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Purpose@#This study investigated pathological complete response (pCR) according to androgen receptor (AR) in breast cancer patients undergoing neoadjuvant chemotherapy and estimated the relationship between AR expression and clinicopathological factors. @*Materials and Methods@#We identified 624 breast cancer patients who underwent surgery after neoadjuvant chemotherapy at the National Cancer Center in Goyang, Korea from April 2016 to October 2019. We retrospectively collected the clinicopathologic information and AR expression results and analyzed the data according to cancer stage, hormonal receptor (HR) status, human epidermal growth factor receptor 2 (HER2) status, tumor subtype, and pCR. @*Results@#Among the 624 breast cancer patients, 529 (84.8%) were AR-positive (AR+) patients and 95 (15.2%) were AR-negative (AR–) patients. AR+ patients showed more estrogen receptor (ER) positivity, progesterone receptor (PR) positivity, HER2-positivity, and HR-positive and HER2-negative (HR+/HER2–) subtype. The rate of pCR was 31.4% (196/624). AR– patients had a significantly higher rate of pCR than AR+ patients (AR– 43.2% vs. AR+ 29.3%, p=0.007). The tumor factors associated with pCR were early stage, histologic grade 3, ER-negative, PR-negative, AR-negative, HER2-positive, and high Ki-67 values. In univariable analysis, AR+ significantly decreased the state of pCR (odds ratio, 0.546; 95% confidence interval, 0.349 to 0.853; p=0.008). According to tumor subtype, AR– tumor showed higher pCR rate in HR+/HER2– subtype (AR– 28.6% vs. AR+ 7.3%, p=0.022). @*Conclusion@#AR expression is predominant in the HR+/HER2– subtype. AR– is significantly associated with the pCR rate in breast cancer patients, especially within HR+/HER2– subtype. When determining neoadjuvant chemotherapy for the HR+/HER2– subtype, AR expression can be considered as a pCR predictive marker.
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Purpose@#Microinvasive breast cancer (MIBC) is an invasive carcinoma with a tumor dimension not exceeding 1 mm. Owing to its low incidence, the rate of axillary node metastasis and its management are not well established. The aim of this study was to assess the incidence of lymph node metastasis (LNM) and identify variables associated with LNM, as well as to evaluate the need for axillary staging in MIBC patients by analyzing nationwide data. @*Methods@#The Korean Breast Cancer Society registry was searched to identify MIBC patients diagnosed between January 1996 and April 2020. Patients without neoadjuvant chemotherapy experiences, systemic metastasis, and missing or discordant data were eligible for the analysis. The incidence rate of LNM was determined, and variables associated with LNM were identified by multivariable regression analysis. @*Results@#Of 2,427 MIBC patients identified, 98 (4.0%) had LNM and 12 (0.5%) had N2/3 disease. Type of breast operation (odds ratio [OR], 2.093; 95% confidence interval [CI], 1.332–3.290; P = 0.001), age (OR, 2.091; 95% CI, 1.326–3.298; P = 0.002), hormone receptor status (OR, 2.220; 95% CI, 1.372–3.594; P = 0.001), and lymphovascular invasion (OR, 11.143; 95% CI, 6.354–19.540; P < 0.001) were significantly related to LNM. @*Conclusion@#The incidence of LNM in MIBC patients was only 4.0% in our study, suggesting that de-escalation of axillary surgical interventions could be carefully considered. The indications for axillary staging should be individualized considering tumor volume, age, hormone receptor status, and lymphovascular invasion to improve the quality of life of MIBC survivors.
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Purpose@#This study compares the snacking pattern, diet, lifestyle, and food preference of children by evaluating the most frequently eaten snacks. @*Methods@#The survey enrolled 435 students from three elementary schools in Gyeonggi. Based on the most frequently eaten snacks, the subjects were divided into 3 groups: fruits and milk/dairy products for natural snacks (NS, n = 114); noodles, snack foods and fast foods for meal-like snacks (MS, n = 74); cookies, beverages and bread as sweet snacks (SS, n = 247). @*Results@#Compared to the MS group, preferences of the NS group were significantly higher for jabgokbap (cooked rice with multi-grains, p < 0.05) and saengchae (seasoned raw vegetables, p < 0.01), and significantly lower for gogitwigim (deep-fried meat, p < 0.05). Taste preference of the NS group was considered to be more desirable; the taste preference of more subjects was ‘sweet taste’ in the SS group, ‘spicy taste’ in the MS group, ‘salty taste’ in the MS and SS groups, and ‘sour taste’ and ‘bland taste’ in the NS group than the other groups. Compared tothe MS and SS groups, the NS group was determined to exercise more frequently; exercising for more than 30 minutes/day was determined to be 76.3% in the NS group and 58.1% and 57.9% in the other groups (p < 0.01). Moreover, a higher proportion of subjects in the MS group tended to answer ‘not hungry’ as the reason for leaving school meals, as compared to other groups (p = 0.055), thereby suggesting that inappropriate snacking habits interfere with regular meals. @*Conclusion@#This study provides evidence that healthy snacking habits, which include natural snacks such as milk/dairy products and fruits, are important for children during the elementary school years, since these habits are associated with healthier diet, lifestyle, and food and taste preferences. These results provide basic information for developing nutritional education materials for elementary school children.
