Cancer-related fatigue is one of the most frequently reported symptoms after treatment for (non-)Hodgkin lymphoma. This dissertation describes the procedure and results of the SPARKLE trial which... Show moreCancer-related fatigue is one of the most frequently reported symptoms after treatment for (non-)Hodgkin lymphoma. This dissertation describes the procedure and results of the SPARKLE trial which primarily aimed to investigate whether light therapy can be used as a treatment for chronic cancer-related fatigue since the diagnosis of Hodgkin lymphoma or diffuse large B-cell lymphoma. Secondary aims included the investigating of the effect of light therapy on symptoms related to cancer-related fatigue, for example depression, anxiety, quality of life, sleep quality, cognitive complaints and cognitive functioning. Objective measurements of the sleep-wake cycle (assessed with actigraphy) and circadian rhythms (melatonin and cortisol from saliva) were also included. An additional chapter describes the psychometric evaluation of the Multidimensional Fatigue Inventory. This questionnaire was one of the primary outcomes of the SPARKLE trial. The final chapter describes a critical evaluation of the results of the SPARKLE trial compared to the current literature, offers clinical implications and proposals for future research. Show less
Background Breast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. We estimated the incidence of hypothyroidism in women with... Show moreBackground Breast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. We estimated the incidence of hypothyroidism in women with breast cancer, and according to cancer treatment. Methods Using nationwide registries, we identified all Danish women aged >= 35 years diagnosed with non-metastatic breast cancer (1996-2009). We matched up to five cancer-free women (controls) for each BCS. We excluded women with prevalent thyroid disease. Cancer treatment was chemotherapy with or without radiotherapy (RT) targeting the breast/chest wall only, or also the lymph nodes (RTn). We identified hypothyroidism using diagnostic codes, and/or levothyroxine prescriptions. We calculated the cumulative incidence, incidence rates (IR) per 1000 person-years, and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (CIs) of hypothyroidism, adjusting for comorbidities. Results We included 44,574 BCS and 203,306 matched controls with 2,631,488 person-years of follow-up. BCS had a slightly higher incidence of hypothyroidism than controls [5-year cumulative incidence, 1.8% (95%CI = 1.7-1.9) and 1.6% (95%CI = 1.5-1.6), respectively]. The overall IR was 4.45 (95%CI = 4.25-4.67) and 3.81 (95%CI = 3.73-3.90), corresponding to an adjusted HR = 1.17 (95%CI = 1.11-1.24). BCS who received RTn with chemotherapy (HR = 1.74, 95%CI = 1.50-2.02) or without chemotherapy (HR = 1.31, 95%CI = 1.14-1.51) had an elevated risk of hypothyroidism compared with matched controls and compared with BCS who underwent surgery alone [HR = 1.71, 95%CI = 1.45-2.01 and HR = 1.36, 95%CI = 1.17-1.58, respectively]. Conclusions BCS have an excess risk of hypothyroidism compared with age-matched controls. BCS and those working in cancer survivorship settings ought to be aware that this risk is highest in women treated with radiation therapy to the lymph nodes and chemotherapy. Show less
Bottomley, A.; Reijneveld, J.C.; Koller, M.; Flechtner, H.; Tomaszewski, K.A.; Greimel, E.; ... ; 5th EORTC Quality Life Canc 2019
