Characteristics associated with the discrepancy between subjective and objective executive functioning in depression.

Major depressive disorder (MDD) is associated with both self-reported (subjective) cognitive complaints and deficits in neurocognitive (objective) measures, but the correspondence between subjective and objective measures of cognition is low. This cross-sectional study aimed to (1) assess the association between subjective and objective measures of executive functions (EFs), and (2) explore factors associated with the discrepancy between subjective and objective EFs in MDD. Sixty-two participants with current or previous mild to moderate MDD and subjective EF complaints completed a clinical trial baseline assessment. An objective EF composite score was drawn from six neurocognitive measures, while the Behavior Rating Inventory of Executive Function-Adult version was applied as a measure of subjective EF. The association between the subjective and objective composites was evaluated using Spearman's rank order correlation. A discrepancy score was calculated to quantify the difference between subjective and objective EF. Factors associated with the discrepancy score were analyzed using regression analysis (p < .05). Participants reported extensive EF difficulties, but most performed in the normal range on objective EF measures. A weak correlation was detected between the subjective and objective measures (rs = .015). More rumination (ß = -.364) and higher IQ (ß = -.420) were associated with reporting more subjective complaints than was evident from objective measures of EF (i.e., underestimation). Subjective and objective EF measures are weakly overlapping in MDD. Findings underscore recommendations to include both subjective and objective measures when assessing EFs in depression. In addition, findings suggest that targeting ruminative processes could help correct underestimation.

Cognitive rehabilitation in post-COVID-19 condition: A study protocol for a randomized controlled trial.

BACKGROUND: Post-COVID-19 condition is frequently comprised of persistent cognitive sequela, including deficits in attention and executive functions (EFs), which can act as a barrier for regaining pre-illness functional levels. Goal Management Training (GMT) is a cognitive rehabilitation (CR) intervention for improving attention and EFs that has received empirical support in studies of other patient groups. The present study aims to determine the efficacy of GMT for improving everyday attention and EFs in adults who experience persistent cognitive deficits after COVID-19. METHODS: This study protocol describes an open-label randomized controlled trial comparing the efficacy of GMT to a wait list control condition (WL), for improving persistent (> 2 months) cognitive sequela in post-COVID-19 condition. The study aims to recruit 240 participants aged 18 to 65 years with a history of SARS-CoV-2 infection and perceived attentional and EF difficulties in daily life. Participants will be block randomized (computer-algorithm) to either group-based GMT (n = 120) or WL (n = 120). GMT will be internet-delivered to groups of six participants in six two-hour sessions delivered once a week. The primary outcome will be the Metacognition Index of the Behavior Rating Inventory of Executive Function - Adult Version, a self-report measure assessing everyday EF difficulties, specifically metacognition, at six months post-treatment. Secondary outcomes include performance-based neurocognitive measures, and tertiary outcomes include rating scales of cognition, emotional health, quality of life, and fatigue. CONCLUSION: Study findings could contribute to providing an evidence-based treatment option for symptoms that are frequent and debilitating following a prevalent condition. TRIAL REGISTRATION NUMBER: NCT05494424.

Connecting residual depressive symptoms to self-reported executive functioning: A network analytical approach.

Persisting executive functioning (EF) impairments following remission from depression form an important source of disability in daily life. However, little is known regarding how specific aspects of EF relate to residual depressive symptomatology. Using network analysis, the current study investigates unique associations between cognitive-, affective-, and somatic depressive symptoms (Beck Depression Inventory 2nd edition, BDI-II) and self-reported EF (Behavior Rating Inventory of Executive Function - Adult version, BRIEF-A) in a sample of 161 remitted depressed individuals. We identified three clusters of closely connected nodes, corresponding with the Metacognition- and Behavioral Regulation Index of the BRIEF-A, and one cluster consisting of cognitive, affective-, and somatic depressive symptomatology. Among the clusters consisting of EF domains, working memory and shifting difficulties emerged as bridging nodes. Depressive cognition most strongly connected the cluster of depressive symptoms with the EF clusters. Depressive symptom dimensions demonstrated both shared and unique associations with EF domains. Each depressive symptom dimension was directly related to emotional control impairments. In addition, multiple associations were observed between depressive symptomatology and complaints at the level of working memory, shifting, and planning/organizing. Depressive affect was uniquely related to difficulties initiating activity. The current findings provide insights into the relationship between perceived difficulties in EF and residual depressive symptomatology. EF domains were differentially related to depressive symptom dimensions, suggesting the need for further research into the role of EF following remission from depression.

