anxiety. Women should be fully informed properly about the risks and benefits of breast cancer screening programs. We recommend identifying women at risk of reduced QoL using a psychometric test.


Assuntos
Ansiedade , Doenças Mamárias/diagnóstico por imagem , Detecção Precoce de Câncer/psicologia , Adulto , Doenças Mamárias/psicologia , Depressão , Feminino , Humanos , Pessoa de Meia-Idade , Palpação , Estudos Prospectivos , Qualidade de Vida , Radiografia , Inquéritos e Questionários
15.
Ann Surg Oncol ; 19(4): 1185-91, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22031063

RESUMO

PURPOSE: To evaluate the trend in the use of primary endocrine treatment (PET) for elderly patients with operable breast cancer and to study mean time to response (TTR), local control, time to progression (TTP), and overall survival. METHODS: Data of 184 patients aged≥75 years, diagnosed with breast cancer in the south of the Netherlands between 2001 and 2008 and receiving PET, were analyzed. RESULTS: The percentage of women≥75 years with breast cancer receiving PET in the south of the Netherlands decreased from 23% in the period 1988-1992 to 12% in 1997-2000, and increased to 29% in 2005-2008. Mean age at diagnosis of 184 patients treated with PET in the period 2001-2008 was 84 years (range 75-89 years). Mean length of follow-up was 2.6 years. In 107 patients (58%), an initial response was achieved (mean TTR 7 months), 21 patients (12%) showed stable disease. A total of 64 patients (35%), with or without prior response, eventually displayed progression (mean TTP 20 months). No differences in TTR and TTP were observed between the patients starting with tamoxifen or an aromatase inhibitor. One hundred nineteen (65%) of 184 patients had died by January 1, 2010. In 17 patients (14%), breast cancer was the cause of death. CONCLUSIONS: Tumor progression was observed in a substantial proportion of the cohort, but only a small number of patients died of breast cancer. Further research is needed on the safety and effectiveness of PET for elderly women with breast cancer to justify the current widespread use.


Assuntos
Androstadienos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Nitrilas/uso terapêutico , Triazóis/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anastrozol , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/metabolismo , Carcinoma Lobular/mortalidade , Carcinoma Lobular/patologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Letrozol , Receptor ErbB-2/metabolismo , Taxa de Sobrevida , Tamoxifeno/uso terapêutico , Resultado do Tratamento
16.
Br J Surg ; 98(11): 1654-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21706475

RESUMO

BACKGROUND: Adverse events occur in 3·8-17 per cent of hospital admissions. The purpose of this study was to analyse the incidence of medical errors and assess the feasibility of an error registry for quality improvement programmes. METHODS: Errors were recorded prospectively in a complication registry between 1 June 2005 and 31 December 2007. Events were coded according to the Trauma Registry of the American College of Surgeons; the nature of events was recorded and the severity graded using the 1992 Clavien system. Recorded events were discussed by the medical staff on a daily basis and, if by consensus judged to be errors, were saved to the registry database. RESULTS: Of 12,121 patients admitted to the surgical ward during the study interval, 2033 (16·8 per cent) had a complication and 735 (6·1 per cent) had an error documented in the registry. Of 873 recorded errors, 607 (69·5 per cent) were of little or no consequence (Clavien grade I) and 220 (25·2 per cent) required therapeutic intervention (Clavien grade IIa and IIb). Errors leading to permanent injury (Clavien grade III) occurred in 41 instances (4·7 per cent) and five patients (0·6 per cent) died (Clavien grade IV). CONCLUSION: This study shows that errors are common in surgery, and that near misses are more frequent than errors with serious consequences. It is hypothesized that registration of near misses might prevent errors with serious consequences and thus improve quality of care.


Assuntos
Complicações Intraoperatórias/epidemiologia , Erros Médicos/estatística & dados numéricos , Sistema de Registros , Estudos de Viabilidade , Humanos , Incidência , Erros Médicos/efeitos adversos , Erros Médicos/prevenção & controle , Países Baixos/epidemiologia , Estudos Prospectivos , Qualidade da Assistência à Saúde
17.
Br J Surg ; 98(4): 537-42, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21656719

