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  • Tadalafil br The European Organisation for Research and Trea


    The European Organisation for Research and Treatment of Cancer Breast Reconstruction Questionnaire (EORTC QLQ-BRR26) assesses satisfaction with the results after breast reconstruction. The questionnaire was validated/tested for reliability in a set of breast cancer patients after breast reconstruction [19,20]. It consists of 26 items constituting three scales with scores ranging from 1 (‘Not at all’) to 4 (‘A lot’). The Swedish version has been formally translated, and was a part of the development of this questionnaire [19,20]. 
    The Body Image Scale (BIS) is a 10-item scale measuring the impact of surgery on self-consciousness, physical/sexual attrac-tiveness, femininity, satisfaction with body/scars, body integrity, and avoidance behaviour after surgery for cancer patients [21]. The development of the scale did not rely on a particular theoretical model, as there was no consensus on the definition of body image disturbance in 1997, when the first study was carried out. Scores per item ranges from (‘Not at all’) to 3 (‘Very much’), creating a total score of 0e30/patient. A higher total score translates to more problems. The Swedish version was translated at Karolinska Uni-versity Hospital in 1997. It has not been formally validated/ reliability-tested, but the Cronbach a coefficient for the study sample at the six-month assessment was 0.85 [9].
    The Sexuality Activity Questionnaire (SAQ) consists of a 10-item scale assessing sexual activity: ‘Pleasure’ (desire, enjoyment, and satisfaction; higher scores indicate more pleasure (range 0e18)), ‘Discomfort’ (dryness and pain; higher scores indicate more discomfort (range 0e6)), and ‘Sexual habit’ (<0.33 indicate less frequent than usual (range 0e3)) [22]. The Swedish Tadalafil has not been formally validated, but the English version was shown to be valid/reliable as a measure of women's sexual functioning [22].
    The Hospital Anxiety and Depression (HAD) scale assesses anxi-ety/depressive symptoms [23]. It consists of 14 items (seven Tadalafil items assessing ‘Anxiety’ and ‘Depressive symptoms’ each), scored to 3, yielding a summated score per scale between and 21. Cut-offs for clinically relevant anxiety/depressive symptoms have been estab-lished [23]. Less than 8 points indicate normal levels of problems, 8e10 points indicate possible clinical cases, and 11 points indicate clinical cases. The Swedish version has been validated against di-aries in a sample of breast cancer patients [24].
    The Swedish Short Term-36 Health Survey (SF-36) measures HRQoL [25]. It covers eight-domains by 36 items. For each domain, mean scores were transformed to a to 100 scale, where a higher number represents higher functioning.
    2.3. Statistical analysis
    Differences in scores between the one-year and long-term as-sessments were investigated using paired t-tests. Mean paired differences are presented together with 95% confidence intervals. Unpaired comparisons between women with or without previous breast cancer were performed by linear regression models. Factors included in the adjusted models were: scores one year post-RRM, time since RRM, age at long-term follow-up, mutation-status, bilateral prophylactic salpingo-oophorectomy, and body mass in-dex (BMI; kg/m2). Results from these models are presented as mean differences with 95% confidence intervals. For SF-36, clinically meaningful differences were determined according to Osoba [26]. A difference of 5e9 points was considered as ‘small’ (S), 10e19 as ‘moderate’ (M), and 20 as ‘large’ (L). Reported p-values are two-sided and refer to Wald tests. The statistical significance level was set to 0.05. All analyses were performed using STATA/IC 14.2 for Mac, StataCorp, TX, USA.
    3. Results
    The Consort diagram (Fig. 1) presents the 148 (74%) women Single-strand assimilation returned the envelopes, of whom 146 (73%) (99 without previous breast cancer; 47 with previous breast cancer) completed the questionnaires. Demographic/clinical data for 136 (68%) women who consented to data collection from medical records are pre-sented in Table 1. For the women who completed the question-naires without giving permission to extract data from their medical records, some missing data were replaced using the research
    Women going through risk-reducing mastectomy at Karolinska University Hospital 1997–2010 n=298
    Women responding to at least one previous short-term assessment n=246
    Eligible women for the long-term follow-up n=200 (136 without previous breast cancer; 64 with previous breast cancer)
    Women responding to the invitation n=148 (100 without previous breast cancer, mean age at follow-up 52.8 years; 48 with previous breast cancer,