Tuesday, September 17, 2013

Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS)

We just published in the journal Systematic Reviews -with Dr. Laurien Buffart as first author- the rationale and design for meta-analyses of individual patient data of randomized controlled trials that evaluate the effect of physical activity and psychosocial interventions on health-related quality of life in cancer survivors, i.e. the POLARIS study.
Because of better cancer treatments, we have more and more cancer http://www.polaris-study.orgsurvivors. Effective interventions to improve quality of life of these cancer survivors are essential. Numerous randomized controlled trials have evaluated the effects of physical activity or psychosocial interventions on health-related quality of life of cancer survivors, with generally small sample sizes and modest effects. Better targeted interventions may result in larger effects. To realize such targeted interventions, we must determine which interventions that are presently available work for which patients, and what the underlying working mechanisms are. Individual patient data meta-analysis has been described as the 'gold standard' of systematic review methodology. Instead of extracting aggregate data from study reports or from authors, the original research data are sought directly from the investigators. Individual patient data meta-analyses allow for adequate statistical analysis of intervention effects and moderators of such effects. In the paper we just published, we report the rationale and design of the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) Consortium. The primary aim of POLARIS is 1) to conduct meta-analyses based on individual patient data to evaluate the effect of physical activity and psychosocial interventions on the health-related quality of life of cancer survivors; 2) to identify important demographic, clinical, personal, or intervention-related moderators of the effect; and 3) to build and validate clinical prediction models identifying the most relevant predictors of intervention success.

Who is more likely to smoke during pregnancy in the Netherlands?

Smoking during pregnancy is a risk factor for various adverse birth outcomes. In order to develop and target interventions to reduce smoking during pregnancy, insight is needed into the characteristics associated with pregnant women who smoke. In a study we just published in PLOS ONE with Ruth Baron as first author we looked at associations of thirteen socio-demographic or lifestyle-related characteristics with ‘any smoking’, ‘daily smoking’ and ‘occasional smoking’ during pregnancy. Our study sample was drawn from the DELIVER study, a cohort of 6107 pregnant women in primary care in the Netherlands who were up to 34 weeks pregnant. Characteristics most strongly associated with any smoking were low education, being of Turkish ethnicity and having no partner. Women of Dutch ethnicity were three times more likely to smoke than those from Dutch-speaking Caribbean countries and non-religious women were much more likely to smoke than religious women. Daily smokers were more likely to be associated with other unfavorable lifestyle-related characteristics, such as not taking folic acid, being underweight, and having had an unplanned pregnancy. There is still much potential for health gain with respect to smoking during pregnancy in the Netherlands. Daily and occasional smokers appear to differ in characteristics, and therefore possibly require different interventions.