A multicentre epidemiological study on sunbed use and cutaneous melanoma in Europe

A large European case-control study investigated the association between sunbed use and cutaneous melanoma in an adult population aged between 18 and 49 years. Between 1999 and 2001 sun and sunbed exposure was recorded in 597 newly diagnosed melanoma cases and 622 controls in Belgium, France, The Netherlands, Sweden and the UK. Fifty three precent of cases and 57% of controls ever used sunbeds. The overall adjusted odds ratio (OR) associated with ever sunbed use was 0.90 (95% CI: 0.71-1.14). There was a South-to-North gradient with high prevalence of sunbed exposure in Northern Europe and lower prevalence in the South (prevalence of use in France 20%, OR: 1.19 (0.68-2.07) compared to Sweden, prevalence 83%, relative risk 0.62 (0.26-1.46)). Dose and lag-time between first exposure to sunbeds and time of study were not associated with melanoma risk, neither were sunbathing and sunburns (adjusted OR for mean number of weeks spent in sunny climates >14 years: 1.12 (0.88-1.43); adjusted OR for any sunburn >14 years: 1.16 (0.9-1.45)). Host factors such as numbers of naevi and skin type were the strongest risk indicators for melanoma. Public health campaigns have improved knowledge regarding risk of UV-radiation for skin cancers and this may have led to recall and selection biases in both cases and controls in this study. Sunbed exposure has become increasingly prevalent over the last 20 years, especially in Northern Europe but the full impact of this exposure on skin cancers may not become apparent for many years

Risk perception after genetic counseling in patients with increased risk of cancer

<p>Abstract</p> <p>Background</p> <p>Counselees are more aware of genetics and seek information, reassurance, screening and genetic testing. Risk counseling is a key component of genetic counseling process helping patients to achieve a realistic view for their own personal risk and therefore adapt to the medical, psychological and familial implications of disease and to encourage the patient to make informed choices <abbrgrp><abbr bid="B1">1</abbr><abbr bid="B2">2</abbr></abbrgrp>.</p> <p>The aim of this study was to conceptualize risk perception and anxiety about cancer in individuals attending to genetic counseling.</p> <p>Methods</p> <p>The questionnaire study measured risk perception and anxiety about cancer at three time points: before and one week after initial genetic counseling and one year after completed genetic investigations. Eligibility criteria were designed to include only index patients without a previous genetic consultation in the family. A total of 215 individuals were included. Data was collected during three years period.</p> <p>Results</p> <p>Before genetic counseling all of the unaffected participants subjectively estimated their risk as higher than their objective risk. Participants with a similar risk as the population overestimated their risk most. All risk groups estimated the risk for children's/siblings to be lower than their own. The benefits of preventive surveillance program were well understood among unaffected participants.</p> <p>The difference in subjective risk perception before and directly after genetic counseling was statistically significantly lower in all risk groups. Difference in risk perception for children as well as for population was also statistically significant. Experienced anxiety about developing cancer in the unaffected subjects was lower after genetic counseling compared to baseline in all groups. Anxiety about cancer had clear correlation to perceived risk of cancer before and one year after genetic investigations.</p> <p>The affected participants overestimated their children's risk as well as risk for anyone in population. Difference in risk perception for children/siblings as for the general population was significant between the first and second measurement time points. Anxiety about developing cancer again among affected participants continued to be high throughout this investigation.</p> <p>Conclusion</p> <p>The participant's accuracy in risk perception was poor, especially in low risk individuals before genetic counseling. There was a general trend towards more accurate estimation in all risk groups after genetic counseling. The importance of preventive programs was well understood. Cancer anxiety was prevalent and associated with risk perception, but decreased after genetic counseling.</p> <p><abbrgrp><abbr bid="B1">1</abbr></abbrgrp> National Society of Genetic Counselors (2005), Genetic Counseling as a Profession. Available at <url>http://www.nsgc.org/about/definition.cfm</url> (accessed November 25th 2007)</p> <p><abbrgrp><abbr bid="B2">2</abbr></abbrgrp> Julian-Reynier C., Welkenhuysen M-, Hagoel L., Decruyenaere M., Hopwood P. (2003) Risk communication strategies: state of the art and effectiveness in the context of cancer genetic services. Eur J of Human Genetics 11, 725736.</p

Quality of life and psychological reactions in women on first line chemotherapy for metastatic breast cancer - Correlations to tumour response and predictive factors.

