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- Barot, Shabane, et al.
(författare)
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Combined associations of a healthy lifestyle and body mass index with colorectal cancer recurrence and survival : a cohort study
- 2024
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Ingår i: Cancer Causes and Control. - : Springer Nature. - 0957-5243 .- 1573-7225. ; 35:2, s. 367-376
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Colorectal cancer (CRC) risk is associated with modifiable lifestyle factors including smoking, physical inactivity, Western diet, and excess body weight. The impact of lifestyle factors on survival is less known. A cohort study was conducted to investigate the combined effects of a healthy lifestyle and body mass index on prognosis following CRC diagnosis.METHODS: Treatment and follow-up data were collected from the patient files of 1098 participants from the Colorectal cancer low-risk study cohort including stage I-III CRC patients. A healthy lifestyle and BMI (HL) score was computed using self-reported data on smoking status, physical activity, adherence to a Mediterranean diet pattern, and BMI, and divided into four categories ranging from least to most healthy. Survival analyses were performed to assess recurrence-free survival and overall survival across categories of exposure, using the Kaplan-Meier method and Cox proportional hazards models adjusted for age, sex, and educational level.RESULTS: Among 1098 participants with stage I-III CRC, 233 (21.2%) had an HL score of 0-1 (least healthy), 354 (32.2%) HL score of 2, 357 (32.5%) HL score of 3 and 154 (14.0) HL score 4 (most healthy). Patients with the healthiest lifestyle (HL score 4) compared to the least healthy (HL score 0-1) had an improved recurrence-free survival (HL 4 vs HL 0-1, HRadj 0.51 (95% CI 0.31-0.83) and overall survival (HL 4 vs HL 0-1, HRadj 0.52 (95% CI 0.38-0.70).CONCLUSION: Adherence to a healthy lifestyle may increase the recurrence-free and overall survival of patients with stage I-III CRC.
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| 2. |
- Bozorg, Soran Rabin, 1993-
(författare)
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Various Aspects of Gastrointestinal Disease : Examining Validity and Health Economic Outcomes
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Recent years have seen significant research advances within the gastroenterological field. Some of these consist of the recognition of serrated polyps as a precursor to colorectal cancer, and the realization of the health economic burden associated with gastrointestinal diseases.Aim: In this thesis, we aim to validate the specificity of serrated polyps in the ESPRESSO cohort (Paper I). We also aim to estimate work loss in patients with celiac disease, including the temporal relationship of work loss before and after diagnosis (Paper II).Method: By using the ESPRESSO cohort, we collected data on patients with serrated polyps and patients with celiac disease. In Paper I, the specificity of serrated polyps in the ESPRESSO cohort were validated by a structured retrospective review of patient chart. In Paper II, we estimated work loss in patients with celiac disease as compared withgeneral-population comparators matched on age, sex, county of residence and year of diagnosis.Result: The presence of a serrated polyp was confirmed in 101 out of 106 individuals identified through the ESPRESSO cohort, yielding a positive predictive value of 95% (95% confidence interval: 89-98%). Patients with celiac disase had 42.5 lost work days as compared to 28.6 days in comparators (mean difference, 14.7; 95% confidence interval, 13.2-16.2), corresponding to a relative increase of 49%. Excess work loss in patients with celiac disease was observed even 5 years before diagnosis and remained eleveated during the years after diagnosis this loss. Notebly, the excess work loss was concentrated to a small proportion while most celiac patients did not have any work loss before or after diagnosis. Conclusion: The ESPRESSO cohort has a high specificity for serrated polyps. Patients with celiac disease miss more work days than the general population even before diagnosis, and this loss persists after diagnosis.
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| 3. |
- Hallqvist Everhov, Åsa
(författare)
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Hormonal consequences, replacement therapy, and lost workdays after cervical cancer treatment
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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-Müllerian 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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| 4. |
- Olén, Ola, et al.
(författare)
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Increasing Risk of Lymphoma Over Time in Crohn's Disease but Not in Ulcerative Colitis : A Scandinavian Cohort Study
- 2023
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier. - 1542-3565 .- 1542-7714. ; 21:12, s. 3132-3142
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Earlier studies have provided varying risk estimates for lymphoma in patients with inflammatory bowel disease (IBD), but often have been limited by detection biases (especially during the first year of follow-up evaluation), misclassification, and small sample size; and rarely reflect modern-day management of IBD.Methods: We performed a binational register-based cohort study (Sweden and Denmark) from 1969 to 2019. We compared 164,716 patients with IBD with 1,639,027 matched general population reference individuals. Cox regression estimated hazard ratios (HRs) for incident lymphoma by lymphoma subtype, excluding the first year of follow-up evaluation.Results: From 1969 to 2019, 258 patients with Crohn's disease (CD), 479 patients with ulcerative colitis (UC), and 6675 matched reference individuals developed lymphoma. This corresponded to incidence rates of 35 (CD) and 34 (UC) per 100,000 person-years in IBD patients, compared with 28 and 33 per 100,000 person-years in their matched reference individuals. Although both CD (HR, 1.32; 95% CI, 1.16–1.50) and UC (HR, 1.09; 95% CI, 1.00–1.20) were associated with an increase in lymphoma, the 10-year cumulative incidence difference was low even in CD patients (0.08%; 95% CI, 0.02–0.13). HRs have increased in the past 2 decades, corresponding to increasing use of immunomodulators and biologics during the same time period. HRs were increased for aggressive B-cell non-Hodgkin lymphoma in CD and UC patients, and for T-cell non-Hodgkin lymphoma in CD patients. Although the highest HRs were observed in patients exposed to combination therapy (immunomodulators and biologics) or second-line biologics, we also found increased HRs in patients naïve to such drugs.Conclusions: During the past 20 years, the risk of lymphomas have increased in CD, but not in UC, and were driven mainly by T-cell lymphomas and aggressive B-cell lymphomas.
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