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Bill-Axelson, Anna
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Publications (10 of 55) Show all publications
Glimelius, B., Melin, B., Enblad, G., Alafuzoff, I., Beskow, A. H., Ahlström, H., . . . Sjöblom, T. (2018). U-CAN: a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden.. Acta Oncologica, 57(2), 187-194
Open this publication in new window or tab >>U-CAN: a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden.
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2018 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 2, p. 187-194Article in journal (Refereed) Published
Abstract [en]

Background: Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population.

Material and Methods: Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data.

Results: In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort.

Conclusions: Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.

National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-325565 (URN)10.1080/0284186X.2017.1337926 (DOI)000423473200003 ()28631533 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2018-03-09Bibliographically approved
von Below, C., Wassberg, C., Norberg, M., Tolf, A., Kullberg, J., Ladjevardi, S., . . . Ahlström, H. (2017). Additional value of magnetic resonance-targeted biopsies to standard transrectal ultrasound-guided biopsies for detection of clinically significant prostate cancer. Scandinavian journal of urology, 51(2), 107-113
Open this publication in new window or tab >>Additional value of magnetic resonance-targeted biopsies to standard transrectal ultrasound-guided biopsies for detection of clinically significant prostate cancer
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2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, no 2, p. 107-113Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to evaluate the additional value of magnetic resonance imaging-targeted biopsy (MRI-TB) to standard transrectal ultrasound-guided biopsy (SB) for detection of clinically significant prostate cancer (PCa). An additional aim was to compare the biopsy results to MRI evaluation using a Likert scale.

MATERIALS AND METHODS: Patients with newly diagnosed localized PCa (n = 53) by clinical routine SB were prospectively included. The majority of the patients were scheduled for curative therapy before enrollment. The patients underwent multiparametric MRI (mpMRI) at 3 T using an endorectal coil followed by two MRI-TBs, using ultrasound with cognitive fusion. All included patients underwent MRI-TB, even those who had low to very low suspicion of significant PCa on mpMRI. The detection rate of significant cancer on SB versus SB + MRI-TB was compared in the 53 included patients and with whole-mounted histopathology as reference in 34 cases. Comparison of the biopsy results to MRI evaluation and interreader agreement calculation of five-point Likert score evaluation were performed.

RESULTS: In total, 32 significant (Gleason ≥7) PCa were detected by SB, while SB + MRI-TB detected an additional five significant PCa. MRI-TB alone detected 20 and missed 17 significant PCa. Ten of the significant PCa cases missed by MRI-TB had a Likert score of 3 or lower. Interreader agreement using the Likert scale was high, with a kappa value of 0.77 (95% confidence interval 0.63-0.92, p < 0.0001).

CONCLUSION: Detection of significant PCa increased by adding MRI-TB to SB. This may not be of enough clinical value to justify the use of targeted biopsies in this patient group.

Keyword
Magnetic resonance imaging, prostatic neoplasm, targeted biopsies, transrectal ultrasound-guided biopsy
National Category
Urology and Nephrology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-325563 (URN)10.1080/21681805.2017.1281346 (DOI)000403629400003 ()28635568 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2017-10-19Bibliographically approved
Hauffman, A., Alfonsson, S., Mattson, S., Forslund, M., Bill-Axelsson, A., Nygren, P. & Johansson, B. (2017). The development of a Nurse-led Internet-based Learning and Self-care program for cancer patients with symptoms of anxiety and depression: a part of U-CARE. Cancer Nursing, 40(5), E9-E16
Open this publication in new window or tab >>The development of a Nurse-led Internet-based Learning and Self-care program for cancer patients with symptoms of anxiety and depression: a part of U-CARE
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2017 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, ISSN 0162-220X, Vol. 40, no 5, p. E9-E16Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Having access to information about the disease and being encouraged to participate in self-care activities may reduce anxiety and depression symptoms in cancer patients. Internet-based interventions may be one way to support effective self-care strategies to improve emotional well-being and health-related quality of life.

OBJECTIVE:

The aim of this study was to describe the development and acceptance of an Internet-based program intended to support cancer patients with anxiety and depression symptoms.

METHODS:

A structured collaboration between patients, clinicians, and researchers was used to develop a theory- and evidence-based interactive health communication application (IHCA) based on Orem's self-care deficit nursing theory with influences from Bandura's social learning theory and psychoeducation.

RESULTS:

The result is an IHCA described as a Nurse-led, Internet-based Learning and Self-care program that helps patients to perform self-care using different types of material in interaction with patients and healthcare staff. The acceptance of the program is consistent with the results of similar studies.

