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      Associations between alcohol consumption and anxiety, depression, and health-related quality of life in colorectal cancer survivors

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          Abstract

          Purpose

          Alcohol consumption is a major risk factor for colorectal cancer (CRC). It is currently poorly understood, however, how alcohol and different alcoholic beverage types are related to psychosocial outcomes in CRC survivors.

          Methods

          We used data of N = 910 CRC survivors from the pooled EnCoRe and PROCORE cohorts and harmonized them into five time points: at diagnosis and 3, 6, 12, and 24 months post-diagnosis. Generalized estimated equation models were used to examine longitudinal associations of alcohol consumption, including consumption of beer, wine, and liquor, with anxiety, depression, and health-related quality of life (HRQoL), while correcting for sociodemographic, lifestyle, and clinical factors.

          Results

          Survivors were on average 67 years and 37% was female. In the first 2 years post-diagnosis, survivors who consumed more alcoholic drinks/week reported lower anxiety and depressive symptoms and better HRQoL on all domains and symptom scales. This was the case for moderate and heavy amounts of alcohol and mostly for consuming beer and wine, but not for liquor. Associations were more often significant for men and for younger persons (< 67 years at baseline).

          Conclusions

          Generally, alcohol consumption was observed to be longitudinally related to less anxiety and depression and better HRQoL in CRC survivors.

          Implications for Cancer Survivors

          Although alcohol consumption is generally unfavorable due to increased risk of carcinogenesis and worse prognosis after CRC, it seems to be associated with better psychosocial outcomes in the first 2 years after diagnosis and treatment. More research is needed to gain knowledge about reasons for drinking and causality.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11764-021-01090-y.

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          Most cited references26

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          The hospital anxiety and depression scale.

          A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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            The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

            In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient > or = .70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials.
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              Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018

              Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018.
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                Author and article information

                Contributors
                D.Revesz@tilburguniversity.edu
                Journal
                J Cancer Surviv
                J Cancer Surviv
                Journal of Cancer Survivorship
                Springer US (New York )
                1932-2259
                1932-2267
                16 September 2021
                16 September 2021
                2022
                : 16
                : 5
                : 988-997
                Affiliations
                [1 ]GRID grid.12295.3d, ISNI 0000 0001 0943 3265, Center of Research on Psychological disorders and Somatic diseases, , Tilburg University, ; PO Box 90153, 5000 LE Tilburg, The Netherlands
                [2 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Epidemiology, GROW School for Oncology and Developmental Biology, , Maastricht University, ; Maastricht, The Netherlands
                [3 ]GRID grid.414480.d, ISNI 0000 0004 0409 6003, Department of Surgery, , Elkerliek Hospital, ; Helmond, The Netherlands
                [4 ]Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
                [5 ]Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
                [6 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Surgery, , Maastricht University Medical Centre, ; Maastricht, The Netherlands
                [7 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Nutrim School of Nutrition and Translational Research in Metabolism, , Maastricht University, ; Maastricht, The Netherlands
                [8 ]GRID grid.414711.6, ISNI 0000 0004 0477 4812, Departments of Surgery and Oncology, , Máxima Medical Center, ; Veldhoven, The Netherlands
                [9 ]GRID grid.416856.8, ISNI 0000 0004 0477 5022, Departments of Surgery, , VieCuri Medical Center, ; Venlo, The Netherlands
                Author information
                http://orcid.org/0000-0003-0435-6808
                Article
                1090
                10.1007/s11764-021-01090-y
                9489554
                34529261
                c89264a9-fc9c-40ec-9bc1-66fbc45c5d6d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 2 December 2020
                : 14 July 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100006135, ERAB: The European Foundation for Alcohol Research;
                Award ID: EA 18 20
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100004622, KWF Kankerbestrijding;
                Award ID: UM-2010-4867
                Award ID: UM-2012-5653
                Award ID: UM 2014-6877
                Award Recipient :
                Funded by: Health foundation Limburg
                Award ID: 00005739
                Award Recipient :
                Funded by: World Cancer Research Fund International
                Award ID: 2016/1620
                Award Recipient :
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2022

                Oncology & Radiotherapy
                alcohol drinking,anxiety,cancer survivors,colorectal cancer,depression,oncology,quality of life

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