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ABSTRACT: To compare risk factors for disease and current problems in long-term testicular cancer survivors (TCSs) and age-matched population-based controls (NORMs).
The study was cross-sectional and concerned 1,291 Norwegian TCSs followed up after a mean of 11 years, and 6,455 NORMs. Both TCSs and NORMs completed questionnaires and had a clinical examination. Indices for risk factors and current problems were calculated. Outcome measures were: visits to general practitioners last year, poor self-rated health, and poor quality of life (QoL).
The mean risk score was significantly lower and the mean current problem score significantly higher in TCSs compared to NORMs without reaching clinical significance. The risk for future fatal cardiac events did not differ between the groups. TCSs had a higher risk for visiting a general practitioner than NORMs (OR 3.58, 95% CI 3.09-4.15), while no significant difference was observed for self-rated health. Poor QoL in TCSs was significantly associated with more current problems than risk factors. Previous treatment for mental problems, presence of severe somatic disease and musculo-skeletal problems were significantly associated with all three outcome measures. Musculo-skeletal problems were most strongly associated with visits to general practitioners among TCSs.
Several risk factors for preventive clinical interventions and current problems that eventually should be treated were identified in TCSs.
TCSs show several risk factors and current problems that are relevant for visits to general practitioners, poorer self-rated health, and poorer QoL. These should get attention from health personnel caring for TCSs.
Journal of Cancer Survivorship 09/2010; 4(3):256-65. · 2.63 Impact Factor
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ABSTRACT: The primary objective of this study was to explore approach and avoiding coping strategies in long-term testicular cancer survivors (TCSs) as self-rated by the brief approach/avoidance coping questionnaire (BACQ). As the BACQ is a new instrument, the second objective was to examine critical psychometric properties of the instrument. The third objective was to examine the correlation between the BACQ and established self-rating instruments commonly used in psychosocial oncology to explore if the BACQ added an additional perspective to the characterization of TCSs. In this cross-sectional questionnaire study, 1326 Norwegian TCSs at a mean of 11.3 years (SD 4.2, median 10.7, range 5-21 years) after diagnosis gave information about their medical and social situation, distress, fatigue, quality of life, self-esteem, and neuroticism. The BACQ ratings of the TCSs were compared to those of a control sample of men from the general population (N = 566; NORM). Among TCSs 84% (95% CI 82-86%) used more approach coping, and this proportion did not differ significantly from 86% among NORM (95% CI 83-89%). The mean BACQ approach/avoidance score of TCSs were similar to that observed in NORM adjusted for age and work status (p = 0.33). The BACQ approach/avoidance score showed only moderate associations with established instruments used in psychosocial oncology. TCSs with more avoidance coping (N = 216) differed significantly from TCSs with more approach coping (N = 1110) by showing a lower proportion in paired relations and in paid work, more somatic and mental morbidity, more fatigue and poorer quality of life and self-esteem. In multivariate analyses lower self-esteem, higher cancer-related avoidance, more depression and neuroticism were most strongly associated with avoidant coping. In conclusion, we found that TCSs used similar coping patterns as NORM, avoidant coping was associated with significantly more problems than observed among TCSs who used more approach coping.
Psychology Health and Medicine 03/2010; 15(2):146-58. · 1.18 Impact Factor
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ABSTRACT: Prognostic scores might be useful tools in both clinical practice and clinical trials, where they can be used as stratification parameter. The five available scores for the general population of patients with brain metastases have never been tested specifically in patients with non-small cell lung cancer (NSCLC). No comparison to the two NSCLC-specific scores has been made either. Hence, it remains unclear which score is most appropriate for these patients.
We evaluated seven previously published prognostic scores in a group of 183 patients with brain metastases from NSCLC. All patients had been treated outside of clinical studies with whole brain radiotherapy with or without radiosurgery or surgical resection.
The three scores with significant prognostic impact were the recursive partitioning analysis classes, the basic score for brain metastases, and the graded prognostic assessment (GPA) score. All three score systems were developed in a general population of patients with brain metastases. The GPA score performed better than the others. In this four-tiered system, the 1-year survival was 43, 20, 8, and 0%, respectively.