CONCLUSIONS:

Collaboration between patients, clinicians, and researchers seems to be a fruitful approach in the development of an IHCA aiming to support cancer patients' self-care strategies. Well-designed intervention studies are needed to evaluate the effects of the IHCA.

IMPLICATIONS FOR PRACTICE:

This article suggests a theoretical foundation for an IHCA and allows researchers and healthcare providers to take part in the discussion regarding format and content of IHCAs.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-283650 (URN)10.1097/NCC.0000000000000402 (DOI)000414798700002 ()27223884 (PubMedID)
Funder
U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example
Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2018-02-12Bibliographically approved
Lycken, M., Drevin, L., Garmo, H., Stattin, P., Adolfsson, J., Lissbrant, I. F., . . . Bill-Axelson, A. (2017). The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.. European Journal of Cancer, 88, 101-108
Open this publication in new window or tab >>The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.
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2017 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 88, p. 101-108Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.

METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.

RESULTS: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).

CONCLUSION: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.

Keyword
Anxiety, Cancer pain, Castration, Depression, Fatigue, Observational study, Opioids, Palliative medicine, Prostate cancer, Sleep disorders
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-336227 (URN)10.1016/j.ejca.2017.10.023 (DOI)000418290800012 ()29216521 (PubMedID)
Funder
Swedish Cancer Society, CAN 2008/598:1Swedish Research Council, 2012-5047
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-01-29Bibliographically approved
Lycken, M., Drevin, L., Garmo, H., Stattin, P., Adolfsson, J., Lissbrant, I. F., . . . Bill-Axelson, A. (2017). Use of palliative medications before death from prostate cancer: a population based study. Scandinavian journal of urology, 51(SI 220), 25-26
Open this publication in new window or tab >>Use of palliative medications before death from prostate cancer: a population based study
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2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, no SI 220, p. 25-26Article in journal, Meeting abstract (Other academic) Published
Keyword
Epidemiology & Evaluation, Medical, Hormonal & Non-surgical Therapy, Prostate & Genitalia
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-335830 (URN)10.1080/21681805.2017.1332285 (DOI)000404615000020 ()
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2017-12-19Bibliographically approved
Simpkin, A. J., Donovan, J. L., Tilling, K., Athene Lane, J., Martin, R. M., Albertsen, P. C., . . . Metcalfe, C. (2016). Prostate-specific antigen patterns in US and European populations: comparison of six diverse cohorts. BJU International, 118(6), 911-918
Open this publication in new window or tab >>Prostate-specific antigen patterns in US and European populations: comparison of six diverse cohorts
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2016 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 118, no 6, p. 911-918Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa).

SUBJECTS AND METHODS: We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations.

RESULTS: The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations.

CONCLUSION: We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.

Keyword
bone density; bone mineral density; dual-energy x-ray absorptiometry; Hounsfield units; maxilla; skeletal
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-310904 (URN)10.1111/bju.13422 (DOI)000388479100016 ()26799945 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2017-11-29Bibliographically approved
Lundström, K.-J., Folkvaljon, Y., Loeb, S., Axelson, A. B., Stattin, P. & Nordin, P. (2016). Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy. Scandinavian journal of urology, 50(3), 155-159
Open this publication in new window or tab >>Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy
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2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 3, p. 155-159Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions.

Materials and methods: In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005-2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively.

Results: During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14-3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86-1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50-3.33) but not after 5 years (HR 1.23, 95% CI 0.92-1.63).

Conclusion: Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP.

Keyword
Adhesions, intestinal obstruction, open prostatectomy, robot-assisted radical prostatectomy, small bowel obstruction
National Category
Urology and Nephrology Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-297260 (URN)10.3109/21681805.2016.1141319 (DOI)000375039800004 ()26936203 (PubMedID)
Funder
Swedish Research Council
Available from: 2016-06-29 Created: 2016-06-22 Last updated: 2017-12-13Bibliographically approved
Martin, N. E., Massey, L., Stowell, C., Bangma, C., Briganti, A., Bill-Axelson, A., . . . Huland, H. (2015). Defining a Standard Set of Patient-centered Outcomes for Men with Localized Prostate Cancer. European Urology, 67(3), 460-467
Open this publication in new window or tab >>Defining a Standard Set of Patient-centered Outcomes for Men with Localized Prostate Cancer
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2015 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 67, no 3, p. 460-467Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment.

OBJECTIVE: To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa) treatment value.

