| 1. |
- Plym, Anna, et al.
(author)
-
Impact of chemotherapy, radiotherapy, and endocrine therapy on sick leave in women with early-stage breast cancer during a 5-year period : a population-based cohort study
- 2020
-
In: Breast Cancer Research and Treatment. - : Springer. - 0167-6806 .- 1573-7217. ; 182:3, s. 699-707
-
Journal article (peer-reviewed)abstract
- Purpose: To examine the influence of type of oncological treatment on sick leave in women of working age with early-stage breast cancer.Methods: We identified 8870 women aged 30-64 diagnosed with stage I-II breast cancer between 2005 and 2012 in the Breast Cancer Data Base Sweden. Associations between type of oncological treatment (radiotherapy, endocrine therapy, and chemotherapy) and sick leave were estimated by hazard ratios, probabilities, and length of sick leave using multi-state survival analysis.Results: During the first 5 years after diagnosis, women aged 50-54 years at diagnosis receiving chemotherapy spent on average 182 (95% CI 151-218) additional days on sick leave compared with women not receiving chemotherapy, but with otherwise similar characteristics. Correspondingly, women initiating endocrine therapy spent 30 (95% CI 18-44) additional days on sick leave and women receiving post-mastectomy radiotherapy 53 (95% CI 37-69) additional days. At year five, the rate of sick leave was increased in women who had received chemotherapy (HR 1.19, 95% CI 1.11-1.28) or endocrine therapy (HR 1.15, 95% CI 1.05-1.26). Chemotherapy and endocrine therapy were associated with increased rates of sick leave due to depression or anxiety.Conclusion: Our findings of increased long-term risks of sick leave after oncological treatment for breast cancer warrant attention from caregivers taking part in cancer rehabilitation. In light of the ongoing debate about overtreatment of early-stage breast cancer, our findings point to the importance of properly selecting patients for chemotherapy not only for the medical toxicity but also the possible impact on their livelihood.
|
|
| 2. |
- Shang, Ying, et al.
(author)
-
Association of diabetes with stroke and post-stroke dementia : A population-based cohort study
- 2020
-
In: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 16:7, s. 1003-1012
-
Journal article (peer-reviewed)abstract
- Introduction: The impact of prediabetes and diabetes on stroke and the development of dementia after a stroke remain unclear.Methods: A total of 2655 dementia-free participants (including a stroke-free cohort and a prevalent stroke cohort) were followed-up for 12 years. Dementia and post-stroke dementia were determined by clinical examinations and national registry data. Diabetes was ascertained via medical examination, medication use, medical records, or glycated hemoglobin (HbA1c) >= 6.5%. Prediabetes was defined as H bA1c >= 5.7% in diabetes-free participants.Results: In the stroke-free cohort, 236 participants developed ischemic stroke, and 47 developed post-stroke dementia. Diabetes was associated with ischemic stroke (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.16 to 2.67) and post-stroke dementia (HR 2.56, 95% CI 1.04 to 6.25). In the prevalent stroke cohort, diabetes was also related to dementia risk. Prediabetes was not significantly related to stroke or post-stroke dementia.Discussion: Diabetes, but not prediabetes, is associated with an increased risk of ischemic stroke and post-stroke dementia.
|
|
| 3. |
- Johansson, Anna L. V., et al.
(author)
-
Mortality in women with pregnancy-associated malignant melanoma
- 2014
-
In: The Journal of American Academy of Dermatology. - : Elsevier BV. - 0190-9622 .- 1097-6787. ; 71:6, s. 1093-1101
-
Journal article (peer-reviewed)abstract
- Background: Malignant melanoma (MM) is one of the most common malignancies in young women. It remains debated whether a MM diagnosed during pregnancy or lactation has a worse prognosis. Objective: We sought to examine mortality in women with pregnancy-associated MM (PAMM) (diagnosed during pregnancy and up to 2-years postpartum). Methods: This was a population-based cohort study based on information retrieved from the Swedish Cancer and Multi-Generation Registers. Hazard ratios with 95% confidence intervals adjusted for age, period, education, parity, and tumor location were estimated. Results: In total, 6857 women and girls aged 15 to 44 years with a diagnosis of cutaneous MM between 1963 and 2009 were identified. Of these, 1019 cases were classified as PAMM. The cause-specific mortality did not differ between PAMM and MM not diagnosed near childbirth (adjusted hazard ratio 1.09, 95% confidence interval 0.83-1.42). Limitations: Information on stage at diagnosis was available only for a subset of patients Conclusion: Overall, the cause-specific mortality in women and girls with PAMM did not differ from that in women and girls with non-PAMM. The current findings do not provide evidence of an adverse prognostic influence of pregnancy or a recent birth.