"Long-term outcome in endometrial cancer patients after robot-assisted laparoscopic surgery with sentinel lymph node mapping".

OBJECTIVE: Sentinel Lymph Node (SLN) mapping is increasingly used as an alternative to lymphadenectomy in endometrial cancer. There is, however, limited data regarding the clinical outcome and survival after SLN mapping. The aim of the study was to determine long-term outcome data in endometrial cancer patients undergoing robot-assisted laparoscopic surgery and SLN mapping. STUDY DESIGN: Retrospective cohort study of 108 patients with primary endometrial cancer who underwent robot-assisted laparoscopic surgery and sentinel lymph node mapping using the Memorial Sloan Kettering Cancer Center (MSKCC) algorithm with near-infrared fluorescence detection of indocyanine green for endometrial cancer, from November 20th 2012 to January 1st 2016 at St. Olav's Hospital in Norway. The primary endpoint was recurrence-free survival. Secondary endpoints were overall survival and treatment complications. RESULTS: Among 108 patients operated in accordance with the SLN algorithm, 17 (16%) had lymph node metastases. Adjuvant chemotherapy was administered on indication endometrial cancer to 36 (33%) of the patients. After a median follow up of 75 months (range 61-98), five (4.6%) patients had recurrence, and three patients had died from the disease. Four of the patients who had recurrence had lymph node metastasis at diagnosis. The 5-year recurrence-free survival was 95.4% (95% CI, 91.5 - 99.3). The 5-year disease-specific survival was 97.2% (95% CI, 94.1 - 100.3). The 5-year overall survival was 92.6% (95% CI, 87.7 - 97.5). Peripheral neuropathy after chemotherapy was the most common complication (9.3%), followed by lower limb lymphedema (2%) and postoperative hernia (2%). CONCLUSION: The present study demonstrated excellent oncologic outcome and low long-term treatment complication rate in patients treated according to the SLN algorithm more than five years after diagnosis.

Goal Management Training and Computerized Cognitive Training in Depression-a 2-Year Follow-Up of a Randomized Controlled Trial.

Objective: Information on the long-term effects of cognitive remediation (CR) in major depressive disorder (MDD) is lacking. The present study reports 2-year follow-up data from a previously published randomized controlled trial (RCT) from our research group, comparing Goal Management Training (GMT), a strategy-based CR intervention, to drill-and-practice computerized cognitive training (CCT). In previous work, we found comparable improvements in executive function (EF), in addition to reductions in depressive symptoms, following both GMT and CCT at 6-month follow-up. Methods: Forty-two participants of the RCT, all diagnosed with MDD, were invited to complete rating-scales pertaining daily-life EF, rumination, and depressive symptoms. Explorative analyses compared the 2-year follow-up with previously published baseline and 6-month follow-up data, using non-parametric statistics. Similarly, GMT and CCT were compared at the 2-year follow-up, and completers were compared with non-completers. Results: Twenty participants completed the study. Overall, completers (n = 20) and non-completers (n = 22) were similar. There were no significant differences between GMT (n = 11) and CCT (n = 9) for any outcome 2 years post-treatment. Reduction compared to baseline in depressive symptoms and rumination, but not in daily-life EFs, emerged for GMT only. Conclusions: Findings suggest long-term improvements in mental health following GMT, while improvements in everyday EFs might require additional treatment or maintenance to sustain. Caution is warranted in the interpretation due to the small sample size and high attrition rates.

