Longitudinal associations of former and current alcohol consumption with psychosocial outcomes among colorectal cancer survivors 1–15 years after diagnosis

We aimed to explore positive and negative associations of consuming alcohol with psychosocial outcomes among colorectal cancer (CRC) survivors. We used data of an observational prospective cohort study, consisting of 2625 Dutch CRC survivors enrolled 1-11 years post-diagnosis that were followed-up in 4 yearly surveys. Generalized estimated equation models were used to examine longitudinal associations between alcohol consumption and anxiety, depression, and health-related quality of life (HRQoL), while correcting for sociodemographic, lifestyle and clinical characteristics. Compared to lifetime abstainers, former alcohol consumption was associated with more depressive symptoms, and worse global quality of life and social functioning, while current drinking was associated with less anxiety, depression and better HRQoL. More drinks per week was associated with less nausea/vomiting. Compared to abstainers, moderate (≤7 drinks/week) and heavy alcohol consumption (>7 drinks/week) were associated with less anxiety and depression and better HRQoL, mostly attributable to wine consumption. Whereas current alcohol consumption was longitudinally associated with less anxiety and depression and better HRQoL, former drinking was associated with worse psychosocial outcomes, although based on a small sample size. It is important to consider that besides the potential negative effects of alcohol on patients’ health, alcohol consumption may be positively related with psychosocial outcomes

Is CT-based body composition associated with long-term chemotherapy-induced peripheral neuropathy in colorectal cancer survivors?

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect among colorectal cancer (CRC) survivors, and the severity is mainly dependent on the chemotherapy dose. Nowadays, chemotherapy dose is based on body surface area, while determination based on more accurate measures of body composition may be better. This study aimed to investigate the association between body composition and long-term CIPN among CRC survivors 2–11 years after diagnosis. METHODS: Data from CRC survivors from the population-based PROFILES registry were used. Survivors were included when they received chemotherapy, filled in the EORTC QLQ-CIPN20, and had a computed tomography (CT) scan at diagnosis (n = 202). Total, sensory, motor, and autonomic CIPN were based upon the EORTC QLQ-CIPN20. The abdominal CT scans were used to determine skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT). Logistic regression was used to analyze the association between CIPN outcomes and body composition variables. RESULTS: CIPN was experienced by 64% of the CRC survivors several years after chemotherapy. More SAT was associated with a higher odds of reporting total CIPN (OR = 1.01 95% CI 1.00–1.01, p = 0.01), motor CIPN (OR = 1.01 95% CI 1.00–1.01, p = 0.01), and sensory CIPN (OR = 1.01 95% CI 1.00–1.01, p = 0.04). No associations of other body composition parameters with CIPN were observed. CONCLUSION: Only SAT was associated with total, motor, and sensory CIPN. Based on these results, we cannot conclude that determining the chemotherapy dose based on body composition is preferred over determining the chemotherapy dose based on body surface to prevent CIPN. More research is needed to assess associations of body composition with CIPN, a common side effect of chemotherapy

The First Science Results from SPHERE: Disproving the Predicted Brown Dwarf around V471 Tau

Variations of eclipse arrival times have recently been detected in several post common envelope binaries consisting of a white dwarf and a main sequence companion star. The generally favoured explanation for these timing variations is the gravitational pull of one or more circumbinary substellar objects periodically moving the center of mass of the host binary. Using the new extreme-AO instrument SPHERE, we image the prototype eclipsing post-common envelope binary V471 Tau in search of the brown dwarf that is believed to be responsible for variations in its eclipse arrival times. We report that an unprecedented contrast of 12.1 magnitudes in the H band at a separation of 260 mas was achieved, but resulted in a non-detection. This implies that there is no brown dwarf present in the system unless it is three magnitudes fainter than predicted by evolutionary track models, and provides damaging evidence against the circumbinary interpretation of eclipse timing variations. In the case of V471 Tau, a more consistent explanation is offered with the Applegate mechanism, in which these variations are prescribed to changes in the quadrupole moment within the main-sequence sta

Sociodemographic, clinical, lifestyle, and psychological correlates of peripheral neuropathy among 2- to 12-year colorectal cancer survivors

Background Peripheral neuropathy (PN) is a debilitating complication among colorectal cancer (CRC) survivors that can become chronic. No large-scale study has yet analyzed correlates in multivariable models. We did multivariable analyses to find correlates of PN. Methods In 1,516 all-stage Dutch CRC survivors, cross-sectional data were collected on sensory, motor, autonomic and total PN, sociodemographic (age, sex, education, employment, partner), clinical (time since diagnosis, tumor location, stage, chemotherapy, radiotherapy, co-morbidities), lifestyle (alcohol, smoking, physical activity, body mass index), psychological factors (anxiety, depression, personality) and health-related quality of life (HRQoL). After multiple imputation, correlates were analyzed with linear regressions and eliminated with backwards selection. Results CRC survivors (69 years; 42% female) were on average five years post-diagnosis, and 28-65% reported PN. PN was associated with older age, being male (sensory) or female (motor), shorter time since diagnosis, chemotherapy, co-morbidities, anxiety, depression, and worse scores on HRQoL domains, and pain, nausea, vomiting, insomnia, constipation and financial problems. Conclusions In multivariable analyses, PN is affected by receiving chemotherapy, aging, sex, co-morbidities, stress-related factors and HRQoL in CRC survivors. Future PN-related studies can include these factors, and they can be examined in longitudinal studies to gain more knowledge about chronicity and severity of PN

Longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption in colorectal cancer survivors up to 2 years post-diagnosis

Purpose Alcohol consumption can lead to worse prognosis and mortality among colorectal cancer (CRC) patients. We investigated alcohol consumption of CRC survivors up to 2 years post-diagnosis, and how sociodemographic, lifestyle, and clinical factors were associated longitudinally with these habits. Methods We pooled longitudinal data of 910 CRC survivors from the ongoing PROCORE and EnCoRe studies with data collected at diagnosis (baseline) and 3, 6, 12, and 24 months post-diagnosis. Both studies assessed alcohol consumption, including beer, wine, and liquor. Generalized estimated equation models were used to examine changes over time in alcohol consumption and multivariable longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption. Results At baseline, participants were on average 67 years old, 332 (37%) were female, and alcohol was consumed by 79%. Most survivors (68-71%) drank less at all follow-ups. Beer, wine, and liquor were consumed by 51%, 58%, and 25% at baseline, respectively, and these declined over time. Males consumed more alcohol, and higher education, more physical activity, and not having a (permanent) stoma were associated with consuming more alcohol. Conclusion CRC survivors decreased their alcohol consumption in the 2 years post-diagnosis. Future studies should take the significant factors that were associated with alcohol post-diagnosis consumption into account, when they investigate CRC health outcomes or for identifying subgroups for interventions. Males with higher education, more physical activity, and no stoma should be reminded after diagnosis for reducing their alcohol consumption

Psychological distress and lower health-related quality of life are associated with need for dietary support among colorectal cancer survivors with overweight or obesity

Objective: Two-third of colorectal cancer (CRC) survivors are overweight or obese. Psychological distress and low health-related quality of life (HRQoL) may be barriers to improving diet. We aimed to assess associations between psychological distress and HRQoL and the need for dietary support in CRC survivors with overweight or obesity. Methods: All alive individuals diagnosed with CRC between 2000 and 2009, as registered by the Dutch population-based Eindhoven Cancer Registry, were eligible for participation and received a questionnaire. Multivariable logistic regression analyses were conducted to assess associations between HRQoL (EORTC QLQ-C30), symptoms of anxiety and depression (HADS), and self-reported need for dietary support (single-item). Results: A total of 1458 completed the questionnaire (response rate 82%), and 756 (43%) had a BMI of 25.0 or higher and complete data on “need for dietary support” and were included for analyses. BMI ranged between 25.0 and 60.6 (mean, 28.9; SD, 3.6). The majority (71.7%) was overweight (BMI ≥ 25), and 28.3% obese (BMI ≥ 30). Twenty-one percent reported a need for dietary support which was associated with more psychological distress and lower HRQoL. Those who experienced symptoms of anxiety or depression were more likely to report a need for dietary support (27.6% and 28.7%) than those who did not experience symptoms of anxiety (12.3%; OR 2.02; 95% CI 1.22–3.35) or depression (13.5%; OR 1.96; 95% CI 1.19–3.22). Conclusions: Results suggest that psychological distress and lower HRQoL should be taken into account while promoting a healthy diet in overweight or obese CRC survivors since these factors may hinder adherence to a healthy diet.</p

Heavy metals in a light white dwarf: abundances of the metal-rich, extremely low-mass GALEX J1717+6757

Using the Hubble Space Telescope, we detail the first abundance analysis enabled by farultraviolet spectroscopy of a low-mass (0.19 M) white dwarf (WD), GALEX J1717+6757, which is in a 5.9-h binary with a fainter, more-massive companion. We see absorption from nine metals, including roughly solar abundances of Ca, Fe, Ti, and P. We detect a significantly sub-solar abundance of C, and put upper limits on N and O that are also markedly sub-solar. Updated diffusion calculations indicate that all metals should settle out of the atmosphere of this 14 900 K, log g = 5.67 WD in the absence of radiative forces in less than 20 yr, orders of magnitude faster than the cooling age of hundreds of Myr. We demonstrate that ongoing accretion of rocky material that is often the cause of atmospheric metals in isolated, more massive WDs is unlikely to explain the observed abundances in GALEX J1717+6757. Using new radiative levitation calculations, we determine that radiative forces can counteract diffusion and support many but not all of the elements present in the atmosphere of this WD; radiative levitation cannot, on its own, explain all of the observed abundance patterns, and additional mechanisms such as rotational mixing may be required. Finally, we detect both primary and secondary eclipses using ULTRACAM high-speed photometry, which we use to constrain the low-mass WD radius and rotation rate as well as update the ephemeris from the discovery observations of this WD+WD binary