Three prognostic scoring models describe the survival of patients with brain metastases from NSCLC to a satisfactory degree. In the current patient population, GPA performs better than the others. The two NSCLC-specific scores were developed in radiosurgery-treated populations, and their prognostic impact in a general NSCLC population seems limited.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 09/2009; 4(11):1337-41. · 4.55 Impact Factor
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ABSTRACT: Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs).
All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses.
Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynaud's Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism.
Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.
Acta oncologica (Stockholm, Sweden) 06/2009; 48(6):842-9. · 2.27 Impact Factor
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ABSTRACT: The aim of this study was to compare the need for re-irradiation, rates of pathological fractures, and spinal cord compressions in patients randomised to single-fraction radiotherapy (8 Gy x 1) or multiple-fraction therapy (3 Gy x 10) and with a long-term follow-up. The underlying hypothesis was that single-fraction and multiple-fraction regimens are equally effective.
The present study reports on the Norwegian sub sample of an international large prospective-randomised multicentre study. One hundred and eighty patients with painful skeletal metastases in four Norwegian hospitals were randomised to receive single-fraction (8 Gy x 1) or multiple-fraction (3 Gy x 10) radiotherapy.
Patients in the single-fraction arm received significantly more re-irradiations as compared to the multiple-fraction arm (27% versus 9%, p=0.002). There were no significant differences in the rate of pathological fractures (5% versus 5%, p=1.00) or spinal cord compressions (1% versus 4%, p=0.37) between the two treatment groups.
The present study indicates no difference between radiotherapy with 8 Gy x 1 and 3 Gy x 10 for the majority of patients with painful bone metastases, also in a long-term perspective. Importantly, the patients in this study were followed up until death, and the trial showed no disadvantage for 8 Gy x 1 compared to 3 Gy x 10. Despite the fact that single-fraction treatment will imply an approximately 2.5-fold greater need for re-irradiation, single-fraction treatment is considered more convenient for the patients and more cost-effective for the radiotherapy departments.
Radiotherapy and Oncology 04/2009; 91(2):261-6. · 5.58 Impact Factor
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ABSTRACT: Fibroblast growth factor 2 (FGF2; basic fibroblast growth factor, b-FGF) and its main receptor FGFR-1 are important in both hemangiogenesis and lymphangiogenesis. Murine studies have indicated a close interplay between both FGF2 and platelet-derived growth factor-B (PDGF-B) as well as FGF2 and vascular endothelial growth factor-3 (VEGFR-3). This study investigates the prognostic impact of FGF2 and FGFR-1 in tumor cells and tumor stroma of resected non-small cell lung carcinomas (NSCLC) and explores the importance of their coexpression with VEGFR-3 or PDGF-B.
Tumor tissue samples from 335 resected patients with stage I to IIIA NSCLC were obtained and tissue microarrays were constructed from duplicate cores of tumor cells and tumor-related stroma from each specimen. Immunohistochemistry was used to evaluate the expression of the molecular markers FGF2, FGFR-1, VEGFR-3, and PDGF-B.
In univariate analyses, high tumor cell FGF2 expression (p = 0.015) was a negative prognostic indicator for disease-specific survival. In tumor stroma, high FGF2 (p = 0.024) expression correlated with good prognosis. In multivariate analyses, high expression of FGF2 in tumor cells (p = 0.038) was an independent negative prognostic factor whereas increased FGF2 in stroma (p = 0.015) was a positive prognosticator. Tumor cell coexpressions of FGF2/VEGFR-3 (p < 0.001) and FGFR-1/PDGF-B (p = 0.002) were significant indicators of poor prognosis.
Expression of FGF2 in tumor cells is an independent negative prognostic factor, and the coexpressions of FGF2/VEGFR-3 and FGFR-1/PDGF-B are strongly associated with poor survival in NSCLC patients.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 04/2009; 4(5):578-85. · 4.55 Impact Factor
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ABSTRACT: Protein expressions of angiogenic markers provide prognostic information on patients with non-small cell lung cancer (NSCLC). Both expression and its prognostic impact may be associated with patient selection. Data addressing the prognostic relevance of angiogenic marker expression in NSCLC patients treated with postoperative radiotherapy (PORT) is warranted.
