Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions:Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and controlspublishedVersio

Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study

Introduction: Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments. Materials and methods: A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models. Results: 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes. Discussion: Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance.publishedVersio

Long-term work outcomes and the efficacy of multidisciplinary rehabilitation programs on labor force participation in cancer patients - a protocol for a longitudinal prospective cohort study

Background. Many cancer survivors experience late effects of cancer treatment and therefore struggle to return to work. Norway provides rehabilitation programs to increase labor force participation for cancer survivors after treatment. However, the extent to which such programs affect labor force participation has not been appropriately assessed. This study aims to investigate i) labor force participation, sick leave and disability rates among cancer survivors up to 10 years after being diagnosed with cancer and identify comorbidities contributing to long-term sick leave or disability pensioning; ii) how type of cancer, treatment modalities, employment sectors and financial- and sociodemographic factors may influence labor force participation; ii) how participation in rehabilitation programs among cancer survivor affect the long-term labor force participation, the number of rehospitalizations and incidence of comorbidities. Design and methods. Information from four medical, welfare and occupational registries in Norway will be linked to information from 163,279 cancer cases (15.68 years old) registered in the Norwegian Cancer Registry from 2004 to 2016. The registries provide detailed information on disease characteristics, comorbidities, medical and surgical treatments, occupation, national insurance benefits and demographics over a 10-year period following a diagnosis of cancer. Expected impact of the study for Public Health. The study will provide important information on how treatment, rehabilitation and sociodemographic factors influence labor force participation among cancer survivors. Greater understanding of work-related risk factors and the influence of rehabilitation on work-participation may encourage informed decisions among cancer patients, healthcare and work professionals and service planners.publishedVersio

Cardiac health in persons with intellectual disability: rare, forgotten or overlooked?

About 1% of the population has intellectual disabilities (ID) involving impaired cognitive function and varying degrees of challenges with motor and social skills including difficulty expressing themselves. This also applies to somatic health. To a large extent, people with ID who receive municipal health and care services are dependent on assistance to identify needs for health services as they are less able to actively seek health care to prevent cardiovascular disease (CVD). CVD has long been the most common cause of death in the general population in Norway, but a study conducted in 2014 showed that surprisingly few adults with ID had received treatment at outpatient clinic for heart disease over the last 10 years. People with ID have a higher incidence of diabetes, obesity, inactivity, poorer physical fitness, and diet compared to the general population. These factors increase the risk of developing CVD and may be a contributing factor to the group having a shorter life expectancy than the general population. Despite risk factors such as diabetes, hypertension and abdominal obesity are common in people with ID, both national and international studies show that people with ID receive drugs to prevent CVD to a lesser extent than the general population. A study from the western part of Norway in 2019 shows that only 8.3% of people with ID receive medication to prevent CVD (mainly cholesterol-lowering and blood pressure-lowering medication) compared to 16.7% in an age matched cohort from the general population in the same region. There is therefore a need to explore how we can ensure optimal preventive efforts and treatment for CVD in adults with ID. In this project we want to address this by 1. Examine cardiac health and physical activity in a sample of persons with ID. The results will be compared with data from the HUNT study – a longitudinal population health study in Norway. 2. To explore barriers in prevention, diagnostics, and treatment of CVD in persons with ID. The study will take place in the region of Trøndelag in Norway and will be conducted through collaboration between researchers at the University of Bergen, the University of Oslo, The Norwegian University of Science and Technology, the Regional Centre for Obesity Research and Innovation at St. Olav’s university Hospital, the National Competence Centre for Intellectual disabilities, and Frambu Resource Centre for Rare Disorders. In part 1, the project will recruit n=75 persons with ID 28 years of age or older. We will collect data on weight, height and waist- and hip circumference. Blood samples will be collected and analysed for HbA1c, cholesterol and blood lipids, markers of iron status, liver function and inflammation. In addition, we will examine resting heart rate, blood pressure and electrical impulses in the heart by electrocardiography. Participants will also perform a 6-minute walk test and measure physical activity level for seven consecutive days with use of accelerometer. Data from persons with ID will be compared to a control group in the general population retrieved from the HUNT 4 study cohort. In part 2, semi structured qualitative interviews will be conducted with employees at the Department of Cardiac Medicine, St. Olav’s Hospital, employees at the Obesity Clinic, St. Olav’s Hospital, employees at rehabilitation institutions, employees in municipality-based health and care services for persons with ID. In addition, four general practitioners and four relatives to persons with ID will be interviewed

Healthy Life Centres: a 3-month behaviour change programme's impact on participants' physical activity levels, aerobic fitness and obesity: an observational study

Objectives Individuals with low socioeconomic status and multimorbidity tend to have lower physical activity (PA) levels than the general population. Primary care is an important setting for reaching high-risk individuals to support behaviour change. This study aimed to investigate the impact of behaviour change interventions delivered by Norwegian Healthy Life Centres (HLCs) on participants’ PA levels, aerobic fitness and obesity, and furthermore to investigate possible predictors of change. Design An observational study with a pre–post design and a 3-month follow-up. Setting Thirty-two HLCs in Norway were included. Participants A total of 713 participants (72% of the participants included at baseline), 71% women, with a mean age of 51 (18–87 years) and body mass index (BMI) of 32 (SD 7) met to follow-up. Intervention Individual consultations and tailored individual and group-based exercise and courses organised by the HLCs and cooperating providers. Outcome measures The primary outcome was time spent in moderate to vigorous PA (MVPA, min/day) (ActiGraph GT3X+ accelerometer). The secondary outcomes were light PA (LPA, min/day), number of steps per day, time spent sedentary (SED, min/day), aerobic fitness (submaximal treadmill test, min), BMI (kg/m2) and waist circumference (WC, cm). Results There was no change in MVPA (B 1.4, 95% CI −0.4 to 3.1) after 3 months. The participants had improved LPA (4.0, 95% CI 0.5 to 7.5), increased number of steps (362, 95% CI 172 to 552), reduced SED (−5.6, 95% CI −9.8 to –1.3), improved fitness (0.8, 95% CI 0.6 to 1.0), reduced BMI (−0.2, 95% CI −0.1 to –0.3) and reduced WC (−1.7, 95% CI −2.0 to –1.3). Positive predictors of change were number of exercise sessions completed per week, duration of adherence to HLC offers and participation in exercise organised by HLC. Conclusion Participation in the HLC interventions had small positive impacts on participants’ PA levels, aerobic fitness and obesity. Further research to develop effective behaviour change programmes targeting individuals with complex health challenges is needed