Initial experience with positron emission tomography/computed tomography in addition to computed tomography and magnetic resonance imaging in preoperative risk assessment of endometrial cancer patients.

OBJECTIVE: Improved preoperative evaluation of lymph node status could potentially replace lymphadenectomy in women with endometrial cancer. PET/CT was routinely implemented in the preoperative workup of endometrial cancer at St Olav's University Hospital in 2016. Experience with PET/CT is limited, and there is no consensus about the use of PET/CT in the diagnostic workup of endometrial cancer. The aim of the study was to evaluate the diagnostic accuracy of PET/CT compared to standard CT/MRI in identifying lymph node metastases in endometrial cancer with histologically confirmed lymph node metastases as the standard of reference. We especially wanted to look at PET/CT as a supplement to the sentinel lymph node algorithm in the detection of paraaortic lymph nodes. STUDY DESIGN: A retrospective study included all women undergoing surgery for endometrial cancer from January 2016 through July 2019 at St Olav's University Hospital. Clinical data, results of CT, MRI, and PET/CT, and histopathological results were analyzed. RESULTS: Among 185 patients included, 27 patients (15 %) had lymph node metastases. 17 (63 %) had pelvic lymph node metastases, one (4 %) had isolated paraaortic lymph node metastases, and 9 (33 %) had lymph node metastases in both the pelvis and the paraaortic region. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for the detection of lymph node metastases were 63 %, 98 %, 85 %, 94 %, and 93 %, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT/MRI were 41 %, 98 %, 73 %, 91 %, and 90 %, respectively (p = 0.07). For the 26 pelvic lymph node metastases, PET/CT had a sensitivity of 58 %, compared to 42 % for CT/MRI (p = 0.22). PET/CT detected all 10 paraaortic lymph node metastases, for a sensitivity of 100 %, compared to 50 % for CT/MRI (p = 0.06). CONCLUSIONS: PET is superior to CT/MRI for detection of lymph node metastases in endometrial cancer, particularly in detecting paraaortic lymph node metastases. The ability of preoperative PET to exclude paraaortic lymph node metastases may strengthen the credibility of the sentinel lymph node algorithm.

Survival and cause-specific mortality of harvested willow ptarmigan (Lagopus lagopus) in central Norway.

Survival is a key demographic component that often varies as a result of human activities such as recreational harvest. Detailed understanding of seasonal variation in mortality patterns and the role of various risk factors is thus crucial for understanding the link between environmental variation and wildlife population dynamics and to design sustainable harvest management systems. Here, we report from a detailed seasonal and cause-specific decomposition of mortality risks in willow ptarmigan (Lagopus lagopus) in central Norway. The analyses are based on radio-collared (n = 188) birds that were monitored across all seasons, and we used time-to-event models for competing risks to estimate mortality patterns. Overall, annual survival was estimated at 0.43 (SE: 0.04), with no distinct difference among years (2015/16 to 2018/19) or between sexes. Analysis of mortality risk factors revealed that on the annual basis, the risk of harvest mortality was lower than the risk of dying from natural causes. However, during the autumn harvest season (September-November), survival was low and the dominating cause of mortality was harvest. During winter (December-March) and spring seasons (April-May), survival was in general high and did not vary between males and females. However, during the spring season, juveniles (i.e., birds born last year) of both sexes had lower survival than adults, potentially because they are more prone to predation. During the summer season (June-August), females experienced a higher hazard than males, underlining the greater parental investment of females during egg production, incubation, and chick rearing compared to males. Our analyses provide unique insight into demographic and seasonal patterns in willow ptarmigan mortality risks in a harvested population and revealed a complex interplay across seasons, risk factors, and demographic classes. Such insight is valuable when designing sustainable management plans in a world undergoing massive environmental perturbations.

Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms.