In 55 patients with stage I-IIIA NSCLC administered PORT between 1990 and 2005, we have reviewed the clinicopathological variables and investigated the expression of angiogenic markers in tumor and stroma in tissue micro arrays.
The median follow-up was 114 months and the major end point disease-specific survival (DSS). Univariate analysis showed that high expression of vascular endothelial growth factor A (VEGF-A) (p = 0.004), VEGF receptor-1 (VEGFR-1, p = 0.028), VEGFR-2 (p = 0.021), VEGFR-3 (p = 0.001) and platelet derived growth factor (PDGF) in tumors correlated significantly with a poor survival. Inversely, high basic fibroblast growth factor (bFGF) expression in stroma was associated with significantly improved DSS (p = 0.017). In multivariate analyses, tumor PDGF expression appeared independently associated with a shorter DSS (hazard ratio 5.42, p = 0.002) and stromal bFGF expression an increased DSS (hazard ratio 0.077, p < 0.001).
Tumor PDGF expression was an independent negative prognostic factor and stromal bFGF expression an independent positive prognostic factor for survival in NSCLC receiving PORT.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 02/2009; 4(4):463-71. · 4.55 Impact Factor
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ABSTRACT: Smoking cessation is often attempted in the context of a lung cancer diagnosis. If cessation causes slowly continuing changes of total lung capacity and vital capacity, this may have consequences for lung volume, results of dose-volume histogram (DVH) analysis and targeting precision, in addition to changes in oxygenation, tumor biology (gene expression) and prognosis.
To address the impact of smoking cessation on radiation treatment of lung cancer, a literature review was performed.
Smoking cessation is associated with important benefits such as improved lung function and a better general health and performance status. In surgically and radiation treated patients, smoking cessation might lead to longer survival and reduced complications. Early data indicate that hypoxia in non-small cell lung cancer should be considered a poor prognostic factor. Yet, specific human data on how hypoxia is influenced by smoking status are not available. The influence of smoking history on the pneumonitis risk is not entirely clear. However, it appears that other factors outweigh the influence of smoking. The short-term effects of smoking cessation on lung function do not appear to cause relevant errors in treatment planning or targeting precision. Yet, no prospective study formally addressing this question was identified.
Smoking cessation appears to be prognostically beneficial. The role of hypoxia in this context requires more detailed evaluation.
Strahlentherapie und Onkologie 12/2008; 184(11):605-9. · 3.56 Impact Factor
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Andreas Hermes,
Bengt Bergman, Roy Bremnes,
Lars Ek,
Sverre Fluge,
Christer Sederholm,
Stein Sundstrøm,
Lars Thaning,
Jan Vilsvik,
Ulf Aasebø,
Sverre Sörenson
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ABSTRACT: A Japanese randomized trial showed superior survival for patients with extensive-disease (ED) small-cell lung cancer (SCLC) receiving irinotecan plus cisplatin compared with etoposide plus cisplatin. The present trial evaluated the efficacy of irinotecan plus carboplatin (IC) compared with oral etoposide plus carboplatin (EC).
Patients with ED SCLC were randomly assigned to receive either IC, which consisted of carboplatin (area under the curve = 4; Chatelut formula) and irinotecan (175 mg/m2) intravenously both on day 1, or EC, which consisted of carboplatin as in IC and etoposide (120 mg/m(2)/d) orally on days 1 through 5. Courses were repeated every 3 weeks with four cycles planned. Doses were reduced by one third in patients with a WHO performance status (PS) of 3 to 4 and/or age older than 70 years. Primary end point was overall survival (OS). Secondary end points were quality of life (QOL) and complete response (CR) rate.
