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Objectives: To assess five-year changes in health behaviours in later life and associations with onset of chronic health problems. The results may inform policy and interventions to promote healthy life years in ageing populations.Methods: Data are derived from the Norwegian study on Life-course, Ageing and Generation (NorLAG), a five-year (2002-2007) panel survey comprising a nation wide community sample. The present analyses include a sample of 1,019 respondents aged 60 years and older. Five-year changes in smoking, alcohol use, physical exercise and Body Mass Index (BMI) are assessed according to prevalent and incident chronic health problems. Multivariate logistic analyses of “healthy” behavioural changes are conducted.Results: A total of 453 respondents (45%) reported at least one chronic condition and 13% (N=133) reported onset of chronic conditions in the course of the past five years. Over a five-year period, there was an overall reduction in smoking rates and a decrease in regular physical activity. Alcohol consumption in older people slightly increased over time, but the incidence of chronic health problems tended to reduce alcohol intake. Older persons experiencing chronic health problems were less likely to initiate physical activity.Conclusions: The results provide limited support for the assumption that the onset of a chronic health condition triggers improved health behaviours. This suggests that the health care system could do more in targeting a potential “window of opportunity” for individuals to adopt new healthy behaviours in later life.

Background: Cancer is a disease closely associated with aging. Aging populations will thus lead to a pronounced increase in the absolute number of elderly persons with cancer, resulting in profound public health challenges in the coming decades. Older patients have distinct treatment and care needs, but are nevertheless largely overlooked in studies. We therefore examine cancer incidence, prevalence and survival among older cancer patients to help guide various stakeholders in the acute and more long-term handling of this patient group.Data and methods: >400 000 cancers diagnosed in individuals age 65+ in 1975-2009 were extracted from the Cancer Registry of Norway. Descriptive analyses of incidence and prevalence were undertaken, and survival analysis was used to model survival.Results: The absolute number of elderly (65-79 years) and oldest old (80+ years) patients has more than doubled since 1975, and will continue to grow towards 2030. A more than threefold increase in patients 80+ years has taken place. The largest patients groups comprise colorectal, prostate, lung and breast cancer. For all patients 65 and older, the median survival has increased with 135%. The increase has been most pronounced for the elderly patients. Surgical resection rates decline with increasing patient age. The difference in relative survival is around 8 percentage points at three years (60% vs 52%). It has been constant over time.Conclusion: “Best practice” guidelines for the large and increasing group of older cancer patients remain to be established. The gain in length of lives must be balanced against patients’ quality of life, and considered in a cost-benefit perspective for society at large.

Cancer during childhood may have severe consequences for the children affected (1-5). It may, however, also influence entire families adversely: In order to care for a child with cancer, roles might be altered and family functioning may need to change for shorter or longer periods of time. Parents’ work situations and/or relationships may thus be affected by increased psychological stress shortand long-term (6-8), but also by an increased parental care burden associated with chronic illness in children in general (9). As a consequence, the household’s income may be reduced (10;11), and this may affect the family’s welfare negatively. In addition, these factors alone or in combination may create strain on the family as a system. In line with this, a meta-analysis on the influence of pediatric cancer on parent and family functioning demonstrated that these mothers report a relatively small but significant increased level of family conflicts compared to healthy controls (12). This may negatively affect children’s and parents’ adjustment and thus affect various aspects of family life. This chapter will summarize existing research on how cancer illness in a child may impact on parental employment and earnings, and thus affect the economic situation of households affected by cancer. It will also present findings on how cancer in a child may affect parents’ relationships and divorce rates. Empirical results from Norway on these matters will thereafter be presented (11;13). Knowledge of common outcomes may help families plan their lives, and serve as an important basis for societal attempts to assist.