OBJECTIVE: Cognitive remediation (CR) techniques (interventions to enhance cognitive functioning) have proven moderately effective in improving cognition and daily functioning in major depressive disorder (MDD). However, baseline predictors of treatment response are lacking. The present study aimed to identify factors influencing long-term CR outcomes in a sample with current or previous, mild or moderate MDD and with self-reported cognitive deficits. METHODS: Forty-two completers of group-based CR (strategy learning or drill-and-practice), were pooled into one sample. Based on change scores from baseline to 6-month follow-up, participants were categorized as "improvers" or "non-improvers" using reliable change index calculations. Measures included a questionnaire of everyday executive functioning and a neuropsychological test of attention. Finally, improvers and non-improvers were compared in terms of various sociodemographic, psychological, illness-related, and neuropsychological baseline variables. RESULTS: Seventeen participants improved reliably in everyday executive functioning, and fourteen demonstrated a reliable improvement in attention. No statistically significant differences emerged between improvers and non-improvers. CONCLUSION: No major predictors of CR were identified. Importantly, the current findings are insufficient to guide clinical decision-making. Large-scale studies with a priori hypotheses are needed to make advances in the future.

Goal management training as a cognitive remediation intervention in depression: A randomized controlled trial.

BACKGROUND: Major depressive disorder (MDD) is associated with deficits in executive functioning (EF) that may have a detrimental effect on everyday functioning. Despite this, there are no established cognitive remediation interventions available targeting EF in MDD. Hence, the primary aim of the present pre-registered randomized controlled trial was to evaluate the effectiveness of Goal Management Training (GMT), a metacognitive and strategy-based cognitive remediation intervention to improve EF in MDD. METHODS: Sixty-three participants with current or previous mild or moderate MDD and self-reported executive deficits were included and randomized to nine sessions of either GMT (two hours, once weekly; n = 35) or computerized cognitive training (one hour, twice weekly; n = 28). Assessments were conducted at baseline (T1), immediately following training (T2), and at six-month follow-up (T3). The primary outcome measure was The Behavior Rating Inventory of Executive Function - Adult version, pertained to daily life EF. Secondary outcome measures included additional EF assessments (performance-based measures and questionnaires), and depressive symptom severity. RESULTS: Forty-three participants completed treatment. Both groups improved following training, and linear mixed model analyses revealed no statistically significant differences between the groups for any outcome measure. Additional exploratory within-group analyses revealed a statistically significant reduction of everyday executive dysfunction and reduced depressive symptoms at the six-month follow-up in GMT only. LIMITATIONS: The study was single-blind, and the sample size was modest. CONCLUSIONS: Our findings indicate comparable improvements in everyday and performance-based measures of EF, in addition to reductions in depressive symptoms following both GMT and CCT.

Scavenging on a pulsed resource: quality matters for corvids but density for mammals.

BACKGROUND: Human food subsidies can provide predictable food sources in large quantities for wildlife species worldwide. In the boreal forest of Fennoscandia, gut piles from moose (Alces alces) harvest provide a potentially important food source for a range of opportunistically scavenging predators. Increased populations of predators can negatively affect threatened or important game species. As a response to this, restrictions on field dressing of moose are under consideration in parts of Norway. However, there is a lack of research to how this resource is utilized. In this study, we used camera-trap data from 50 gut piles during 1043 monitoring days. We estimated depletion of gut piles separately for parts with high and low energy content, and used these results to scale up gut pile density in the study area. We identified scavenger species and analyzed the influences of gut pile quality and density on scavenging behavior of mammals and corvids (family Corvidae). RESULTS: Main scavengers were corvids and red fox (Vulpes vulpes). Parts with high energy content were rapidly consumed, mainly by corvids that were present at all gut piles shortly after the remains were left at the kill site. Corvid presence declined with days since harvest, reflecting reduction in gut pile quality over time independent of gut pile density. Mammals arrived 7-8 days later at the gut piles than corvids, and their presence depended only on gut pile density with a peak at intermediate densities. The decline at high gut pile densities suggest a saturation effect, which could explain accumulation of gut pile parts with low energy content. CONCLUSIONS: This study shows that remains from moose harvest can potentially be an important food resource for scavengers, as it was utilized to a high degree by many species. This study gives novel insight into how energy content and density of resources affect scavenging patterns among functional groups of scavengers.