Of 220 randomly assigned patients, 209 were eligible for analysis (IC, n = 105; EC, n = 104). Thirty-five percent were older than 70 years, and 47% had a PS of 2 to 4. The groups were well balanced with respect to prognostic factors. OS was inferior in the EC group (hazard ratio = 1.41; 95% CI, 1.06 to 1.87; P = .02). Median survival time was 8.5 months for IC compared with 7.1 months for EC. One-year survival rate was 34% for IC and 24% for EC. CR was seen in 18 IC patients compared with seven EC patients (P = .02). There were no statistically significant differences in hematologic grade 3 or 4 toxicity. Grade 3 or 4 diarrhea was more common in the IC group. QOL differences were small, with a trend toward prolonged palliation with the IC regimen.
IC prolongs survival in ED SCLC with slightly better scores for QOL.
Journal of Clinical Oncology 10/2008; 26(26):4261-7. · 18.37 Impact Factor
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ABSTRACT: To explore fear of recurrence (FoR) in long-term testicular cancer survivors (TCSs) since FoR hardly has been examined in TCSs.
In a cross-sectional questionnaire study, 1336 TCSs at a mean of 11.4 years (SD 4.2) after diagnosis gave information about their medical and social situation, and completed measures on mental distress, fatigue, quality of life, coping, self-esteem and neuroticism. FoR during the last week was explored with one question, with the response categories rated on a 4-point Likert scale. Nine percent of the TCSs had a structured psychiatric interview.
Twenty-four percent of the TCSs reported 'quite a bit' FoR and 7% reported 'very much' FoR during the last week. The FoR question showed moderate correlations (0.22-0.51) with established psychological measures. The level of FoR was significantly positively correlated with mental distress, fatigue and neuroticism and significantly negatively correlated with quality of life, self-esteem and coping. In univariate analyses, neurotoxic side effects and somatic symptoms, but not treatment modality, were significantly associated with level of FoR. In a multivariate analysis, a medium educational level, increasing levels of traumatic cancer-related stress symptoms and of neuroticism were significantly associated with rising FoR. Among those who had a psychiatric interview, the presence of at least one current mental disorder was significantly associated with FoR.
High levels of FoR in long-term TCSs are not uncommon. Levels of mental and somatic problems are associated with the levels of FoR. Clinical consequences of these findings for TCSs are discussed.
Psycho-Oncology 10/2008; 18(6):580-8. · 3.34 Impact Factor
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ABSTRACT: High prevalence of cancer-related fatigue (CRF) has been reported among many groups of cancer survivors when compared to the general population. However, this topic has rarely been studied in long-term survivors of testicular cancer (TCSs). The present multi-centre study examines the prevalence of chronic CRF in Norwegian TCSs compared to chronic general fatigue (GF) in the Norwegian general population, and associations between a variety of relevant variables and CRF in TCSs.
Participants were 1431 TCSs, aged 18-75, at an average of 11 years posttreatment (range 4.5-21 years), and a sample of 1080 age-matched men from the general Norwegian population (GenPop). The participants responded to a mailed questionnaire that included the Fatigue Questionnaire for the assessment of chronic CRF and chronic GF.
The prevalence of chronic CRF was 17.1% (95% CI 15.2-19.1%) among TCSs compared to 9.7% of chronic GF in GenPop (95% CI 8.0-11.5%). Regression analyses showed that poor quality of life (QOL), various psychosocial and somatic problems, and neuroticism were highly associated with presence of chronic CRF in TCSs.
Chronic CRF is far more common among TCSs than chronic GF in the general population and is associated with poor QOL and multiple psychological and somatic health problems. As a consequence, fatigue should be in focus during routine follow-ups as well as later in the general medical care of TCSs.
Journal of Psychosomatic Research 05/2008; 64(4):363-71. · 3.30 Impact Factor
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ABSTRACT: This study explores sexual function in a large unselected sample of Norwegian testicular cancer survivors (TCSs) by comparing the results with population data.
The study included 1084 TCSs aged 20-59 yr with mean follow-up time of 11.1 (range: 5-21) yr. They provided information about their medical, social, lifestyle, and familial situations on a questionnaire that included the Brief Male Sexual Function Inventory (BSFI). Outcome measures were mean BSFI domain scores and BSFI-based prevalence rates of sexual problems. The BSFI findings of an age-adjusted random sample of the Norwegian male population (N=929) constituted normative data (NORM). Descriptive statistics and logistic regression analyses were applied, and a significance level of <0.01 was applied.