Video abstract Video, Background Today many people are choosing to have children later in life. Additionally, the use of sophisticated diagnostic tools and screening modalities has increased over recent years. Because of these factors, cancer is being diagnosed more frequently during the child-rearing years. Sociodemographic and cancer-related information on families and minor (0–18 years) and young adult (YA) (19–25 years) children experiencing parental cancer is scarce, but this information is vital for healthcare initiatives aimed toward those potentially adversely affected. Therefore, the aim of this study was to describe features of families and minor and YA children affected by parental cancer in a nationwide population. Methods Complete Norwegian birth cohort data were obtained from national registries. Descriptive prevalence and incidence statistics were collected for parents and minor and YA children. Logistic regression models were used to assess factors likely to influence parental death. Results Every year around 0.3% of all families with children under the age of 18 years encounter parental cancer, and 3.1% of minors and 8.4% of YAs have a parent who has been diagnosed with cancer. This study found skin, breast, testicular, and colorectal cancers were the most common forms of cancer diagnosed. The sociodemographic features of those affected were fairly similar to those of the general population. One in five children experienced parental death from cancer; parental death was more often paternal than maternal and was most common in parents diagnosed with leukemia or brain, colorectal, and lung tumors. Deaths are uncommon among parents without cancer. Conclusion Adequate assistance for minor and YA children affected by parental cancer requires knowledge of their number and characteristics. Parental cancer is more common than previously suggested: the annual incidence of parental cancer for children under 18 years of age is 0.3%, whereas approximately 4% of children aged 0–25 years have or have had parents diagnosed with cancer, corresponding to a population prevalence of 1.4%. Around 20% of these children experience parental death, and surveys of live respondents should account for this.

Diagnostic and treatment protocols for childhood cancer are generally standardized, and therefore, survival ought to be fairly equal across social strata in societies with free public health care readily available. Nevertheless, our study explores whether there are disparities in mortality after childhood cancer in Norway depending on socioeconomic status of parents. Limited knowledge on differentials exists from earlier analyses. Discrete-time hazard regression models for all-cause mortality for the first 10 years after diagnosis were estimated for all Norwegian children (younger than 20 years), who were diagnosed with cancer during 1974-2007 (N = 6,280), using data from five national registers. Mortality was reduced by about 15% for children with highly educated mothers and children without siblings. These effects were most pronounced for cancers predicted to encompass intense, long-lasting treatments resulting in chronic health problems. Neither earnings nor the marital status of parents affected children's survival. This large, registry-based study suggests that time constraints and various noneconomic rewards of parents from their education appears to have an impact on childhood cancer survival. It may be that children with resourceful parents are healthier at the outset and/or are more likely to avoid later health problems. It may also be that children of well-informed and strongly involved parents are offered better treatment or are able to make better use of what is offered, for instance, by adhering more closely to recommendations for follow-up treatment. The possibility of such differentials in offered and actual treatment should be addressed in future research.

Background Rates of all-cause and cause-specific mortality are higher among unmarried than married individuals. Cancer survival is also poorer in the unmarried population. Recently, some studies have found that the excess all-cause mortality of the unmarried has increased over time, and the same pattern has been shown for some specific causes of death. The objective of this study was to investigate whether there has been a similar change over time in marital status differences in cancer survival. Methods Discrete-time hazard regression models for cancer deaths among more than 440 000 women and men diagnosed with cancer 1970-2007 at age 30-89 were estimated, using register data encompassing the entire Norwegian population. More than 200 000 cancer deaths during over 2 million person-years of exposure were analyzed. Results The excess mortality of the never-married compared to the married has increased steadily for men, in particular the elderly. Among elderly women, the excess mortality of the never-married compared to the married has increased, and there are indications of an increasing excess mortality of the widowed. The excess mortality of divorced men and women, however, has been stable. Conclusions There is no obvious explanation for the increasing disadvantage among the never-married. It could be due to a relatively poorer general health at time of diagnosis, either because of a more protective effect of partnership in a society that may have become less cohesive or because of more positive selection into marriage. Alternatively, it could be related to increasing differentials with respect to treatment. Today's complex cancer therapy regimens may be more difficult for never-married to follow, and health care interventions directed and adapted more specifically to the broad subgroup of never-married patients might be warranted.

Purpose : Cancer in a child may adversely affect parents' work opportunities due to enlarged care burdens and/or altered priorities. Few studies exist, and possible effects on parental employment and earnings were therefore explored. Materials and methods : Data on the entire Norwegian population aged 27–65 with children under the age of 20 in 1990–2002 ( N =1.2 million) was retrieved from national registries. Employment rates for parents of 3263 children with cancer were compared to those of parents with children without cancer by means of logistic regression models. Log-linear regression models were used to explore childhood cancer's effect on parental earnings for the large majority of parents who remained employed. Results : Cancer in a child was in general not associated with a reduced risk of employment, although some exceptions exist among both mothers and fathers. For employed mothers, CNS cancers, germinal cell cancers, and unspecified leukemia were associated with significant reductions in earnings (10%, 21%, and 60%, respectively). Reductions were particularly pronounced for mothers with a young and alive child, and became more pronounced with time elapsed from diagnosis. Fathers' earnings were not affected significantly. Discussion and conclusion : Parents' employment is not adversely affected by a child's cancer in Norway. Earnings are reduced in certain instances, but the overall effects are minor. Generous welfare options and flexible labor markets typical for Nordic welfare states may account for this. In line with traditional caregiving responsibilities, reductions in earnings were most pronounced for mothers.