Indocyanine green fluorescence imaging of lymph nodes during robotic-assisted laparoscopic operation for endometrial cancer. A prospective validation study using a sentinel lymph node surgical algorithm.

OBJECTIVE: A sentinel lymph node (SLN) strategy may have particular value in endometrial cancer (EC) because a therapeutic effect of lymphadenectomy per se is unproven. The aim was to evaluate indocyanine green (ICG) and near-infrared (NIR) fluorescence mapping using a surgical algorithm. METHODS: From November 2012 through December 2015, women with apparently early stage EC underwent robot-assisted laparoscopic hysterectomy including ICG fluorescence SLN mapping following the Memorial Sloane Kettering Cancer Center (MSKCC) surgical algorithm. RESULTS: Among 108 patients included, ≥1 SLNs was identified in 104 (96%), bilaterally in 84 (78%) and unilaterally in 20 patients (18%). Four patients failed SLN mapping. All SLN-positive patients had pelvic SLNs. Median number of nodes were 4.0 and 6.0 (p<0.001), when SLNs only and SLNs plus non-SLNs were removed, respectively. Lymph node metastases were detected in 17 patients (16%). One patient who failed SLN mapping had a non-SLN metastasis. The remaining 16 patients had metastases in SLNs, 12 in SLNs only and four in both SLNs and non-SLNs. Routine pathology detected 75% of patients with cancer positive SLNs while 25% were based on extended pathology. Lymph node metastases were found among 9% with low-, 11% with intermediate- and 32% with high-risk profiles, respectively. CONCLUSIONS: We have reproduced the high total and bilateral SLN mapping using cervical ICG injection and NIR fluorescence. Practical application of the MSKCC algorithm allowed high lymph node metastasis detection in combination with a low extent of lymph node removal.

Colposcopy and additive diagnostic value of biopsies from colposcopy-negative areas to detect cervical dysplasia.

INTRODUCTION: We evaluated colposcopy in the routine diagnostic workup of women with abnormal cervical cytology, as well as the diagnostic value of endocervical curettage material and biopsies taken from colposcopy-positive and colposcopy-negative quadrants of the cervix. MATERIAL AND METHODS: This cross-sectional study included 297 nonpregnant women with abnormal cervical cytology and no prior treatment for cervical dysplasia or cancer. All women underwent gynecological examination, colposcopy, endocervical curettage, and had cervical biopsies taken. Colposcopy was considered satisfactory if the squamocolumnar junction was fully visible, and biopsies were taken from all four quadrants of the cervix, regardless of colposcopy results. RESULTS: In all, 130 of the women in our study had satisfactory colposcopy results and were diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 61% via a colposcopy-positive biopsy and 39% via a colposcopy-negative biopsy. Eighty-seven of them had positive colposcopy results, but CIN2+ was histologically verified from colposcopy-positive biopsies in 91% (n = 79) and from colposcopy-negative biopsies in 9% (n = 8). The remaining 43 women with CIN2+ had negative colposcopy findings, so their diagnosis was verified in colposcopy-negative biopsies. The sensitivity of colposcopy alone to detect CIN2+ was 61% (95% CI 52-69). CONCLUSIONS: In the present study, colposcopy was not a stand-alone diagnostic method. Colposcopy-negative biopsies had a clear additive value, identifying a substantial proportion of women with both positive and negative colposcopy results with treatment-worthy cervical dysplasia. Endocervical curettage material had little diagnostic value in this study.

Impact of shade on outdoor thermal comfort-a seasonal field study in Tempe, Arizona.

