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BACKGROUND: The prevalence of prescribed drugs in survivors of colorectal cancer (CRC) was evaluated. METHODS: Data from the Cancer Registry of Norway were linked to the Norwegian Prescription Database for a study population of 3.52 million individuals. Prevalence ratios (PRs) with 95% confidence intervals (CIs) of prescribed drugs in CRC-survivors compared to the cancer-free population, were estimated by log-binomial regression, adjusting for age and education. RESULTS: Almost 27 000 individuals, aged 20 to 84, were diagnosed with CRC during 2005 to 2014. The first year after diagnosis, the prevalence of prescribed drugs was higher in CRC-survivors compared with the cancer-free population, especially drugs for anxiety and tension, and steroid-responsive conditions. PRs for several drugs, especially drugs used for mental and behavioural disorders, decreased with time since diagnosis. The prevalence of drugs used for anxiety and tension was elevated 10 years after diagnosis; PRs the first year after diagnosis were 20 (95% CI: 18-22) in males and 17 (16-18) in females. Ten years after diagnosis PRs were 5.0 (3.1-7.9) and 2.0 (1.0-3.8), respectively. In absolute numbers, the largest increase, compared to the cancer-free population, was in drugs used for gastric acid disorders and pain. The prevalence of neuromodulatory drugs was higher in CRC-survivors. CONCLUSIONS: The prevalence of several drugs was higher in CRC-survivors than in the cancer-free population 10 years after diagnosis. The largest absolute excess in prevalence was for gastric acid disorder and pain medications, while the relative prevalence of drugs used for anxiety and tension was high in CRC-survivors. Long persisting neuropathia was indicated.

Background: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups. Methods: All Norwegian children born 1992–2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization. Results: Children with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %. Conclusions: This large nationwide registry linkage study confirms that the clinical picture in CFS/ME is complex. Children with CFS/ME were frequently diagnosed with infections, supporting the hypothesis that infections may be involved in the causal pathway. The long time span often observed from the first diagnosis of weakness / general tiredness to the diagnosis of CFS/ME might indicate that the treatment of these patients is sometimes not optimal. publishedVersion

Background: Improved survival for childhood and adolescent cancer patients due to advances in medical and supportive care is a great achievement of modern medicine. As the number of long-term survivors of cancer in childhood and adolescence is growing rapidly, increasing attention is being paid to the possible impact of the disease and its treatment on long-term health and social performance. Impact of cancer in childhood (0– 14 years), adolescence (15–19 years) and young adulthood (20–24 years) on early cancer death, uptake of social security benefits and educational attainment has been explored in a national cohort. Material and methods: All children born alive in Norway during 1965–1985 were identified by the Norwegian Central Population Registry and defined as the study cohort (approximately 1.2 million individuals). By linkage to the Cancer Registry of Norway, all children (N=2,481), adolescents (N=1,289) and young adults (N=2,032) diagnosed with cancer were identified. The cohort was followed from birth into adulthood by further linkage to compulsory national databases; the Cause of Death Registry, the National Insurance Scheme, and the Norwegian National Education Database. These registries include data on mortality, social security benefits, and education which were the main outcomes. Data were analysed by applying various regression models that allow for adjustment for confounders; Cox regression, logistic regression and competing risk model. Standardized incidence ratios were used in cases of rare outcomes. Results: Differences in overall mortality between the cancer patients and the cancer-free population decreased during our study period. Early cancer mortality (within 5-years after diagnosis) for all cancers also decreased since 1965. Overall, there were relatively fewer cancer-related deaths among female than male patients. Adolescents and young adult patients had lower risk of cancer death than children in general, except for patients who were diagnosed with leukaemia (all combined). Overall, 5-year cancer survivors were 4.4 times more likely to receive any kind of social security benefits than the cancer-free population. Survivors from bone and connective/soft tissue tumours, central nervous system (CNS) tumours and leukaemia were most likely to be recipients of social security benefits. After neoplasms, the most common causes of receiving social security benefits were diseases of the nervous system, and injury and poisoning. In general, completion of education was lower among 5-year cancer survivors than the cancer-free population at all levels i.e. intermediate, under graduate and graduate education. Mainly survivors of CNS-tumours and those assumed to have received CNSdirected therapy were at risk of educational deficits and experienced some delays in completion of an educational level. However, educational impairment diminished at higher levels of education, and consequently choice of educational fields was similar for the cancer survivors and the cancer-free population. Conclusions: More cancer patients become 5-year survivors today compared to earlier. These survivors are at increased risk of late effects. Medical surveillance and supportive care is therefore of high importance for the cancer survivors. Special attention should be paid to survivors of CNS-tumours, leukaemia and bone and connective/soft tissues tumours since they were at higher risk for late effects compared with other survivors. Careful follow-up of cancer survivors during their education is also recommended in order to maximize educational achievements.

Background: The aim of the current study was to estimate sex- and age-specific incidence rates of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) using population-based registry data. CFS/ME is a debilitating condition with large impact on patients and their families. The etiology is unknown, and the distribution of the disease in the general population has not been well described. Methods: Cases of CFS/ME were identified in the Norwegian Patient Register (NPR) for the years 2008 to 2012. The NPR is nationwide and contains diagnoses assigned by specialist health care services (hospitals and outpatient clinics). We estimated sex- and age-specific incidence rates by dividing the number of new cases of CFS/ME in each category by the number of person years at risk. Incidence rate ratios were estimated by Poisson regression with sex, age categories, and year of diagnosis as covariates. Results: A total of 5,809 patients were registered with CFS/ME during 2008 to 2012. The overall incidence rate was 25.8 per 100,000 person years (95% confidence interval (CI): 25.2 to 26.5). The female to male incidence rate ratio of CFS/ME was 3.2 (95% CI: 3.0 to 3.4). The incidence rate varied strongly with age for both sexes, with a first peak in the age group 10 to 19 years and a second peak in the age group 30 to 39 years. Conclusions: Early etiological clues can sometimes be gained from examination of disease patterns. The strong female preponderance and the two age peaks suggest that sex- and age-specific factors may modulate the risk of CFS/ME. publishedVersion