Background: Health-related quality of life (HRQoL) is an important endpoint in clinical trials and as an aspect that must be considered in the treatment of patients with metastatic breast cancer. Treatment efficacy and toxicity are important factors for HRQoL, so it is imperative to study the effects of oncological treatment in terms of HRQoL. Different individuals experience different side effects, and genetic variation may affect the metabolism of certain chemotherapy drugs. Single nucleotide polymorphism (SNP) is the most common type of genetic variation in the human genome, and studies have shown that functional genotypes may be an underlying cause of severe chemotherapy toxicity. Prognostic factors are used to choose adequate treatment for the patient. Previous studies of metastatic breast cancer have shown that HRQoL data can predict response, time to progression, and survival. We have only limited knowledge of how patients experience their situation at the point of disease progression after first-line chemotherapy, and so there is a need to further investigate this area in order to better understand and support women with advanced-stage disease. Aim: All four studies in this thesis were based on the TEX study. The aim was to study HRQoL and psychological reactions in women with metastatic breast cancer receiving chemotherapy. HRQoL was investigated as a prognostic factor for tumour response, progression-free survival, and overall survival; and the relationship between HRQoL, toxicity, and selected biological variations (SNPs) was also examined. Patients and methods: In the TEX trial, 287 patients with locally advanced or distant metastatic breast cancer were randomized to either epirubicin and paclitaxel (ET) or epirubicin, paclitaxel, and capecitabine (TEX). Treatment was repeated every three weeks. HRQoL was assessed by the EORTC-QLQ C30 and EORTC QLQ-BR23 questionnaires at five points during nine months. Both quantitative (studies I-III) and qualitative (study IV) methods were used. Study I included 163 patients who answered the questionnaire at all five assessment points. Linear regression analysis was used to examine differences in HRQoL between the two groups, over time, and interactions between group and time. Study II included 252 patients who answered the questionnaire before randomization. Logistic regression analysis was used to examine whether HRQoL could be an independent prognostic factor for response to treatment, progression-free survival, and overall survival. Study III included 185 patients who answered the questionnaire at the two-month assessment and provided blood samples for the genotyping analyses. Multiple regression analysis was conducted to investigate if there were any correlations between HRQoL and toxicity, specific SNPs and toxicity, and SNPs, toxicity, and the impact on quality of life. Finally, Study IV was based on interviews with 20 patients; content analysis was used to analyse the data. Results: Study 1: At nine months, the groups showed a statistically significant difference in overall quality of life and physical function, in favour of patients treated with TEX. There were no other differences or interactions between the treatment groups. Study II: Fatigue was correlated with response to treatment and overall survival. There were also associations between several variables and response (role functioning, social functioning, nausea and vomiting, and anorexia). The analysis showed no association between HRQoL and progression-free survival. Study III: Statistically significant associations were found between several of the HRQoL variables and toxicity (fatigue, pain, dyspnoea, cardiovascular problems, gastrointestinal problems, and skin problems). Toxicity was also associated with specific SNPs that may affect the metabolism of the drugs used in the TEX trial. There is a connection between SNPs, toxicity, and HRQoL. Study IV: Many of the women had suspected that their cancer was progressing. Worry was the most common reaction. The women had many different strategies to deal with the situation, and the majority of them understood and accepted their situation. Interest in professional counselling was small, and many reported that they felt that their first relapse was more traumatic. Conclusion: HRQoL over time provides information that can be used in the choice of treatment, especially if no difference can be demonstrated in treatment response between the chosen treatments. Frequent quality of life measurements at different times give increased knowledge of patients’ needs, allowing practitioners to better provide support and care during the course of disease. The analysis showed a relationship between fatigue and response to treatment and overall survival. The results also show that as patients’ progress through treatment, they develop resources to deal with difficult information and do not necessarily express a need for professional psychosocial support. The analyses revealed an association between HRQoL and toxicity, between specific SNPs and toxicity, and between SNPs, toxicity, and the impact on quality of life. Such knowledge may influence the choice of chemotherapy in this patient population, depending on the treatment’s toxicity profile and its impact on patients' quality of life

Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer-a comparative cross-sectional study of fatigue intensity and characteristics

Goals of work This cross-sectional comparative study was designed to explore and describe the prevalence and patterns of cancer-related fatigue in patients with advanced cancer as well as patients undergoing curative radiotherapy. Another aim was to explore the association of anxiety and depression with fatigue. Materials and methods Patients with an advanced stage of disease (n=228) and patients receiving radiotherapy (n=81) completed the Borg Category Ratio Scale, the Multidimensional Fatigue Inventory and the Hospital Anxiety and Depression Scale. Main results Patients with advanced disease had an increased probability of experiencing all aspects of fatigue except for mental fatigue as compared to patients undergoing radiation, e.g., odds ratio 11.5 (CI 5.8–22.7) for physical fatigue. Higher scores for depression than for anxiety were reported when patients had high levels of fatigue, with 23% of the patients classified as anxious and 39% depressed. Conclusions The present study was carried out in order to address a gap in research by comparing the multidimensional aspects of fatigue in different groups of cancer patients. It is the intensity of fatigue that seems to be related to the underlying exposure to radiation or to the level of disease burden rather than the different fatigue profiles, such as the relation between physical and mental aspects