Shade plays an important role in designing pedestrian-friendly outdoor spaces in hot desert cities. This study investigates the impact of photovoltaic canopy shade and tree shade on thermal comfort through meteorological observations and field surveys at a pedestrian mall on Arizona State University's Tempe campus. During the course of 1 year, on selected clear calm days representative of each season, we conducted hourly meteorological transects from 7:00 a.m. to 6:00 p.m. and surveyed 1284 people about their thermal perception, comfort, and preferences. Shade lowered thermal sensation votes by approximately 1 point on a semantic differential 9-point scale, increasing thermal comfort in all seasons except winter. Shade type (tree or solar canopy) did not significantly impact perceived comfort, suggesting that artificial and natural shades are equally efficient in hot dry climates. Globe temperature explained 51 % of the variance in thermal sensation votes and was the only statistically significant meteorological predictor. Important non-meteorological factors included adaptation, thermal comfort vote, thermal preference, gender, season, and time of day. A regression of subjective thermal sensation on physiological equivalent temperature yielded a neutral temperature of 28.6 °C. The acceptable comfort range was 19.1 °C-38.1 °C with a preferred temperature of 20.8 °C. Respondents exposed to above neutral temperature felt more comfortable if they had been in air-conditioning 5 min prior to the survey, indicating a lagged response to outdoor conditions. Our study highlights the importance of active solar access management in hot urban areas to reduce thermal stress.

Ten years' experience with centralized surgery of ovarian cancer in one health region in Norway.

BACKGROUND: Better outcome of advanced ovarian cancer after centralized surgery has led to the recommendation for centralized surgery in a Norwegian health region. Whether the practice pattern has changed according to this recommendation has not been examined. OBJECTIVE: The objective of this study was to evaluate the referral practice and treatment of ovarian cancer in a Norwegian health region after the introduction of centralized surgery. METHODS: This was a retrospective, population-based study, including all women undergoing surgery for primary ovarian, tubal, and peritoneal cancer between 2000 and 2005, in Health Region IV of Norway. Clinical data and data regarding treatment and 5-year follow-up were analyzed. RESULTS: In total, 279 cases of ovarian, peritoneal, and tubal cancer were included. Eighty-four percent underwent primary surgery at the teaching hospital and 16% at the nonteaching hospitals. After an immediate rise in the number of cases undergoing primary surgery at the teaching hospital after the introduction of centralization in 1995, the percentage distribution between the teaching and nonteaching hospitals was stable during the study period. The women who underwent surgery at the nonteaching hospitals had a higher percentage of early-stage disease and were at higher risk of reoperation for comprehensive staging. CONCLUSIONS: Centralization of ovarian cancer surgery has been successfully accomplished in a health region in Norway. The referral practice of assumed advanced ovarian cancer cases shows satisfactory compliance with centralization at 10 years after the implementation of centralized surgery.

Cervical carcinoma: postoperative radiotherapy: fifteen-year experience in a Norwegian health region.

INTRODUCTION: To study the results in cervical carcinoma after a combined treatment with surgery and radiotherapy with regard to survival and side effects. METHODS: A retrospective analysis of 71 patients who underwent radical hysterectomy and postoperative radiotherapy between January 1, 1987, and December 31, 2001, was performed. RESULTS: Median follow-up periods were 162 months for surviving patients and 62 months for deceased patients. The 5-year overall survival and disease-specific survival for all stages were 80.3% and 82.7%, respectively. The 5-year actuarial incidence of late reactions for grade 1 + 2 was as follows: for upper gastrointestinal tract, 36%; for rectum, 37%; for urinary tract, 19%; for vagina, 26%; and for lymph edema, 19%. The 5-year actuarial incidence of late reactions for grade 3 + 4 was as follows: for upper gastrointestinal tract, 12%; and for rectum, 3%. CONCLUSIONS: Careful pretreatment workup and well-defined criteria for postoperative radiotherapy are essential, and new treatment options such as intensity-modulated radiation therapy should be considered.

High risk for ovarian cancer in a prospective series is restricted to BRCA1/2 mutation carriers.