RESUMO

BACKGROUND: Screening for breast cancer reduces breast cancer-related mortality. Advantages of screening are explained clearly, but its disadvantages are underrepresented in consent folders. METHODS: In September 2002 a prospective, longitudinal study started concerning quality of life (QoL) in women with breast disease. Between September 2002 and January 2007, 385 women with an abnormal screening mammogram were included. Of these, 152 women were diagnosed with breast cancer (BC group) and 233 had a false-positive result (FP group). Questionnaires concerning anxiety (State and Trait Anxiety Inventory) and QoL (World Health Organization Quality of Life assessment instrument 100) were completed before diagnosis, and 1, 3, 6 and 12 months later. RESULTS: The BC group was significantly older (60.2 versus 57.3 years; P < 0.001); significantly more histological biopsies were needed in the FP group (P < 0.001). Almost 60 per cent of the FP group revisited the outpatient clinic in the first year. Trait anxiety had a profound influence on QoL. Women in the FP group with a high score on trait anxiety had lowest QoL on all measurements (P < 0.001). They also reported more feelings of anxiety compared with women in the FP group with a lower trait anxiety score, and women in the BC group with a low trait anxiety score (P < 0.001). CONCLUSION: Women with a false-positive diagnosis of screen-detected breast cancer had a low QoL and feelings of anxiety, especially when they scored high on trait anxiety. This effect lasted for at least 1 year.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Qualidade de Vida , Idoso , Análise de Variância , Ansiedade/etiologia , Neoplasias da Mama/psicologia , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia/psicologia , Pessoa de Meia-Idade , Personalidade , Fatores de Risco
18.
Br J Surg ; 98(7): 956-63, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21509748

RESUMO

BACKGROUND: The objective was to evaluate the impact of concentration of surgery for oesophageal and gastric cardia cancer on long-term survival in the population-based Eindhoven Cancer Registry area. In contrast to most previous studies, this study aimed to evaluate both surgically and non-surgically treated patients, to avoid the confounding effect of selective referral. METHODS: This retrospective cohort study included all patients diagnosed with oesophageal or gastric cardia cancer between 1995 and 2006. Results for the period 1995-1998 were compared with those for 1999-2006, after concentration of surgery. RESULTS: Between 1995 and 2006, 2212 patients were registered with the diagnosis, of whom 638 underwent resection. Before 1999, 73·4 per cent of surgically treated patients underwent a resection in a low-volume hospital (fewer than 4 resections per year) and 23·2 per cent were referred to an academic hospital. After concentration, 63·2 per cent of surgically treated patients underwent resection in one of two regional high-volume centres (15-20 resections per year) and 13·8 per cent were referred to an academic hospital. Three-year survival rates increased from 32·0 to 45·1 per cent for patients who had surgery (P = 0·004), and from 13·1 to 17·9 per cent for all included patients (P = 0·026). These improvements remained after adjustment for case mix or (neo)adjuvant treatments, and were similar for patients with squamous cell carcinoma or adenocarcinoma. However, adjustment for annual hospital volume attenuated this association for patients who had surgery. CONCLUSION: Concentration of oesophageal and gastric cardia cancer surgery was associated with improvements in long-term, population-based overall survival for surgically as well as non-surgically treated patients, apparently mediated by an increase in volume.


Assuntos
Cárdia/cirurgia , Neoplasias Esofágicas/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
19.
Br J Surg ; 97(2): 189-94, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20069609

RESUMO

BACKGROUND: : Short-stay breast cancer surgery (24 h or day case) is not common practice in Europe. This before-after comparative study was carried out to test the feasibility of systematically implementing a care programme incorporating short-stay admission using strategies tailored to individual hospital needs, and to assess safety and facilitating factors. METHODS: : Patients with breast cancer from four Dutch hospitals participated. The intervention concerned the programme developed by the Maastricht University Medical Centre. This was implemented through local multidisciplinary meetings and educational outreach visits. RESULTS: : Of 421 eligible patients, 324 (77.0 per cent) gave consent to participate. The proportion of patients who had short-stay treatment increased from 45.3 per cent before to 82.2 per cent after implementation of the programme (P < 0.001). No increase was observed in the rate of complications, readmissions, reoperations or number of visits to the emergency department. Factors associated with an increased chance of short-stay treatment were: breast-conserving surgery, having children and being employed. Being aged over 64 years showed a trend towards a decreased chance. CONCLUSION: : Introducing a care programme incorporating short stay following breast cancer surgery in four hospitals was feasible and safe.


Assuntos
Neoplasias da Mama/cirurgia , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento , Adulto Jovem
20.
Breast Cancer Res Treat ; 115(1): 181-3, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-18516674

RESUMO

The purpose of this study was to examine trends in incidence and detection of ductal carcinoma in situ (DCIS) of the breast in southern Netherlands in the period 1984-2006 and assess the effect of mass screening. All patients with primary DCIS registered between 1984 and 2006 in the population-based Eindhoven Cancer Registry were included (n = 1,767). These data were linked to data from the population-based screening programme. The incidence of DCIS of the breast increased from 3/100,000 to almost 34/100,000 person-years in women aged 50-69 years in southern Netherlands since 1984. Mass screening was responsible for this increase. A stable 60% of DCIS was screen-detected. Over 11% of breast cancer patients have DCIS. In conclusion, the incidence of DCIS increased markedly in southern Netherlands with a clear effect of mammography screening since 1992.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/epidemiologia , Programas de Rastreamento , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Mamografia/métodos , Pessoa de Meia-Idade , Países Baixos , Vigilância da População/métodos , Sistema de Registros , Fatores de Tempo
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