|
|
| 4. |
- Plym, Anna, et al.
(author)
-
Causes of sick leave, disability pension, and death following a breast cancer diagnosis in women of working age
- 2019
-
In: Breast. - : CHURCHILL LIVINGSTONE. - 0960-9776 .- 1532-3080. ; 45, s. 48-55
-
Journal article (peer-reviewed)abstract
- Objectives: Women diagnosed with breast cancer during working age are at increased risk of permanent absence from work, but the underlying medical causes have rarely been studied. We examined the risk of cause-specific sick leave, disability pension, and the competing event death after a breast cancer diagnosis in a population-based cohort study.Materials and methods: From the Breast Cancer Data Base Sweden, we identified 16,603 women diagnosed with stage I-III breast cancer between 2000 and 2012, and 63,773 control women. Using multi-state modelling, we calculated probabilities and durations of sick leave, disability pension, and death by registered cause, together with cause-specific hazard ratios.Results: Five years after diagnosis, causes other than cancer accounted for around half of all sick leave (3.5% out of 6.8% of women) and disability pension (1.4% out of 2.6%) in women with breast cancer. Compared with control women, women with breast cancer were at increased risk of sick leave and disability pension due to mental disorders (HR 1.24, 95% CI 1.15-1.33 and HR 1.54, 95% CI 1.29-1.85, respectively) and disability pension due to inflammatory diseases (HR 1.46, 95% CI 1.05-2.03). The risk of sick leave and disability pension due to cardiovascular disease was also elevated, although only statistically significant for disability pension in women diagnosed after 2005 (HR 2.24, 95% CI 1.22-4.13).Conclusion: Follow-up, support, and rehabilitation programs for women diagnosed with breast cancer must address a wide range of psychological and physical conditions to limit the consequences on working life.
|
|
| 5. |
- Gedeborg, Rolf, et al.
(author)
-
An Aggregated Comorbidity Measure Based on History of Filled Drug Prescriptions : Development and Evaluation in Two Separate Cohorts
- 2021
-
In: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 32:4, s. 607-615
-
Journal article (peer-reviewed)abstract
- Background: The ability to account for comorbidity when estimating survival in a population diagnosed with cancer could be improved by using a drug comorbidity index based on filled drug prescriptions.Methods: We created a drug comorbidity index from age-stratified univariable associations between filled drug prescriptions and time to death in 326,450 control males randomly selected from the general population to men with prostate cancer. We also evaluated the index in 272,214 control females randomly selected from the general population to women with breast cancer.Results: The new drug comorbidity index predicted survival better than the Charlson Comorbidity Index (CCI) and a previously published prescription index during 11 years of follow-up. The concordance (C)-index for the new index was 0.73 in male and 0.76 in the female population, as compared with a C-index of 0.67 in men and 0.69 in women for the CCI. In men of age 75-84 years with CCI = 0, the median survival time was 7.1 years (95% confidence interval [CI] = 7.0, 7.3) in the highest index quartile. Comparing the highest to the lowest drug comorbidity index quartile resulted in a hazard ratio (HR) of 2.2 among men (95% CI = 2.1, 2.3) and 2.4 among women (95% CI = 2.3, 2.6).Conclusions: A new drug comorbidity index based on filled drug prescriptions improved prediction of survival beyond age and the CCI alone. The index will allow a more accurate baseline estimation of expected survival for comparing treatment outcomes and evaluating treatment guidelines in populations of people with cancer.
