61 research outputs found
Hormonal consequences, replacement therapy, and lost workdays after cervical cancer treatment
Background: Uterine cervical cancer affects women of all ages and has a generally favorable prognosis. Many survivors live long with the consequences of the disease and its treatment, and therefore it is important to characterize potential treatment-induced morbidity.
Aims: To investigate different hormonal aspects and work loss among cervical cancer survivors, by treatment modality.
Methods: In a pilot study, we analyzed serum levels of anti-MĂĽllerian hormone (AMH) and follicle-stimulating hormone (FSH) as measurements of ovarian function, as well as estradiol and androgens in serum, and assessed sexual function before and after treatments in a one-year cohort of cervical cancer patients (N = 71). We also used Swedish national registers to investigate use of hormone therapy after cervical cancer treatment, and lost workdays due to sick leave and disability pension among 837 and 1971 patients, respectively.
Results: Serum levels of AMH were undetectable one year after salpingooophorectomy or radiotherapy among patients < 45 years of age at diagnosis. After radical hysterectomy and pelvic lymphadenectomy with ovarian preservation, AMH declined, whereas no change was found in serum levels of FSH. Circulating levels of total and free testosterone decreased after pelvic radiotherapy among pre- as well as postmenopausal women. No correlations were found between androgen levels and female sexual function index (FSFI) scores following treatment. Among women with estrogen deprivation due to salpingo-oophorectomy or radiotherapy, 67% had at least one dispensing of hormone therapy during the period 0.5 to 1 year after diagnosis, and 46% dispensed at least 75% of the recommended dose. The proportion of users decreased during follow-up. Relapse-free cervical cancer patients had more lost workdays than matched comparators from the general population for 4 years following diagnosis, and were at increased risk of disability pension following hysterectomy or chemo/radiotherapy. Women treated with fertilitysparing surgery did not have more lost workdays than the comparators beyond the first year and were not at increased risk of disability pension.
Conclusions: Serum levels of AMH were reduced after radical hysterectomy with ovarian preservation, indicating a possible risk of early ovarian failure. Testosterone in serum was reduced after radiotherapy, but was not associated with sexual function in this pilot setting. Less than half of cervical cancer survivors likely to have therapy-induced early menopause used hormone therapy at, or close to, the recommended dose, and the use decreased during follow-up. All treatment modalities for cervical cancer except fertility-sparing surgery were associated with long-term work disability
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Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register
Background
About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes.
Methods
Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 randomly selected patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated.
Results
In total, 158 surgical procedure codes were registered in the NPR. One hundred fifty-five of these, representing 60 different procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant with the patient charts, corresponding to a PPV of 96.8% (95%CI = 93.9–99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI = 88.7–98.6), 100% (95%CI = 100–100) and 98.1% (95%CI = 93.1–100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI = 89.6–99.3). The specificity of the NPR was 98.5% (95%CI = 97.6–100).
Conclusions
Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery
Letter: is unrealised adult height resulting from paediatric Crohn’s disease associated with a potential reduction in lifetime earnings? Authors’ reply
Letter: phenotype and natural history of elderly onset inflammatory bowel disease-Authors’ reply
Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery? Authors’ reply
Comment on :Post-operative complications in elderly onset inflammatory bowel disease: a population-based study. [Aliment Pharmacol Ther. 2018]Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery? [Aliment Pharmacol Ther. 2018]International audienc
Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery? Authors’ reply
Women’s Earnings are more Affected by Inflammatory Bowel Disease than Men’s: A Register-Based Swedish Cohort Study
Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery?
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