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Purpose@#Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph nodepositive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC. @*Methods@#This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND. @*Results@#This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6–155) in the SLNB group and 99 (range 2–159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% (p = 0.392), and 89.2% and 86.4% (p = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, p = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, p < 0.001). @*Conclusion@#As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.
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Purpose@#This study was performed to identify the risk of mortality in patients diagnosed with human epidermal growth factor receptor 2 (HER2)-positive ductal carcinoma in situ (DCIS). @*Methods@#We selected 2,592 patients with HER2-positive DCIS from Korean Breast Cancer Society (KBCS) database between January 1997 and December 2019. Patients who received neoadjuvant chemotherapy were excluded. Logistic regression analysis was used to determine the association between clinical factors and overall death after adjusting for tumor and clinical characteristics. Mortality data were modified using the Statistics Korea data. @*Results@#Thirty deaths (1.2%) were identified out of 2,592 patients in the KBCS database. In the univariate logistic regression analysis, older age, higher body mass index (BMI), type of breast surgery (mastectomy), estrogen receptornegative, progesterone receptor-negative, and exposure to endocrine therapy were significant clinical factors associated with death. In the multivariate analysis, age (hazard ratio [HR], 1.062; 95% confidence interval [CI], 1.015–1.111; P = 0.006), BMI (HR, 1.179; 95% CI, 1.032–1.347, P = 0.016), breast surgery type (mastectomy vs. lumpectomy; HR, 0.285; 95% CI, 0.096–0.844; P = 0.024), and endocrine therapy (HR, 0.314; 95% CI, 0.099–0.995; P = 0.049) were significant risk factors for mortality. @*Conclusion@#Advanced age, higher BMI, mastectomy, and the absence of endocrine therapy were factors associated with poor survival of patients with HER2-positive DCIS. This finding requires further validation combined with additional analysis of large databases.
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At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.
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At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.
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Purpose@#The ACOSOG Z0011 trial has proven the oncological safety of sentinel lymph node biopsy (SLBx) for node negative breast cancer. Accordingly, treatment paradigm including axilla surgery was changed. We retrospectively reviewed breast cancer patients to evaluate the clinical effect of paradigm shift in breast cancer surgery after applying the Z0011 criteria. @*Methods@#All women who underwent breast-conserving surgery at the National Cancer Center between January 1, 2000, and December 31, 2015, were enrolled and classified according to the Z0011 criteria. The primary endpoint of the study was the disease-free survival rates, and the secondary was the adverse events, especially arm lymphedema. @*Results@#Total 361 patients were enrolled the study (271 axillary lymph node dissection [ALND] group, 90 SLBx group). After the Z0011 guideline was adopted in our institute, the use of ALND decreased, and lymph node sampling (removing only a few axillary lymph nodes) replaced ALND. The total mean number of retrieved nodes were more in ALND group (13.02) than SLBx group (3.43). However, there was no difference in the mean number of positive nodes between two groups (2.34 in ALND group vs. 1.12 in SLBx group, P=0.001). During follow-up, 25 patients experienced disease recurrence: 22 from the ALND group and three from the SLBx group. All of died seven patients were from the ALND group. The ALND group had more complications than the SLBx group (P=0.02). Arm edema occurred more frequently in the ALND group (29.5%) than in the SLBx group (5.6%), although without statistical significance (P=0.07). @*Conclusion@#In our study, we concluded that SLBx can be used safely in Z0011-eligible cohort without increased risk of locoregional recurrence. Moreover, we found that omission of ALND is favored to reduce some serious complications such as arm lymphedema.