|
|
| 6. |
- Plym, Anna
(author)
-
Breast and prostate cancer : the impact of diagnosis and treatment on sick leave and work
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- Treatment for breast or prostate cancer can have negative consequences on working life. In addition to sick leave during treatment, women and men with breast or prostate cancer are at increased risk of permanent absence from work, although data on the underlying reasons for this are sparse. The overall aim of this thesis was to study the impact of breast and prostate cancer and their specific treatments on sick leave and work using population-based Swedish register data. Studies I and II examined the influence of prostate cancer treatment on sick leave and receipt of disability pension. Two different types of surgery (robot- assisted and open retropubic radical prostatectomy) were studied in men with low-, intermediate- or high-risk prostate cancer, as were the treatment strategies (surgery, radiotherapy, or active surveillance) for men with low- or intermediate-risk prostate cancer. The studies included working-aged men diagnosed with prostate cancer from 2007 onward and matched prostate cancer-free men identified in the Prostate Cancer Data Base Sweden (PCBaSe). In 2,571 men with low-, intermediate- or high-risk prostate cancer (Study I), we found that robot-assisted surgery was associated with an earlier return to work compared with open surgery. Surgery type, however, had no influence on long-term rates of sick leave and disability pension receipt. In 8,699 men with low- or intermediate-risk prostate cancer (Study II), men on active surveillance spent less than half as many days on sick leave due to prostate cancer compared with those treated with primary radical prostatectomy or primary radiotherapy in the first 5 years after diagnosis. At year 5 after diagnosis, there were no major differences in the proportion of men on sick leave, disability pension, and death between treatment strategies. Studies III and IV were based on working-aged women diagnosed with breast cancer from 1997 onward and matched breast cancer-free women identified in the Breast Cancer Data Base Sweden (BCBaSe). In Study III, we quantified the permanent loss of working time due to breast cancer diagnosis and treatment. Permanent loss was defined as disability pension receipt of at least 75%, early old- age retirement, or death. The study included 19,661 women with breast cancer and 81,303 breast cancer-free women. We estimated that women aged 50 at diagnosis on average lost between 0 years (for in situ and subgroups of stage I breast cancer) and 8 years (for stage IV breast cancer) of their remaining working time due to breast cancer. Study IV examined the underlying causes of sick leave and disability pension receipt after a breast cancer diagnosis. In 16,603 women with stage I to stage III breast cancer, we found that cancer was the most commonly reported cause of sick leave and disability pension receipt, with cancer progression as the strongest determinant. In addition, sick leave and/or disability pension receipt due to lymphedema, fatigue-related conditions, mental disorders, cardiovascular diseases, and inflammatory diseases was more common in women with breast cancer compared with breast cancer-free women. The results of this thesis show that prostate cancer treatment type has an impact on sick leave and work mainly in the first year of diagnosis. Breast cancer may have a considerable impact on working life, although it is reassuring that many women with early-stage breast cancer are able to remain in the labor market. Disease progression is not the only reason for absence from work in women with breast cancer; our findings suggest that a wide range of physical and physiological conditions underlie the increased risk of permanent absence from work observed in both our studies and others. As a whole, the findings of this thesis can be used to improve the management and rehabilitation of breast and prostate cancer diagnosed in working-aged women and men.
|
|
| 7. |
- Plym, Anna, et al.
(author)
-
Clinical characteristics, management and survival in young adults diagnosed with malignant melanoma : A population-based cohort study
- 2014
-
In: Acta Oncologica. - 0284-186X .- 1651-226X. ; 53:5, s. 688-696
-
Journal article (peer-reviewed)abstract
- Background. Few studies to date have described the clinical features of malignant melanoma in young adulthood. Also, little is known about patterns of care in young patients. We examined and compared clinical characteristics, management and survival between young adult (15-39 years) and older adult melanoma patients in Central Sweden. Material and methods. Patients diagnosed with invasive malignant melanoma between 1997 and 2011 were identified in the Regional Quality Register of Cutaneous Malignant Melanoma in Central Sweden, a population-based register covering a source population of about two million. Data on clinical characteristics, management and survival were retrieved and compared according to age at diagnosis. Results. Of 5915 patients included in the study, 584 (9.9%) were between 15 and 39 years of age at diagnosis. Compared with older patients, young adult patients were more likely to be female, with higher proportions of thin, non-ulcerated melanomas, superficial spreading melanoma and melanomas located on the lower extremity. Young adults had shorter waiting times for surgical procedures and a higher proportion received surgical treatment according to guidelines. Overall, young patients had better relative survival than older patients. Age-related survival differences varied by stage of disease at diagnosis, and were most prominent in stage II disease. Conclusion. The observed differences in clinical characteristics, management and survival between young adult and older melanoma patients call for an improved understanding of not only disease etiology but also factors driving management decisions. A better understanding of these differences may help improve care and prognosis for melanoma patients of all ages.
