Background: With the increasing number and diversity of cancer survivors, studies of survivors’ physical, emotional, and social health are of growing importance. While there is a growing body of literature on the quality of life (QoL) of cancer patients during the early years past diagnosis, less is known regarding QoL in long-term survivors (LTS) (5 + years past diagnosis) and particularly in very long-term survivors (VLTS) (10 + years past diagnosis). The objective of our study is to: (1) compare QoL of long-term cancer survivors and population norms; and (2) assess whether any deficits in QoL of survivors observed 5–10 years past diagnosis persist beyond the 10th year past diagnosis. Methods: In total 6952 long-term cancer survivors (5–16 years past diagnosis of breast, colorectal, or prostate cancer) from Germany recruited in the context of the population-based CAESAR + study were compared with 1878 population-based controls without a history of cancer. QoL was assessed with the EORTC QLQ-C30. Differences in QoL between survivors and controls were assessed via multiple regression while controlling for age, gender, education, and case mix for survivors 5–9 years and 10 + years past diagnosis separately. Results: Overall QoL in long-term cancer survivors was comparable to population norms but specific deficits in social, role, emotional, cognitive, and physical functioning and symptoms such as insomnia, fatigue, dyspnea, constipation, diarrhea, and financial difficulties were more prevalent in LTSs. Detriments in QoL persisted during the observation period and affected particularly cancer survivors at younger ages (<50 years). Non-significant aggravations in QoL with longer time since diagnosis were observed in very young and very old cancer survivors. Conclusions: Detriments in health-related quality of life persist over more than a decade and affect predominantly younger patients. Improvements both in early and long-term follow-up care of cancer survivors seem warranted.

Missing data on tumour stage information is a common problem in population-based cancer registries. Statistical analyses on the level of tumour stage may be biased, if no adequate method for handling of missing data is applied. In order to determine a useful way to treat missing data on tumour stage, we examined different imputation models for multiple imputation with chained equations for analysing the stage-specific numbers of cases of malignant melanoma and female breast cancer.

The SCREEN (Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany) project involved population-wide skin cancer screening with whole-body examination by general physicians and dermatologists. It was conducted in the German state of Schleswig-Holstein (July 2003–June 2004), but not in the German state of Saarland. The population-based registries of Schleswig-Holstein and Saarland provided data on melanoma incidence before, during, and after SCREEN to assess the association of skin cancer screening with incidence. Approximately 19% of the Schleswig-Holstein population participated in SCREEN (women: 27%, men: 10%). A total of 52% of all melanomas diagnosed during SCREEN in Schleswig-Holstein were detected as part of the project. Melanoma incidence increased during SCREEN (invasive melanoma in women: +8.9 per 100 000 (95% confidence intervals (CI): 6.1; 11.7); men: +4.0 per 100 000 (95% CI: 1.6; 6.4)) and decreased afterwards (women: −10.6 per 100 000 (95% CI: −13.3; −7.9); men: −4.1 per 100 000 (95% CI: −6.5; −1.7)). Similar changes were not observed in Saarland that had no such project. The differences between the two states were greatest among women, the group with the greater SCREEN participation. The SCREEN project had a substantial impact on melanoma incidence. This is consistent with the impact of effective screening for other cancers.

Background: With improving prognosis, the ability to return to work after cancer has become a realistic goal but only little is known regarding details such as sustainability, financial consequences, and potential determinants of return to work in long-term survivors in Germany. Methods: We studied return to work in a population-based sample of 1558 long-term cancer survivors, diagnosed in 1994–2004 with breast, colorectal or prostate cancer before age 60 (mean 50.1). Information regarding employment status and financial difficulties was obtained via mailed questionnaires from patients who were identified by six population-based cancer registries in Germany. Cumulative incidence of return to work was determined by time-to-event analysis with consideration of competing events. Chi² tests and multiple logistic regression modeling were employed to identify potential sociodemographic and clinical determinants of return to work. Results: Within a mean period since diagnosis of 8.3 years, 63% of all working-age cancer survivors initially returned to their old job and another 7% took up a new job. Seventeen percent were granted a disability pension, 6% were early retired (not cancer-related), 4% became unemployed, and 1% left the job market for other reasons. Resumption of work occurred within the first 2 years after diagnosis in 90% of all returnees. Cancer-related reduction of working hours was reported by 17% among all returnees and 6% quit their job due to cancer within 5 years past return to work. The probability of return to work was strongly related with age at diagnosis, tumor stage, education, and occupational class but did not differ with respect to the tumor site, gender nor marital status. Conclusions: Most long-term survivors after breast, colorectal, or prostate cancer of working-age are able to return to work. However, financial problems might arise due to a reduction in working hours. An additional provision of targeted interventions for high-risk groups should be discussed.

The aim of the present study was to generate up-to-date normative data for health-related quality of life (QoL) measured with the “European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30)” in a random sample of the population in Northern Germany. We conducted a population-based survey of a random sample of 10,000 persons aged 16 years or older. The postal questionnaire included questions regarding lifetime prevalence of common diseases and quality of life. EORTC QLQ-C30 scales were scored according to standard procedures. The results were stratified for age and sex. The questionnaire was completed by 4,684 (47%) of 9,928 eligible persons. Mean age of the participants was 51.7 years (standard deviation: 18.5) and 57% were females. Missing values for the EORTC QLQ-C30 scales and items were sparse (minimum: 0.2%, maximum: 1.5%). Self-reported health related QoL varied by age and sex. Generally, men reported better functioning and fewer symptoms than women. In both sexes function declined and symptoms increased with increasing age. Symptoms most frequently reported were fatigue, pain and insomnia. Compared to the German reference data published in 2001 our participants scored more than 10 points higher on the latter three scales/items. The most frequently reported diseases were hypertension (36%), hyperlipidemia (26%) and arthritis (30%). Lifetime prevalence of depression was 16% in women and 11% in men. Our study participants are representative for the German general population with regard to age, sex and education. Of special interest is the high proportion of participants reporting depression which is also mirrored by high fatigue, pain and insomnia scores. The normative data provided should be used as comparison health-related QoL data when evaluating the QoL in German cancer patients.

Worldwide, the incidence of skin cancer has risen dramatically during the past 10 to 30 years.¹ With the aim to reduce the burden of skin cancer, different screening activities have been conducted in many European countries and overseas during recent years.^2-5 In 1999, the Euromelanoma campaign began in Belgium (http://www.euromelanoma.org), with free skin cancer screening offered once a year during “Euromelanoma Day.” Almost 30 European countries participate in “Euromelanoma Week” and offer skin cancer screening by dermatologists at specialized clinics to anyone who has a suspicious-looking skin lesion.⁶ The “Euromelanoma Weeks” are accompanied by mass media campaigns that have successfully attracted many individuals at risk for skin cancer.^5,7