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Purpose@#This study was an quasi-experimental study to compare the effect of applying polyethylene wrap and aircap in maintaining body temperature of preterm infants. @*Methods@#The participants were 51 preterm infants.Aircap was applied to the experimental group (n=23) and polyethylene wrap was applied to the control group (n=28) when the preterm infants admitted to neonatal intensive care unit. The data was collected at W hospital in J-province from June 2016 to May 2017. A total of 9 body temperature measurements were taken at 3 hours interval from 5 min to 24 hours after admission. Repeated measure ANOVA, independent t-test and x 2 test were conducted used with SPSS/WIN 24.0 @*Results@#There were no significant difference in the homogeneity tests for general characteristics and dependent variables prior to the experiments (t=0.57, p=.566). There was a significant difference on body temperature of preterm infants over time (F=3.24, p=.020). There was no significant difference on body temperature between polyethylene wrap and aircap application groups (F=1.29, p=.261). The interaction between the group and the time was insignificant (F=1.51, p=.214). @*Conclusion@#The findings demonstrated that both methods of applying polyethylene wrap and aircap on the body in preterm infants had effect in maintaining body temperature.
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The development of refractory tumor cells limits therapeutic efficacy in cancer by activating mechanisms that promote cellular proliferation, migration, invasion, metastasis, and survival. Benzimidazole anthelmintics have broad-spectrum action to remove parasites both in human and veterinary medicine. In addition to being antiparasitic agents, benzimidazole anthelmintics are known to exert anticancer activities, such as the disruption of microtubule polymerization, the induction of apoptosis, cell cycle (G2/M) arrest, anti-angiogenesis, and blockage of glucose transport. These antitumorigenic effects even extend to cancer cells resistant to approved therapies and when in combination with conventional therapeutics, enhance anticancer efficacy and hold promise as adjuvants. Above all, these anthelmintics may offer a broad, safe spectrum to treat cancer, as demonstrated by their long history of use as antiparasitic agents. The present review summarizes central literature regarding the anticancer effects of benzimidazole anthelmintics, including albendazole, parbendazole, fenbendazole, mebendazole, oxibendazole, oxfendazole, ricobendazole, and flubendazole in cancer cell lines, animal tumor models, and clinical trials. This review provides valuable information on how to improve the quality of life in patients with cancers by increasing the treatment options and decreasing side effects from conventional therapy.
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Objective@#The emergency medical service (EMS) is expected to improve the prognosis of patients suffering from acutemyocardial infarction (AMI). We investigated the impact of utilizing EMS on the clinical outcomes of AMI patients. @*Methods@#From November 2011 to November 2015, a total of 13,102 patients in the Korea Acute Myocardial InfarctionRegistry-National Institute of Health (KAMIR-NIH) registry were enrolled. Patients were divided into two groups: the EMSgroup, first medical contact (FMC) with 119; the non-EMS group, the FMC at local hospitals that were not available forpercutaneous coronary intervention. The authors analyzed the mortality and major adverse cardiac and cerebrovascularevents during one-year of clinical follow-up. @*Results@#A total of 8,863 patients were finally analyzed for this study, and a total of 1,999 patients (22.6%) utilized theEMS as FMC. The patients utilizing EMS were more frequently diagnosed with ST-segment elevation AMI. At presentation,the EMS group had a higher incidence of Killip class IV, and they had a shorter symptom-to-door time than non-EMS group. The patients utilizing EMS had higher incidence of peri-procedural complications and in-hospital mortality.The multivariate logistic regression analysis with backward elimination revealed that utilizing EMS is an independent factorfor predicting lower one-year mortality. @*Conclusion@#This study has demonstrated that the high-risk AMI patients can utilize the EMS in Korea. The EMS grouphas more favorable clinical outcome during one-year follow-up after discharge than the non-EMS group, whereas it had ahigher rate of death during hospitalization compared with that of the non-EMS group.
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Purpose@#Hereditary cancer syndrome means that inherited genetic mutations can increase a person's risk of developing cancer. We assessed the frequency of germline mutations using an nextgeneration sequencing (NGS)–based multiple-gene panel containing 64 cancer-predisposing genes in Korean breast cancer patients with clinical features of hereditary breast and ovarian cancer syndrome (HBOC). @*Materials and Methods@#A total of 64 genes associated with hereditary cancer syndrome were selected for development of an NGS-based multi-gene panel. Targeted sequencing using the multi-gene panel was performed to identify germline mutations in 496 breast cancer patients with clinical features of HBOC who underwent breast cancer surgery between January 2002 and December 2017. @*Results@#Of 496 patients, 95 patients (19.2%) were found to have 48 deleterious germline mutations in 16 cancer susceptibility genes. The deleterious mutations were found in 39 of 250 patients (15.6%) who had breast cancer and another primary cancer, 38 of 169 patients (22.5%) who had a family history of breast cancer (≥ 2 relatives), 16 of 57 patients (28.1%) who had bilateral breast cancer, and 29 of 84 patients (34.5%) who were diagnosed with breast cancer at younger than 40 years of age. Of the 95 patients with deleterious mutations, 60 patients (63.2%) had BRCA1/2 mutations and 38 patients (40.0%) had non-BRCA1/2 mutations. We detected two novel deleterious mutations in BRCA2 and MLH1. @*Conclusion@#NGS-based multiple-gene panel testing improved the detection rates of deleterious mutations and provided a cost-effective cancer risk assessment.