Purpose Cancer in children may profoundly affect parents' personal relationships in terms of psychological stress and an increased care burden. This could hypothetically elevate divorce rates. Few studies on divorce occurrence exist, so the effect of childhood cancers on parental divorce rates was explored. Patients and Methods Data on the entire Norwegian married population, age 17 to 69 years, with children age 0 to 20 years in 1974 to 2001 (N = 977,928 couples) were retrieved from the Cancer Registry, the Central Population Register, the Directorate of Taxes, and population censuses. Divorce rates for 4,590 couples who were parenting a child with cancer were compared with those of otherwise similar couples by discrete-time hazard regression models. Results Cancer in a child was not associated with an increased risk of parental divorce overall. An increased divorce rate was observed with Wilms tumor (odds ratio [OR], 1.52) but not with any of the other common childhood cancers. The child's age at diagnosis, time elapsed from diagnosis, and death from cancer did not influence divorce rates significantly. Increased divorce rates were observed for couples in whom the mothers had an education greater than high school level (OR, 1.16); the risk was particularly high shortly after diagnosis, for CNS cancers and Wilms tumors, for couples with children 0 to 9 years of age at diagnosis, and after a child's death. Conclusion This large, registry-based study shows that cancer in children is not associated with an increased parental divorce rate, except with Wilms tumors. Couples in whom the wife is highly educated appear to face increased divorce rates after a child's cancer, and this may warrant additional study.

BACKGROUND: Cancer affects patients’ incomes, but to the authors’ knowledge few studies to date have examined how the income of the patients’ spouses may be influenced. In this population-based study from Norway, the effects of cancer on both partners’ earnings are analyzed. METHODS: The difference between labor earnings the year before the cancer diagnosis and that 2, 5, or 8 years later was compared with the difference in earnings over a corresponding period for similar persons without cancer, applying linear regression models to national registry data. Approximately 1.1 million married persons ages 35 to 59 years were included, among them 17,250 persons diagnosed with cancer during 1991 through 1999. RESULTS: Two and 5 years after a cancer diagnosis, married men experienced lower earnings than they would have absent the illness. Cancer in wives, however, did not affect men’s earnings. Women’s earnings were adversely influenced to the same extent by their own as by their spouses’ cancer. Brain, lung, and colorectal cancer in male spouses produced the most adverse effects on women’s earnings. All effects were most pronounced for women no longer married. CONCLUSIONS: Women’s earnings are lower after both their own and their spouses’ cancer illness, and divorced and widowed women experience the most pronounced reduction after spousal cancer. Men’s earnings are lower only if they are diagnosed themselves. This may reflect traditional sex roles, with men as main breadwinners and women as caregivers. For family households, cancer in men may result in greater financial difficulties than cancer among women, although the effect will depend on breadwinner roles before diagnosis. Cancer 2009;115(18 suppl):4350–61. V C 2009

Discrete-time hazard regression models were employed to register and census data on 1.4 million Norwegian married couples from 1974-2001 to explore the probability of divorce following cancer illness. Divorce rates for around 215 000 persons diagnosed with cancer were compared to divorce rates for persons for whom all the other observed variables were the same. No overall harmful influence of a cancer diagnosis was observed. Most cancer forms resulted in small, immediate declines in divorce rates the first years following diagnosis. Exceptions were significant increases in the divorce rates for persons diagnosed with cervical and testicular cancer.

Many cancer forms today have good prognosis, and parenthood after cancer diagnosis and treatment has become a central research topic. Previous research has mainly focused on reproductive cancers, and few population-based studies exist. The effect of several cancer forms on fertility at a population level was explored. Discrete-time hazard regression models were used to analyse register and census data for complete Norwegian birth cohorts. Men and women 17–44 years in the period 1965–2001 were included. Models for first- and higher-order birth rates, for men and women, were estimated. Overall, first-birth rates among persons with cancer were reduced by only about 25% when compared with the general population. Male cancer survivors' second- and third-birth rates were similarly reduced, whereas higher-order birth rates for females were 36% below those of the general population. Significant decreases in cancer survivors' fertility disadvantage relative to the general population were seen from 1965 to 2001. Reductions in fertility were most pronounced for reproductive cancer forms, presumably related to subfecundity. However, also cancer forms unrelated to reproductive function led to reduced fertility, perhaps suggesting underlying social mechanisms. This is further supported by the difference in probability between first and subsequent births observed for women. Copyright © 2007 John Wiley & Sons, Ltd.

