Background Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. Methods Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes—severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)—in participants with versus without cancer, for 13 cancer types. Results Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25–1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02–1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24–1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56–3.77; distress 1.53, 1.20–1.96; poor/fair QoL 2.40, 1.87–3.07), lung cancer (disability 2.81, 2.50–3.15; distress 1.67, 1.46–1.92; poor/fair QoL 2.53, 2.21–2.91) and non-Hodgkin’s lymphoma (disability 1.56, 1.37–1.78; distress 1.20, 1.05–1.36; poor/fair QoL 1.66, 1.44–1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16–1.32; distress 0.95, 0.90–1.01; poor/fair QoL 1.15, 1.05–1.25), prostate cancer (disability 1.11, 1.04–1.19; distress 1.09, 1.02–1.15; poor/fair QoL 1.15, 1.08–1.23) and melanoma (disability 1.02, 0.94–1.10; distress 0.96, 0.89–1.03; poor/fair QoL 0.92, 0.83–1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. Conclusions Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.
Purpose To quantify the relationship of cancer diagnosis to workforce participation in Australia, according to cancer type, clinical features and personal characteristics. Methods Questionnaire data (2006–2009) from participants aged 45–64 years (n=163,556) from the population-based 45 and Up Study (n=267,153) in New South Wales, Australia, were linked to cancer registrations to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for non-participation in the paid workforce—in participants with cancer (n=8,333) versus without (n=155,223), for 13 cancer types. Results Overall, 42% of cancer survivors and 29% of people without cancer were out of the workforce (PR=1.18; 95%CI=1.15–1.21). Workforce non-participation varied substantively by cancer type, being greatest for multiple myeloma (1.83; 1.53–2.18), oesophageal (1.70; 1.13–2.58) and lung cancer (1.68; 1.45–1.93) and moderate for colorectal (1.23; 1.15–1.33), breast (1.11; 1.06–1.16) and prostate cancer (1.06; 0.99–1.13). Long-term survivors, 5 or more years post-diagnosis, had 12% (7–16%) greater non-participation than people without cancer, and non-participation was greater with recent diagnosis, treatment or advanced stage. Physical disability contributed substantively to reduced workforce participation, regardless of cancer diagnosis. Conclusions Cancer survivors aged 45–64 continue to participate in the workforce. However, participation is lower than in people without cancer, varying by cancer type, and is reduced particularly around the time of diagnosis and treatment and with advanced disease. Implications for Cancer Survivors While many cancer survivors continue with paid work, participation is reduced. Workforce retention support should be tailored to survivor preferences, cancer type and cancer journey stage.
The first survey on career prospects in cardiology in England and Wales was started in 1979 and published in 1981.1 The purpose was twofold: to obtain accurate information on the appropriate ratio between the number of consultant posts and senior registrars in training and to identify districts which might be poorly endowed with expertise and facilities in the specialty. In both respects the survey identified serious deficiencies. Recognition of the problems has already influenced attitudes both within the profession and among those, responsible for its administration.A decision was made by the cardiology committee of the Royal College of Physicians and by the council of the British Cardiac Society that the situation should be monitored biennially at least until adequate provision for cardiology becomes more generally available. A second survey has therefore been conducted of both staffing and facilities available in the health districts of England and Wales relating to 1 July 1982. We report a summary of our findings together with additional information made available to us by colleagues in Scotland and Northern Ireland. Methods of inquiryA cardiologist in each health region of England and Wales was sent a list of districts in his locality and asked to suggest a physician in each who might be willing to complete a questionnaire. Some districts are large with hospitals which operate autonomously; in such cases two contacts were approached.The questionnaire was substantial and comprised 19 sections relating to consultant staff, senior registrars, technical staff, referral patterns, facilities, and equipment. Cardiovascular physicians (cardiologists) Accepted for publication 15 September 1983 were defined as physicians who have both a special interest and an appropriate training in the specialty, though these criteria were not specified further. We made a distinction between those who spend virtually all of their professional time in cardiology and those with a major commitment to the specialty (occupying more than 40% of their time) but with additional responsibilities in general medicine.As in our previous survey, about half our questionnaires were returned promptly. When necessary, second and third reminders were sent and finally telephone contact was made until all information had been received for each health district. The level of cooperation was generally excellent.The complete data were stored in a main frame computer (Vax III) to facilitate analysis and subsequent comparisons. They were then assembled for each region and submitted under confidential cover to our original regional advisors for scrutiny as a guard against inadvertent errors. Disagreements between regional advisors and our district contacts were resolved by further inquiries. We believe that the data we have collected are as complete and as accurate as can reasonably be expected without the availability of first hand local knowledge.
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