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Purpose@#This study aimed to determine the incidence of male breast cancer (MBC) and its survival outcomes in Korea, and to compare these results to those for female breast cancer (FBC). @*Materials and Methods@#We searched the Korea Central Cancer Registry and identified 227,122 breast cancer cases that were diagnosed between 1999 and 2016. Demographic and clinical characteristics and overall survival (OS) rates were estimated according to sex, age, histological type, and cancer stage. @*Results@#The 227,122 patients included 1,094 MBC cases and 226,028 FBC cases. Based on the age-standardized rate, the male: female ratio was 0.0055:1. The most common ages at diagnosis were 60-69 years for MBC and 40-49 years for FBC (p < 0.001). Male patients were less likely than female patients to receive adjuvant radiotherapy (7.5% vs. 21.8%, p < 0.001) or adjuvant chemotherapy (40.1% vs. 55.4%, p < 0.001). The 5-year OS rates after diagnosis were 88.8% for all patients, although it was significantly lower for MBC than for FBC (76.2% vs. 88.9%, p < 0.001). In both groups, older age (≥ 60 years) was associated with shorter survival. The 5-year OS rates for the invasive histological types were 75.8% for men and 89.0% for women. The 5-year OS rates in both groups decreased with increasing cancer stage. @*Conclusion@#MBC was diagnosed at older ages than FBC, and male patients were less likely to receive radiotherapy and chemotherapy. The survival outcomes were worse for MBC than for FBC, with even poorer outcomes related to older age, the inflammatory histological types, and advanced stage. It is important that clinicians recognize the differences between FBC and MBC when treating these patients.
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Purpose@#This study reports the cancer statistics and temporal trends in Korea on a nationwide scale,including incidence, survival, prevalence, and mortality in 2017. @*Materials and Methods@#The incidence, survival, and prevalence rates of cancer were evaluated using data from theKorea National Cancer Incidence Database from 1999 to 2017 with follow-up until December31, 2018. Deaths from cancer were assessed using cause-of-death data from 1983 to2017, obtained from Statistics Korea. Crude and age-standardized rates (ASRs) for incidence,mortality, and prevalence, and 5-year relative survival rates were calculated andtrend analysis was performed. @*Results@#In 2017, newly diagnosed cancer cases and deaths from cancer numbered 232,255 (ASR,264.4 per 100,000) and 78,863 (ASR, 76.6 per 100,000), respectively. The overall cancerincidence rates increased annually by 3.5% from 1999 to 2011 and decreased by 2.7%annually thereafter. Cancer mortality rates have been decreasing since 2002, by 2.8%annually. The 5-year relative survival rate for all patients diagnosed with cancer between2013 and 2017 was 70.4%, which contributed to a prevalence of approximately 1.87 millioncases by the end of 2017. @*Conclusion@#The burden of cancer measured by incidence and mortality rates have improved in Korea,with the exception of a few particular cancers that are associated with increasing incidenceor mortality rates. However, cancer prevalence is increasing rapidly, with the dramaticimprovement in survival during the past several years. Comprehensive cancer control strategiesand efforts should continue, based on the changes of cancer statistics.
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Purpose@#This study aimed to report the projected cancer incidence and mortality for the year 2020to estimate Korea’s current cancer burden. @*Materials and Methods@#Cancer incidence data from 1999 to 2017 were obtained from the Korea National CancerIncidence Database, and cancer mortality data from 1993 to 2018 were acquired from StatisticsKorea. Cancer incidence and mortality were projected by fitting a linear regressionmodel to observed age-specific cancer rates against observed years and then by multiplyingthe projected age-specific rates by the age-specific population. A Joinpoint regression modelwas used to determine the year in which the linear trend changed significantly; we only usedthe data of the latest trend. @*Results@#In total, 243,263 new cancer cases and 80,546 cancer deaths are expected to occur inKorea in 2020. The most common cancer site is expected to be the lung, followed by thestomach, thyroid, colon/rectum, and breast. These five cancers types are expected to representhalf of the overall burden of cancer in Korea. The most common type of canceramong people who die is expected to be lung cancer, followed by liver, colon/rectal, pancreatic,and stomach cancers. @*Conclusion@#The incidence rates for all types of cancer in Korea are estimated to decrease gradually.These up-to-date estimates of the cancer burden in Korea could be an important resourcefor planning and evaluating cancer-control programs.