PURPOSE: Inherited ovarian cancer carries a serious prognosis. Prophylactic oophorectomy has been advocated. The degree to which inherited ovarian cancer is restricted to BRCA mutation carriers is not fully known. We wanted to determine the prevalence of BRCA mutation carriers in women at high risk from ovarian cancer. EXPERIMENTAL DESIGN: Healthy women who were found to be at increased risk judged by family history were followed prospectively. Full BRCA1/2 mutation analysis was conducted on all patients who contracted pelvic cancer. RESULTS: We identified 1,582 women at risk during 5,674 person-years. Forty infiltrating epithelial ovarian cancers, six peritoneal cancers, and one fallopian tube cancer were diagnosed. All but one of these patients (98%) had a BRCA mutation, a frequency that was significantly higher than for the 3 patients with borderline ovarian cancers, who were all mutation negative (P = 0.0002). Eighty-two percent of the detected mutations belonged to one of the 10 Norwegian founder mutations previously reported. At prophylactic bilateral salpingo-oophorectomy, cancer was found in 18 of 345 (5.2%) of mutation carriers compared with none in the 446 mutation negative (P = 0.0000). CONCLUSIONS: In healthy women with a family history of ovarian cancer, high risk for ovarian cancer was restricted to BRCA1/2 mutation carriers. A woman at risk for ovarian cancer according to her family history should have access to full BRCA1/2 mutation testing before deciding on prophylactic bilateral salpingo-oophorectomy.

Quality of life among long-term gynaecological cancer survivors.

BACKGROUND: The population of gynaecological cancer survivors is growing. However, there is little knowledge of the long-term quality of life among these former patients. The aim of this study was to investigate the long-term quality of life in women treated successfully for gynaecological cancer and a control group of representative women selected from the general population. MATERIAL AND METHODS: The study comprised women aged 30-75 years residing in the central part of Norway. Cases were 319 gynaecological cancer survivors treated at St Olav's Hospital Trondheim, Norway, between 1987 and 1996, whereas 1276 age-matched women selected at random from the general population served as controls. The study population was identified and the respondents were invited to answer a postal questionnaire. After one reminder, the response rate was 55% (176/319) and 41% (521/1276) for cases and controls, respectively. Sixteen cases and 28 controls had incomplete responses to most questions and were excluded from the analyses. Eligible for the final analyses were 160 cases and 493 controls. Ferrans & Powers' Quality of Life Index (QLI) was used. All analyses were performed in SPSS version 13.0 with chi-square (categorical variables) and Mann-Whitney (continuous variables) tests. p

Long-term consequences of gynecological cancer treatment on urinary incontinence: a population-based cross-sectional study.

OBJECTIVE: To study urinary incontinence among long-term survivors of gynecological cancer. STUDY DESIGN: In a population-based, cross-sectional design, we identified 319 recurrence-free survivors of gynecological cancer, and 1,276 controls without a history of gynecological cancer. All participants were addressed with a 16-pages questionnaire covering issues of quality of life, general health, daily living conditions, natural functions and co-morbidities. Following 1 reminder, the response rates were 55 and 41% for cases and controls, respectively. Urinary incontinence (total, stress, urge and mixed) was in agreement with definitions of the International Continence Society. RESULTS: Mean relapse-free follow-up time after treatment was 12 years (range: 8-17 years) for cases. The prevalence of total, stress, urge and mixed urinary incontinence were 34.3, 24, 0.8 and 9.5%, respectively. Previous gynecological cancer treatment was not associated with any outcomes of urinary incontinence. Obesity, previous and current use of HRT were associated with total, stress and mixed urinary incontinence, whereas increasing parity order was associated with total and stress urinary incontinence. In comparison with single factor analyses, the combination of obesity and parity 2+ had a multiplicative effect on total, stress and mixed incontinence. CONCLUSION: Recurrence-free long-term survivors of gynecological cancer are not at increased risk for urinary incontinence.