DESIGN, SETTING, AND PARTICIPANTS: We convened an international working group of patients, registry experts, urologists, and radiation oncologists to review existing data and practices.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The group defined a recommended standard set representing who should be tracked, what should be measured and at what time points, and what data are necessary to make meaningful comparisons. Using a modified Delphi method over a series of teleconferences, the group reached consensus for the Standard Set.

RESULTS AND LIMITATIONS: We recommend that the Standard Set apply to men with newly diagnosed localized PCa treated with active surveillance, surgery, radiation, or other methods. The Standard Set includes acute toxicities occurring within 6 mo of treatment as well as patient-reported outcomes tracked regularly out to 10 yr. Patient-reported domains of urinary incontinence and irritation, bowel symptoms, sexual symptoms, and hormonal symptoms are included, and the recommended measurement tool is the Expanded Prostate Cancer Index Composite Short Form. Disease control outcomes include overall, cause-specific, metastasis-free, and biochemical relapse-free survival. Baseline clinical, pathologic, and comorbidity information is included to improve the interpretability of comparisons.

CONCLUSIONS: We have defined a simple, easily implemented set of outcomes that we believe should be measured in all men with localized PCa as a crucial first step in improving the value of care.

PATIENT SUMMARY: Measuring, reporting, and comparing identical outcomes across treatments and treatment centers will provide patients and providers with information to make informed treatment decisions. We defined a set of outcomes that we recommend being tracked for every man being treated for localized prostate cancer.

National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-244718 (URN)10.1016/j.eururo.2014.08.075 (DOI)000349374200021 ()25234359 (PubMedID)
Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2017-12-04Bibliographically approved
Loeb, S., Folkvaljon, Y., Makarov, D. V., Bratt, O., Bill-Axelson, A. & Stattin, P. (2015). Five-year Nationwide Follow-up Study of Active Surveillance for Prostate Cancer. European Urology, 67(2), 233-238
Open this publication in new window or tab >>Five-year Nationwide Follow-up Study of Active Surveillance for Prostate Cancer
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2015 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 67, no 2, p. 233-238Article in journal (Refereed) Published
Abstract [en]

Background: Active surveillance (AS) is an important yet underutilized strategy to reduce prostate cancer (PCa) overtreatment. Objective: To examine the 5-yr outcomes of AS in a population-based setting. Design, setting, and participants: From the National Prostate Cancer Register of Sweden, we identified 11 726 men <= 70 yr diagnosed with very low-risk to intermediate-risk PCa from 2003 to 2007 who completed 5 yr of follow-up. Of these men, 1729 (15%) chose AS for the primary management strategy. Outcome measurements and statistical analysis: We calculated the probability of discontinuation of AS over time, and Cox proportional hazards models were used to determine factors associated with discontinuation. Reasons for discontinuation were assessed by data extraction from medical charts. Results and limitations: By 5 yr, 64% of the men remained on AS. Predictors of discontinuation were younger age, fewer comorbidities, more education, higher prostate-specific antigen (PSA), and clinical stage T2 disease; marital status did not predict discontinuation. In a subset with data on the reason for discontinuation (86%), 20% of men discontinued because of patient preference, 52% because of PSA progression, 24% because of biopsy progression, and 3% for other reasons. Conclusions: In a population-based setting, the majority of men remained on AS at 5 yr. However, one-fifth of the men who discontinued AS did so for nonbiologic reasons. Thus, there is a need for support and counseling for men to continue AS in the absence of signs of progression to improve adherence to AS and decrease overtreatment. Patient summary: Active surveillance (AS) is an important option to delay or avoid treatment for men with favorable prostate cancer features. This study shows that at 5 yr, 64% of men across an entire population remained on AS. We concluded that AS is a durable option and that counseling may be useful to promote adherence for men without progression. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Keyword
Prostate cancer, Active surveillance, Adverse pathology, Predictors, Upgrading
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-243423 (URN)10.1016/j.eururo.2014.06.010 (DOI)000347033500024 ()
Available from: 2015-02-17 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved
Bill-Axelson, A. & Bratt, O. (2015). Re: Screening and Prostate Cancer Mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 Years of Follow-up. European Urology, 67(1), 175-175
Open this publication in new window or tab >>Re: Screening and Prostate Cancer Mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 Years of Follow-up
2015 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 67, no 1, p. 175-175Article in journal, Editorial material (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-240867 (URN)10.1016/j.eururo.2014.09.048 (DOI)000345615400040 ()
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-12-05Bibliographically approved
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