Compared with NORM, TCSs had significantly worse scores on ejaculatory and sexual problems in both young (20-39 yr) and middle-aged (40-59 yr) groups. In the young group, sexual satisfaction was significantly better in TCSs versus NORM. Overall sexual problems were expressed by 38.8% of the TCSs versus 35.5% in NORM. In multivariate analyses, overall sexual problems in TCSs were significantly associated with increasing age, lack of a partner, and a higher anxiety score, while ejaculation problems showed significant association with lack of a partner, and a trend for chemotherapy and neurotoxic side effects (p=0.02).
Compared with NORM, ejaculatory function was compromised in TCSs. Overall sexual problems in TCSs were associated with factors also observed in NORM. Better sexual satisfaction in young TCSs compared with NORM should be noted.
European Urology 11/2007; 52(5):1438-47. · 8.49 Impact Factor
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ABSTRACT: The prevalence of long-term survivors after treatment for testicular cancer (TC) is increasing, and most studies display normal or only slightly reduced quality of life (QOL) in TC survivors (TCSs). Impaired QOL is claimed to be associated with treatment modality and its side effects, although most studies in this field can be criticized for various methodologic shortcomings. We wanted to examine variation in long-term QOL in TCSs in relation to TC treatment modality, side effects, and TC-related stress in a large population.
QOL, side effects, and TC-related stress were self-rated by a questionnaire at a mean of 11 years of follow-up in 1,409 TCSs treated from 1980 to 1994. Norm data was obtained from 2,678 males who were representative of the general population. QOL was measured with the Short Form-36 (SF-36), and TC-related stress was measured with the Impact of Event Scale.
There were no clinically relevant differences in QOL between TCSs and age-adjusted norm data, although there was a slightly lowered SF-36 Physical Component Summary Score in TCSs. Variation of QOL in TCSs was related to self-reported side effects and TC-related stress but not to TC treatment modality. A significant association was found between side effects and TC-related stress.
TCSs do not suffer long term from reduced QOL, and only minor differences in QOL were found between different treatment modalities. TCSs who report more side effects or TC-related stress have increased risk for reduced QOL, but these associations are not explained by TC treatment modalities. Further QOL research in this area should explore vulnerability factors for side effects and TC-related stress.
Journal of Clinical Oncology 06/2005; 23(13):3061-8. · 18.37 Impact Factor
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ABSTRACT: To compare the course of symptoms and health-related quality-of-life (HRQOL) after immediate thoracic radiotherapy (TRT) between symptomatic (S) and non-symptomatic (NS) patients with advanced NSCLC.
407 stage III/IV patients were initially treated with immediate TRT within a randomised phase III trial comparing different fractionation schedules. At inclusion, patients were prospectively stratified according to presence (S) or absence (NS) of tumour-related chest/airway symptoms to facilitate comparison between these groups. The EORTC QLQ-C30 and LC-13 were used for symptom and HRQOL assessments at baseline and at regular intervals up to 1 year (N=395).
NS patients had significantly more favourable baseline characteristics when compared to S patients with a median survival of 11.8 versus 6.0 months (P<0.0001), respectively. At baseline, S patients demonstrated HRQOL scores inferior to those of NS patients (P<0.01) for most scales. Until week 14, NS patients developed more symptoms while S patients experienced symptom relief in most scales. After week 14, no significant differences could be observed between the groups.
This study indicates that immediate TRT, given to patients with minimal/none chest symptoms, does not prevent development of disease-related symptoms and diminished HRQOL. A wait-and-see policy appears to be acceptable.
Radiotherapy and Oncology 05/2005; 75(2):141-8. · 5.58 Impact Factor
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ABSTRACT: To increase our knowledge of the prevalence of anxiety disorder and depression in long-term testicular cancer survivors (TCSs), and to identify variables associated with such caseness.