|
|
| 8. |
- Plym, Anna, et al.
(author)
-
Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer
- 2014
-
In: Journal of Sexual Medicine. - : Elsevier. - 1743-6095 .- 1743-6109. ; 11:8, s. 2100-2108
-
Journal article (peer-reviewed)abstract
- Introduction: Despite the high prevalence of erectile dysfunction (ED) in men with prostate cancer, little is known about the use of ED drugs. Also, the possible influence of socioeconomic factors on ED drug use has not been studied previously.Aim: The aim of this study was to examine determinants and patterns of ED drug use before and after diagnosis in men with localized prostate cancer.Methods: Using a nationwide population‐based cohort, 25,390 men with localized prostate cancer diagnosed between 2006 and 2009 and 126,944 control men were identified and followed for filled ED drug prescriptions over a 3‐year period, ranging from 1 year before and up to 2 years after diagnosis.Main Outcome Measures: The main outcome measure was the proportion of men with at least one filled ED drug prescription after diagnosis.Results: The number of men using ED drugs increased markedly following diagnosis. Men who underwent radical prostatectomy had the strongest increase, with a cumulative proportion of 74% for at least one filled prescription within the first 2 years after diagnosis. The corresponding proportion was 33% in men treated with radiotherapy, 21% in men on active surveillance, 10% in men on watchful waiting, and 8% in control men. Among men who underwent prostatectomy, usage attenuated over time. Determinants of postdiagnostic use were young age at diagnosis, high income, high education, and a low‐ or intermediate‐risk cancer.Conclusion: Although drugs for ED are commonly prescribed after diagnosis, use among most men is transient and influenced by socioeconomic status. Posttreatment counseling and affordable ED drugs are likely to reduce treatment dropout and disparities in use and help improve sexual health and quality of life in men with prostate cancer.
|
|
| 9. |
- Plym, Anna, et al.
(author)
-
Duration of sick leave after active surveillance, surgery or radiotherapy for localised prostate cancer : a nationwide cohort study
- 2020
-
In: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 10:3
-
Journal article (peer-reviewed)abstract
- Objectives: To compare the loss of working time due to sick leave by treatment strategy for localised prostate cancer.Design: Nationwide cohort study.Setting: Sweden.Participants: A total of 15 902 working-aged men with localised low or intermediate-risk prostate cancer diagnosed during 2007-2016 from the Prostate Cancer Data Base Sweden, together with 63 464 prostate cancer-free men. Men were followed until 2016.Primary and secondary outcome measures: Using multistate Markov models, we calculated the proportion of men on work, sick leave, disability pension and death, together with the amount of time spent in each state. All-cause and cause-specific estimates were calculated.Results: During the first 5 years after diagnosis, men with active surveillance as their primary treatment strategy spent a mean of 17 days (95% CI 15 to 19) on prostate cancer-specific sick leave, as compared with 46 days (95% CI 44 to 48) after radical prostatectomy and 44 days (95% CI 38 to 50) after radiotherapy. The pattern was similar after adjustment for cancer and sociodemographic characteristics. There were no differences between the treatment strategies in terms of days spent on sick leave due to depression, anxiety or stress. Five years after diagnosis, over 90% of men in all treatment strategies were free from sick leave, disability pension receipt and death from any cause.Conclusions: Men on active surveillance experienced less impact on working life compared with men who received radical prostatectomy or radiotherapy. From a long-term perspective, there were no major differences between treatment strategies. Our findings can inform men diagnosed with localised prostate cancer on how different treatment strategies may affect their working lives.
|
|
| 10. |
- Plym, Anna, et al.
