[Thinness and overweight in children from Amsterdam: a trend analysis and forecast]. / Onder- en overgewicht bij Amsterdamse kinderen: een trendanalyse en prognose.

OBJECTIVE: To determine the trends in prevalence of moderate and severe thinness, overweight and obesity in children living in Amsterdam between 2009 and 2013 and estimate prevalences for 2020. DESIGN: Historical cohort study. METHOD: 158,730 measurements of height and weight of 112,405 children from Amsterdam were analysed. Moderate thinness, severe thinness, overweight and obesity were determined using international BMI cut-off values. Trends were analysed using Generalized Estimating Equations (GEE) for two age groups: pre-schoolers (2 and 3 years) and school-aged children (5, 10 and 14 years). The 'self-projecting method,' which allowed us to extend former trends into the future, was used to estimate prevalences for 2020. RESULTS: The prevalence of moderate thinness increased significantly in both age groups. The prevalence of severe thinness did not change. The prevalences of overweight and obesity declined significantly in both age groups. These trends were most evident in children of Dutch origin. Other ethnic groups also showed declining prevalences but not in both age groups or both categories of overweight. The prognosis for 2020 shows a further decline in the prevalence of overweight and obesity and an increase in the prevalence of thinness. CONCLUSION: A decline in the prevalences of overweight and obesity was observed in Amsterdam children, including children of Turkish and Moroccan origin. The prevalence rates are still high, so investing in prevention remains necessary. The prevalence of moderate thinness also seems to be increasing. Continued monitoring of children in all BMI classes is therefore important.

The information needs of new radiotherapy patients: how to measure? Do they want to know everything? And if not, why?

PURPOSE: To establish 1) further psychometric properties of the information preference for radiotherapy patients scale (IPRP); 2) what information new radiotherapy patients want to receive; 3) which patients have a lower information need. METHODS AND MATERIALS: Eligible patients (n = 159; response rate 54%) of 15 radiation oncologists completed the IPRP and provided background characteristics before their first radiotherapy consultation. Exclusion criteria were: age <18 years, having undergone radiotherapy before, unable to read and write Dutch, cognitive problems or a brain tumor. RESULTS: Reliability (Cronbach's alpha 0.84-0.97) and concurrent validity (r from .39 to .57, p < 0.001) of the subscales of the IPRP were good. New radiotherapy patients want extensive information about their disease, treatment, procedures, side effects, and prognosis (mean scores between 4.1 and 4.4 on a scale from 1 to 5) but less information about psychosocial issues (mean = 3.4). Patients who are older and male, have lung or rectal cancer, more difficulty understanding and a higher trait anxiety level, need less information. CONCLUSIONS: The IPRP can reliably and validly address information needs of patients undergoing radiation treatment. Most new radiotherapy patients want much information. Yet, information giving should be tailored according to their background, understanding and anxiety.

Psychological factors and preferences for communicating prognosis in esophageal cancer patients.

OBJECTIVE: Discussing prognosis is often confronting and complex for cancer patients. This study investigates how patients' psychological characteristics relate to their preferences concerning the disclosure of prognosis. METHODS: One hundred and seventy-six esophageal cancer patients participated in the study. They had undergone esophagectomy within the past 28 months and did not have evidence of cancer recurrence. Patients completed a questionnaire eliciting their preferences for prognostic information. Sociodemographic characteristics, involvement preferences, anxiety, depression, fear of recurrence, striving for quality of life (QOL) or quantity of life and trust in physicians were explored as predictors for (a) wanting to be informed about prognosis and (b) the initiation of discussion about prognosis. RESULTS: Patients wanting all prognostic information had more fear for the disease to recur (p<0.05) and were inclined to be more actively involved during consultation (p<0.001). Post hoc analyses showed that patients with worse QOL scores reported more fear of recurrence. Anxiety, depression, trust and tendency to strive for QOL or quantity of life were not related to preferences concerning prognostic information. CONCLUSIONS: The more fear patients have for esophageal cancer to recur, the more information they want about prognosis. Thus, patient's fear for recurrent disease is not a reason for withholding prognostic information. Results also suggest that there is no harm in asking patients what information they want.

Patient preferences for the disclosure of prognosis after esophagectomy for cancer with curative intent.

INTRODUCTION: The aim of this study was to determine the preferences for content, style, and format of prognostic information of patients after potentially curative esophagectomy for cancer and to explore predictors of these preferences. PATIENTS AND METHODS: This multicenter study included a consecutive series of patients who underwent surgical resection for cancer in the past 2 years and who did not have evidence of cancer recurrence. A questionnaire was used to elicit patient preferences for the content, style, and format of prognostic information. Sociodemographic characteristics, clinicopathological factors, and quality of life (EORTC QLQ-30 and OES18) were explored as predictors for certain preferences. RESULTS: Of the 204 eligible patients, 176 patients (86%) returned the questionnaire. The majority of patients desired prognostic information. Information preferences declined when information became more specific and more negative. Married patients and higher-educated patients were more likely to want all prognostic information. The majority of patients wanted their specialist to start the discussion about prognosis. However, a significant proportion of these patients wanted their specialist to first ask if they want to have prognostic information. The percentage of patients wanted a realistic and individualistic approach was 97%. Words and numbers were preferred over visual presentations. CONCLUSION: After potentially curative esophagectomy for cancer, the majority of patients want detailed prognostic information and want their specialist to begin the prognostic discussion. Patients prefer their doctor to be realistic; words and numbers are preferred over figures and graphs.