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Purpose@#The purpose of this study was to determine the rate and outcomes of pregnancies subsequentto breast cancer in Korea, and the effect of such pregnancies on the prognosis ofwomen who survived breast cancer and subsequently conceived. @*Materials and Methods@#We followed a total of 31,761 Korean women 45 years of age or younger who were treatedfor primary breast cancer from 2002 to 2010. We also included follow-up surveys that wereconducted through December 2011. We identified recurrence and mortality from breastcancer using data linked to the Korea National Health Insurance database. We used propensityscore matching of the study cohort to analyze the risks of recurrence and mortality frombreast cancer depending on pregnancy. @*Results@#Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breastcancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed todeliver. After propensity score matching, we found that the women who became pregnantafter breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503;95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to0.681), compared with those who did not conceive after breast cancer treatment. @*Conclusion@#Our study is the first to report outcomes for Korean women who survived breast cancer andsubsequently conceived. Women who survived breast cancer and subsequently becamepregnant did not show a poorer survival outcome, compared with those who did not becomepregnant.
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Humans , Diagnosis , Focus Groups , Health Occupations , Information Dissemination , Korea , Methods , Precision Medicine , Qualitative Research , Surveys and QuestionnairesABSTRACT
Purpose@#The purpose of the present study is to examine the factors influencing intention of dementia prevention behavior in adults with hypertension or diabetes. @*Methods@#A total of 113 community-dwelling adults with hypertension or diabetes agreed to participate in this study. Data were analyzed using descriptive statistics, t-test, ANOVA, correlation, and multiple regression. @*Results@#Self-efficacy and cues to action toward dementia prevention behavior were factors influencing intention of dementia prevention behavior of participations. Self-efficacy toward dementia prevention behavior was the most influential factor. These factors accounted for 22% of intention of dementia prevention behavior. @*Conclusion@#These results suggest a need for strengthening self-efficacy to increase intention of dementia preventive behaviors. And dementia prevention programs should be developed in consideration of strategies to reinforce cues to action.
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Purpose@#The purpose of the present study is to examine the factors influencing intention of dementia prevention behavior in adults with hypertension or diabetes. @*Methods@#A total of 113 community-dwelling adults with hypertension or diabetes agreed to participate in this study. Data were analyzed using descriptive statistics, t-test, ANOVA, correlation, and multiple regression. @*Results@#Self-efficacy and cues to action toward dementia prevention behavior were factors influencing intention of dementia prevention behavior of participations. Self-efficacy toward dementia prevention behavior was the most influential factor. These factors accounted for 22% of intention of dementia prevention behavior. @*Conclusion@#These results suggest a need for strengthening self-efficacy to increase intention of dementia preventive behaviors. And dementia prevention programs should be developed in consideration of strategies to reinforce cues to action.
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PURPOSE: The present study investigated the psychosocial health of disease-free breast cancer survivors who receive health examinations compared to matched non-cancer controls in a community setting. MATERIALS AND METHODS: We used baseline data from the Health Examinee cohort, which is composed of subjects participating in health. The disease-free breast cancer survivors were defined as those who were ≥ 2 years from initial diagnosis of breast cancer who had completed treatment. Females without a history of cancer were randomly selected at 1:4 ratio by 5-year age groups, education, and household income as a comparison group. We analyzed results from the Psychosocial Well-being Index-Short Form (PWI-SF) as a psychosocial health measurement. RESULTS: A total of 347 survivors of breast cancer and 1,388 matched controls were included. Total scores on the PWI-SF were lower in breast cancer survivors than matched non-cancer controls (p=0.006), suggesting a lower level of psychosocial stress in breast cancer survivors. In comparison to the control group, prevalence of drinking, smoking and obesity were lower, while exercising for ≥ 150 min/wk was higher in breast cancer survivors (p < 0.05). These findings suggest that breast cancer survivors have better health behaviors than their noncancer controls. After adjusting for other sociodemographic variables, breast cancer survivors were 36% less likely to be included in the stress group (odds ratio, 0.64; 95% confidence interval, 0.42 to 0.98). CONCLUSION: The disease-free breast cancer survivors resuming daily life demonstrated better psychosocial health status compared to matched non-cancer controls.