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Cavalli-Bjorkman, Nina
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Publications (6 of 6) Show all publications
Glimelius, B. & Cavalli-Björkman, N. (2016). Does shared decision making exist in oncologic practice?. Acta Oncologica, 55(2), 125-128
Open this publication in new window or tab >>Does shared decision making exist in oncologic practice?
2016 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 2, p. 125-128Article in journal, Editorial material (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-282731 (URN)10.3109/0284186X.2015.1102464 (DOI)000369302000001 ()26503517 (PubMedID)
Available from: 2016-04-18 Created: 2016-04-06 Last updated: 2017-11-30Bibliographically approved
Cavalli-Björkman, N. (2014). Implications of patients' socioeconomic status - what oncologists should be aware of. Acta Oncologica, 53(2), 161-163
Open this publication in new window or tab >>Implications of patients' socioeconomic status - what oncologists should be aware of
2014 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 2, p. 161-163Article in journal, Editorial material (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-217994 (URN)10.3109/0284186X.2013.865079 (DOI)000329522000001 ()
Available from: 2014-02-11 Created: 2014-02-06 Last updated: 2017-12-06Bibliographically approved
Cavalli-Björkman, N., Glimelius, B. & Strang, P. (2012). Equal cancer treatment regardless of education level and family support?: A qualitative study of oncologists’ decision-making. BMJ Open, 2(4), e001248
Open this publication in new window or tab >>Equal cancer treatment regardless of education level and family support?: A qualitative study of oncologists’ decision-making
2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 4, p. e001248-Article in journal (Refereed) Published
Abstract [en]

Objective: Treatment gradients by socioeconomic status have been observed within cancer care in several countries. The objective of this study was to explore whether patients' educational level and social network influence oncologists' clinical decision-making. Design: Semi-structured interviews on factors considered when deciding on treatment for cancer patients. Interviews were transcribed and analysed using inductive qualitative content analysis. Setting: Oncologists in Swedish university-and non-university hospitals were interviewed in their respective places of work. Participants: Twenty Swedish clinical oncologists selected through maximum-variation sampling. Primary and secondary outcome measures: Elements which influence oncologists' decision-making process were explored with focus on educational level and patients' social support systems. Results: Oncologists consciously used less combination chemotherapy for patients living alone, fearing treatment toxicity. Highly educated patients were considered as well-read, demanding and sometimes difficult to reason with. Patients with higher education, those very keen to have treatment and persuasive relatives were considered as challenges for the oncologist. Having large groups of relatives in a room made doctors feel outnumbered. A desire to please patients and relatives was posed as the main reason for giving in to patients' demands, even when this resulted in treatment with limited efficacy. Conclusions: Oncologists tailor treatment for patients living alone to avoid harmful side-effects. Many find patients' demands difficult to handle and this may result in strong socioeconomic groups being over-treated.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-172518 (URN)10.1136/bmjopen-2012-001248 (DOI)000315049300078 ()
Available from: 2012-04-11 Created: 2012-04-11 Last updated: 2017-12-07Bibliographically approved
Cavalli-Björkman, N. (2012). Factors Influencing Selection of Treatment for Colorectal Cancer Patients. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Factors Influencing Selection of Treatment for Colorectal Cancer Patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown.

The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV.

In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients.

In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. p. 45
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 774
Keywords
colorectal cancer, socioeconomic status, clinical trials, education level, family support, living alone, patient-physician interaction
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:uu:diva-172533 (URN)978-91-554-8363-0 (ISBN)
Public defence
2012-06-13, Skoogsalen, Akademiska Sjukhuset Ingång 78, 1 tr, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-05-21 Created: 2012-04-11 Last updated: 2012-08-01Bibliographically approved
Cavalli-Björkman, N., Qvortrup, C., Sebjørnssen, S., Pfeiffer, P., Wentzel-Larsen, T., Glimelius, B. & Sorbye, H. (2012). Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone. British Journal of Cancer, 107(1), 189-194
Open this publication in new window or tab >>Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone
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2012 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 107, no 1, p. 189-194Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored. METHODS: A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n = 781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively. RESULTS: Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04-0.85, P = 0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10-0.86, P = 0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10-4.49, P = 0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P < 0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity. CONCLUSION: Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC. 

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-172517 (URN)10.1038/bjc.2012.186 (DOI)000305888400029 ()
Available from: 2012-04-11 Created: 2012-04-11 Last updated: 2017-12-07Bibliographically approved
Glimelius, B. & Cavalli-Bjorkman, N. (2012). Metastatic colorectal cancer: Current treatment and future options for improved survival : Medical approach - present status. Scandinavian Journal of Gastroenterology, 47(3), 296-314
Open this publication in new window or tab >>Metastatic colorectal cancer: Current treatment and future options for improved survival : Medical approach - present status
2012 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 47, no 3, p. 296-314Article in journal (Refereed) Published
Abstract [en]

Background. Metastatic colorectal cancer has a poor prognosis, and the majority of patients are left with palliative measures. The development seen using medical treatments are reviewed.

Material and methods. A systematic approach to the literature-based evidence of effects from palliative chemotherapy and targeted drugs was aimed at.

Results. The continuous improvements during the past 20-25 years have been documented in several large conclusive trials. At the end of the 1980s, the evidence that chemotherapy should be used at all was very limited, whereas presently most patients can be offered three lines of chemotherapy with or without a targeted drug based upon good scientific evidence. Median survival in trials has gradually improved from about 6 months to above 24 months in the most recent trials. Survival in the populations has, however, not improved to the same extent. Several important issues remain to be solved, such as the best sequence of treatments, what regimens to use in various situations, when to start and when to stop if a response is seen, whether cure may be possible in a small subset of patients, and socioeconomic issues. Integration of surgery and other local methods have further improved outcome for some individuals, but must be fine-tuned.

Conclusions. Progress has been rapid in advanced colorectal cancer. This is likely a result of well-designed trials in collaboration between academy and industry, showing a great interest in the disease. A multi-professional approach and future collaborations may hopefully introduce new treatment concepts, further improving outcome.

Keywords
advanced colorectal cancer, chemotherapy, palliation, targeted drugs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-170319 (URN)10.3109/00365521.2012.640828 (DOI)000300436000006 ()
Available from: 2012-03-13 Created: 2012-03-12 Last updated: 2017-12-07Bibliographically approved
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