(author)
-
Loss in working years after a breast cancer diagnosis
- 2018
-
In: British Journal of Cancer. - : NATURE PUBLISHING GROUP. - 0007-0920 .- 1532-1827. ; 118:5, s. 738-743
-
Journal article (peer-reviewed)abstract
- Background: Breast cancer can negatively influence working life, but it is unclear how many working years women with breast cancer can expect to lose. Methods: Women diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N = 19 661), together with breast cancer-free comparison women (N = 81 303). Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and without breast cancer. Results: Women aged 50 years at diagnosis with stage I disease lost on average 0.5 years (95% CI, 0.2-0.7) of their remaining working time; the corresponding estimates were 0.9 years (0.5-1.2) in stage II, 2.5 years (1.9-3.1) in stage III and 8.1 years (6.5-9.7) in stage IV. Women with in situ breast cancer did not lose any working years. The strongest treatment determinant was axillary lymph node dissection. Conclusions: We found a loss in working years not only in late but also in early-stage breast cancer. Although it is reassuring that some groups had no or only a modest work loss, the economic consequences for society are considerable given the large number of women annually diagnosed with breast cancer.
|
|
| 11. |
|
|
| 12. |
- Plym, Anna, et al.
(author)
-
Work Disability After Robot-assisted or Open Radical Prostatectomy : A Nationwide, Population-based Study
- 2016
-
In: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 70:1, s. 64-71
-
Journal article (peer-reviewed)abstract
- Background: Robot-assisted radical prostatectomy (RARP) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy (RRP), but it is unclear whether these differences translate into shorter absence from work. Objective: To investigate short-and long-term rates of work disability following RARP and RRP. Design, setting, and participants: We conducted a nationwide population-based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden. Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012. Outcome measurements and statistical analysis: We used Cox regression to calculate time to return to work (RTW, or duration of sick leave) after surgery and used generalised estimating equations to analyse days lost from work (because of sick leave and disability pension) after RTW. Results and limitations: Men treated with RARP returned to work after a median of 35 d, whereas the corresponding time for RRP was 48 d (p < 0.001). The difference was seen early; within the first month, men treated with RARP returned to work nearly four times faster than men treated with RRP (adjusted relative RTW rate 3.76; 95% confidence interval [CI], 3.04-4.66). During a median of 3.6 yr after return to work, men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant (p = 0.10). The adjusted rate ratio was 1.08 (95% CI, 0.82-1.42). One limitation is the nonrandomised design of this study. Conclusions: RARP was associated with a faster RTW compared with RRP, but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW. Patient summary: We compared disease-related absence from work between two surgical methods for the removal of the prostate. Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective.
|
|
| 13. |
- Wang, Anqi, et al.
(author)
-
Characterizing prostate cancer risk through multi-ancestry genome-wide discovery of 187 novel risk variants
- 2023
-
In: Nature Genetics. - : Springer Nature. - 1061-4036 .- 1546-1718. ; 55:12, s. 2065-2074
-
Journal article (peer-reviewed)abstract
- The transferability and clinical value of genetic risk scores (GRSs) across populations remain limited due to an imbalance in genetic studies across ancestrally diverse populations. Here we conducted a multi-ancestry genome-wide association study of 156,319 prostate cancer cases and 788,443 controls of European, African, Asian and Hispanic men, reflecting a 57% increase in the number of non-European cases over previous prostate cancer genome-wide association studies. We identified 187 novel risk variants for prostate cancer, increasing the total number of risk variants to 451. An externally replicated multi-ancestry GRS was associated with risk that ranged from 1.8 (per standard deviation) in African ancestry men to 2.2 in European ancestry men. The GRS was associated with a greater risk of aggressive versus non-aggressive disease in men of African ancestry (P = 0.03). Our study presents novel prostate cancer susceptibility loci and a GRS with effective risk stratification across ancestry groups.
|
|