Colorectal cancer patients’ experiences with supervised exercise during adjuvant chemotherapy—A qualitative study

Background Colorectal cancer (CRC) is a common cancer worldwide, with increasing numbers surviving and living with long-term side effects from treatment. Physical exercise during or after treatment may have several beneficial effects, but knowledge of CRC patients’ reflections on exercising during adjuvant therapy is limited. The aim of this study was to explore the experiences of CRC patients participating in a supervised exercise program during adjuvant chemotherapy. Methods This study included CRC patients participating in two intervention studies with individually tailored and supervised combinations of endurance, resistance, and balance exercises during adjuvant chemotherapy. Semi-structured interviews performed at the beginning, during, and immediately after the intervention period from 15 participants were analyzed using thematic analysis. Results Four main themes identified were “structuring life with cancer,” “motivation to exercise,” “training experiences,” and “effects of exercise.” Scheduled appointments gave structure to daily life and served as an external motivational factor. The individual adjustments of exercise gave a sense of security and helped improving adherence, especially when feeling depressed or fatigued. Common expectations were improvement of endurance and strength and counteracting negative effects of chemotherapy. Experienced positive effects from exercising, both mentally and physically, contributed to inner motivation and inspired continued exercising after the study period. Conclusion This study offers important insights into CRC patients’ experiences of participating in a physical exercise program during adjuvant chemotherapy. Based on our findings, we recommend supervised and individually tailored physical exercise during adjuvant chemotherapy to this patient group

Exploring use of activity monitors for patients with obesity during weight-loss treatment - a qualitative study

Background Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss programme. Methods Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit Zip™, Mio Fuse™, or Mio Slice™. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data. Results Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. “Activity monitors visualize proof of effort or failure to change health habits”. 2. “Activity monitors act as a positive or negative enforcer when incorporating change”. Conclusions Using activity monitors either strengthens or undermines patients’ attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity

Pulmonary Rehabilitation in Patients with Pulmonary Sarcoidosis:Impact on Exercise Capacity and Fatigue

Background: There is limited evidence regarding the impact of multidisciplinary pulmonary rehabilitation (PR) on exercise capacity and fatigue in patients with pulmonary sarcoidosis. The aim of this study was to evaluate the impact on exercise capacity and fatigue following PR, and to examine whether baseline fatigue was related to change in peak oxygen uptake (ΔV̇O2peak). Methods: Forty-one patients with pulmonary sarcoidosis attending a 4-week inpatient PR program were recruited to this pre-post study. Both maximal exercise capacity, defined as V̇O2peak and measured with a cardiopulmonary exercise test, and fatigue, assessed with the Fatigue Assessment Scale (score 10–50 points), were measured before and after PR. Results: There was a statistically significant improvement in V̇O2peak (1.2 ± 2.3 mL/kg/min, p = 0.002), and fatigue decreased significantly (–1.7 ± 3.9 points, p = 0.009) following PR. Unadjusted linear regression analyses demonstrated that age (B = –0.076, p = 0.017) and baseline fatigue (B = 0.196, p = 0.001) were predictors for change in V̇O2peak, while in adjusted analyses (age, sex, baseline V̇O2peak, baseline fatigue, and diffusion capacity of the lung for carbon monoxide), only baseline fatigue predicted change in V̇O2peak following PR (B = 0.165, p = 0.026). Conclusion: A 4-week multidisciplinary PR program improves maximal exercise capacity and reduces fatigue in patients with pulmonary sarcoidosis. Baseline fatigue only partly predicted change in V̇O2peak following PR

Exploring use of activity monitors for patients with obesity during weight-loss treatment - a qualitative study

Background Obesity is a major health concern in western countries. In Norway, patients with obesity can attend weight-loss programmes, which focus on changes in dietary and physical activity habits. Use of self-monitoring is advocated when changing dietary and physical activity habits for adults with obesity. This study aimed to explore the experiences of patients with obesity who used activity monitors while attending a weight-loss programme. Methods Patients with body mass index (BMI) > 35 kg/m2 with weight related comorbidities or a BMI > 40 kg/m2 referred to an intermittent weight-loss programme were recruited into this study. They were introduced to one of three different activity monitors, Fitbit Zip™, Mio Fuse™, or Mio Slice™. Semi-structured interviews were performed with patients six months into the weight-loss programme. Thematic analysis was applied when analysing the data. Results Of the 29 informants (aged 21 to 66 years) interviewed, 59% were female. Their experience with activity monitors was related to their adherence to the weight-loss programme. Two main themes emerged from the informants stories: 1. “Activity monitors visualize proof of effort or failure to change health habits”. 2. “Activity monitors act as a positive or negative enforcer when incorporating change”. Conclusions Using activity monitors either strengthens or undermines patients’ attempts to change health habits when attending a weight-loss program. Our findings suggest a need for more individualized weight-loss programmes for patients with obesity