Participants were 1,408 TCSs treated between 1980 and 1994 in Norway. Participants provided information about their medical, social, and familial situation on a questionnaire. They also completed the Hospital Anxiety and Depression Scale (HADS). Anxiety disorder and depression were defined by a score >/= 8 on the HADS subscales. The prevalence rates were compared with age-adjusted norm data.
HADS-defined anxiety disorder was more prevalent in TCSs (19.2%; 95% CI, 17.2% to 21.3%) than in the norm sample (13.5%; 95% CI, 13.1% to 13.9%; P < .001), whereas the prevalence of HADS-defined depression did not differ from the norm (TCSs, 9.7%; 95% CI, 8.1% to 11.2% v norm, 10.1%, 95% CI, 9.5 to 10.5; P = .56). The relative risk for anxiety disorder was 1.49 (95% CI, 1.31 to 1.69) and for depression the relative risk was 0.96 (95% CI, 0.81 to 1.14) in TCSs compared with norm. In multivariate analyses, HADS-defined anxiety disorder in TCSs was associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, relapse anxiety, and having been treated for mental problems.
Long-term TCSs have an increased risk of HADS-defined anxiety disorder that warrants clinical attention. Checking easily available demographic and TC-related data and use of a simple screening test such as HADS assists the identification of TCSs with anxiety disorder.
Journal of Clinical Oncology 04/2005; 23(10):2389-95. · 18.37 Impact Factor
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Tidsskrift for den Norske laegeforening 05/2004; 124(7):982; author reply 982-3.
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ABSTRACT: To investigate whether the effect of hypofractionated thoracic radiotherapy (TRT) is comparable to more standard fractionated radiotherapy (RT) in advanced non-small-cell lung cancer (NSCLC).
A total of 421 patients with locally advanced stage III or stage IV NSCLC tumors were included. Inclusion criteria were inoperable, disease too advanced for curative radiotherapy, and chest symptoms or central tumor threatening the airways. Patients were randomly assigned to three arms: A, 17 Gy per two fractions (n = 146); B, 42 Gy per 15 fractions (n = 145); and C, 50 Gy per 25 fractions (n = 130). Four hundred seven patients were eligible for the study; 395 patients (97%) participated in the health-related quality-of-life (HRQOL) study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ-lung cancer-specific module (LC13) were used to investigate airway symptom relief and changes in HRQOL. Assessments were performed before TRT and until week 54. Clinicians' assessments of symptom improvement were at 2, 6, and 14 weeks after completion of TRT. The patients were observed for a minimum of 3 years. Results Baseline prognostic data were equally distributed in the treatment groups. Patient compliance with respect to the HRQOL investigation was minimum 74%. HRQOL and symptom relief were equivalent in the treatment arms. No significant difference in survival among arms A, B, and C was found, with median survival 8.2, 7.0, and 6.8 months, respectively.
Our data indicate that protracted palliative TRT renders no improvement in symptom relief, HRQOL, or survival when compared with short-term hypofractionated treatment in advanced NSCLC.
Journal of Clinical Oncology 04/2004; 22(5):801-10. · 18.37 Impact Factor
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ABSTRACT: The aim of this study was to examine satisfaction with the quality of the doctor-patient relationship (QCD) and the information (INF) made available, as well as the influence of different treatment modalities and psychosocial variables in testicular cancer survivors (TCSs).
Two-hundred and 6 TCSs, seen at 2 Norwegian university hospitals, were studied retrospectively and currently in a cross-sectional follow-up design. Questionnaires were filled in prior to and at the patients' follow-up examination. The mean length of time since their management period had ended was 6.5 years (range 0-17 years).
The QCD was rated higher than the INF. The QCD was also the strongest contributor to the variance in the INF. The patients in the surveillance group had the lowest QCD.
The relatively high QCD scores may reflect the fact that the patients had been cured from a life-threatening disease. The low INF scores may indicate that the TCSs were poorly informed about the potential health problems related to their treatment. Thus, it is suggested that more attention should be focused on the education of the patients.
Anticancer research 26(2B):1463-9. · 1.73 Impact Factor