Associations between alcohol consumption and anxiety, depression, and health-related quality of life in colorectal cancer survivors

Purpose  Alcohol consumption is a major risk factor for colorectal cancer (CRC). It is currently poorly understood, however, how alcohol and different alcoholic beverage types are related to psychosocial outcomes in CRC survivors.  Methods  We used data of N = 910 CRC survivors from the pooled EnCoRe and PROCORE cohorts and harmonized them into five time points: at diagnosis and 3, 6, 12, and 24 months post-diagnosis. Generalized estimated equation models were used to examine longitudinal associations of alcohol consumption, including consumption of beer, wine, and liquor, with anxiety, depression, and health-related quality of life (HRQoL), while correcting for sociodemographic, lifestyle, and clinical factors.  Results  Survivors were on average 67 years and 37% was female. In the first 2 years post-diagnosis, survivors who consumed more alcoholic drinks/week reported lower anxiety and depressive symptoms and better HRQoL on all domains and symptom scales. This was the case for moderate and heavy amounts of alcohol and mostly for consuming beer and wine, but not for liquor. Associations were more often significant for men and for younger persons (< 67 years at baseline).  Conclusions  Generally, alcohol consumption was observed to be longitudinally related to less anxiety and depression and better HRQoL in CRC survivors. Implications for Cancer Survivors Although alcohol consumption is generally unfavorable due to increased risk of carcinogenesis and worse prognosis after CRC, it seems to be associated with better psychosocial outcomes in the first 2 years after diagnosis and treatment. More research is needed to gain knowledge about reasons for drinking and causality. Netherlands Trial Registry (www.trialregister.nl, NL6904

External validation and updating of prediction models for estimating the 1-year risk of low health-related quality of life in colorectal cancer survivors

Objectives Timely identification of colorectal cancer (CRC) survivors at risk of experiencing low health-related quality of life (HRQoL) in the near future is important for enabling appropriately tailored preventive actions. We previously developed and internally validated risk prediction models to estimate the 1-year risk of low HRQoL in long-term CRC survivors. In this article, we aim to externally validate and update these models in a population of short-term CRC survivors. Study Design and Setting In a pooled cohort of 1,596 CRC survivors, seven HRQoL domains (global QoL, cognitive/emotional/physical/role/social functioning, and fatigue) were measured prospectively at approximately 5 months postdiagnosis (baseline for prediction) and approximately 1 year later by a validated patient-reported outcome measure (European Organization for Research and Treatment of Cancer Quality of life Questionnaire–Core 30). For each HRQoL domain, 1-year scores were dichotomized into low vs. normal/high HRQoL. Performance of the previously developed multivariable logistic prediction models was evaluated (calibration and discrimination). Models were updated to create a more parsimonious predictor set for all HRQoL domains. Results Updated models showed good calibration and discrimination (AUC ≥0.75), containing a single set of 15 predictors, including nonmodifiable (age, sex, education, time since diagnosis, chemotherapy, radiotherapy, stoma, and comorbidities) and modifiable predictors (body mass index, physical activity, smoking, anxiety/depression, and baseline fatigue and HRQoL domain scores). Conclusion Externally validated and updated prediction models performed well for estimating the 1-year risk of low HRQoL in CRC survivors within 6 months postdiagnosis. The impact of implementing the models in oncology practice to improve HRQoL outcomes in CRC survivors needs to be evaluated

Multinational and large national corporations and climateadaptation: are we asking the right questions? A review ofcurrent knowledge and a new research perspective

Adapting to climate change requires the engagement of all actors in society. Until recently, the predominant research focus has been on governments, communities and the third sector as key actors in the adaptation process. Yet, there is a growing emphasis internationally on understanding the role of and the need to engage businesses in adaptation given their potential to finance projects, develop technologies and innovative solutions, and enhance the scale and cost-effectiveness of certain adaptation measures. Large national and multinational corporations are among the key actors in this respect. Already, many of these corporations are purportedly taking steps to adapt their operations to climate change. Some stated reasons for their engagement include minimising potential impacts on value chains, improving resource efficiency, enhancing production of sustainable raw materials, and supporting customers’, suppliers’ and communities’ climate change adaptation efforts. However, there is a paucity of work analysing adaptation actions by these corporations, their motivations and contribution to broader adaptation and climate resilient development efforts, as well as possible instances of maladaptation. We apply a three-tier framework on drivers, responses and outcomes to examine the state of knowledge according to recent literature on private sector and corporate adaptation to climate change. Our review highlights that the literature on the impact and outcomes of corporate adaptation actions is sparse and we consider the implications for future research. Our analysis concludes with a reflection on the relevance of corporate-led adaptation – for the companies themselves, policy-makers at all scales, as well as society at large