Background Inadvertent perforation of the bowel or tumour is a relatively common complication during resection of rectal cancer. The purpose of this study was to examine intraoperative perforation following the introduction of mesorectal excision as a standard surgical technique in Norway. Methods This was a prospective national cohort study of 2873 patients undergoing major resection of rectal carcinoma at 54 Norwegian hospitals from November 1993 to December 1999. Results The overall perforation rate was 8·1 per cent (234 of 2873 patients). In a multivariate analysis, the risk of perforation was significantly greater in patients undergoing abdominoperineal resection (odds ratio (OR) 5·6 (95 per cent confidence interval (c.i.) 3·5 to 8·8)) and in those aged 80 years or more (OR 2·0 (95 per cent c.i. 1·2 to 3·5)). The 5-year local recurrence rate was 28·8 per cent following perforation, compared with 9·9 per cent in patients with no perforation (P < 0·001); survival rates were 41·5 and 67·1 per cent respectively (P < 0·001). Conclusion The risk of intraoperative perforation was significantly greater in patients with rectal cancer undergoing abdominoperineal resection and in those aged 80 years or more. The high local recurrence rates and reduced survival following perforation call for increased attention to avoid this complication.

3622 Background: As populations age, more people are being diagnosed with cancer at late age. We compared outcomes after colorectal cancer (CRC) diagnosis in the oldest old patients in Norway and t...

Finding a life partner is of great importance for persons' life satisfaction, but cancer's potential impact on family life is not well described. Cancer's impact on marriage formation rates was therefore explored.Data on the entire unmarried Norwegian population aged 17-44 in 1974-2001 (N = 2.2 million) come from the Cancer Registry and the Central Population Register. Marriage rates for 12,100 persons diagnosed with cancer were compared to marriage rates for otherwise similar persons using discrete-time hazard regression models.Men with cancer had a marriage probability that was five percent higher (OR 1.05, CI 1.01-1.11) than cancer-free men. No cancer forms reduced men's marriage rates, and significantly elevated rates were seen after skin and testicular cancer (OR 1.16 and 1.11). Cancer did not impact significantly on women's overall marriage rate (OR 0.95, CI 0.90-1.00), but pronounced deficiencies were seen after brain and breast cancer (OR 0.62 and 0.74). Skin cancer elevated women's marriage rate (OR 1.27). Male cancer survivors with children were more likely to marry than their female counterparts. Significant increases in cancer survivors' marriage rates were observed over time.Marrying after cancer is more common today than previously, and only slight overall differences were observed in cancer survivors' marriage rates relative to those of the cancer-free population. However, while brain and breast cancer in women is associated with reduced marriage rates, testicular cancer is associated with increased rates. The differences observed between common cancer forms in young adults deserve further exploration.In general, marriage rates in survivors of most types of cancer are very similar to those in the population as a whole. Women with brain and breast cancer have lower marriage rates than their cancer-free counterparts. While it is necessary to identify exactly why this was observed, the information can alert those with these cancers to the potential impact on marriage and thus work to reduce the possible effect, if desired.

Cancer's impact on family formation in older adulthood is not well described. Marriage rates among older adults were therefore explored.Data on the unmarried Norwegian population aged 45-80 in 1974-2001 (N = 306 000) was retrieved from the Cancer Registry, the Central Population Register, and population censuses. Marriage rates for 27,600 persons diagnosed with cancer were compared to those of the general population by means of discrete-time hazard regression models.Men with cancer had a similar marriage rate as cancer-free men, whereas women experienced a 25% marriage deficit after cancer. This deficit was most pronounced after ovarian (OR 0.48) and breast (OR 0.69) cancer. Marriage rates decreased with time from diagnosis. No cancer forms elevated marriage rates.Marriage rates among older male cancer survivors are similar to those of the general population. Ovarian and breast cancer in older women was associated with pronounced marriage deficits. A possible explanation is that these gender-specific cancers relate to aspects of persons' psychological well-being, body image, and sense of femininity. Long-term adverse treatment effects are also common for the cancers in question. To explore explanations further, more details on treatment and illness progression are needed.Increased awareness of how ovarian and breast cancer may affect (prospects of) interpersonal relationships is valuable for cancer survivors and clinicians, and may facilitate communication of relevant, related issues during consultations. Our findings may suggest a need for more extensive psychosocial follow-up after these gender-specific cancer forms in older women, but further research is clearly warranted.