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  • 1.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Olsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Hursti, Timo
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Høyer Lundh, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Department of Nursing, Metropolitan University College, 2200 Copenhagen N, Denmark.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Socio-demographic and clinical variables associated with psychological distress one and three years after a breast cancer diagnosis2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 9, p. 4017-4023Article in journal (Refereed)
    Abstract [en]

    PURPOSE: A large group of women (20-30%) report psychological distress shortly after breast cancer diagnosis, and some experience continued or increased symptoms over time. The aim of this study was to investigate socio-demographic and clinical variables associated with sustained psychological distress in this patient group. METHODS: Women with breast cancer (n=833) completed self-report questionnaires regarding socio-demographic and clinical variables shortly after (T1) and 3years after diagnosis (T2) while data on illness severity were collected from a quality register. The Hospital Anxiety and Depression Scale was used as a measure of psychological distress at both time points. RESULTS: The number of participants who reported elevated levels of anxiety was 231 (28%) at T1 and 231 (28%) at T2 while elevated depressive symptoms was reported by 119 (14%) women at T1 and 92 (11%) at T2. Despite non-significant differences in mean scores over time, 91 (15%) participants reported increased anxiety symptoms and 47 (7%) reported increased depressive symptoms. Poor financial situation, lack of social support, previous psychiatric treatment, and high levels of fatigue were associated with both anxiety and depressive symptoms. Reporting high levels of fatigue was the variable most strongly associated with increased psychological distress over time. CONCLUSION: Most participants reported decreased psychological distress over time, but there were subgroups of women who experienced sustained or increased symptoms of anxiety or depression. Participants with poor financial status, previous psychological problems, or high levels of fatigue may be at increased risk of psychological distress. Such individuals may benefit most from psychosocial interventions.

  • 2.
    Carlsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Cancer patients seeking information from sources outside the health care system.2000In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 8, no 6, p. 453-457Article in journal (Refereed)
    Abstract [en]

    Most of the information patients receive about cancer and its treatment is probably provided by staff in health care, but if patients do not get sufficient information there is a risk that they might rely on nonmedical sources to satisfy their need. The aim of this study was to survey the degree to which patients seek information from sources outside the health care system. All adult cancer patients visiting or being admitted to the Oncology Department on 1 day were asked to complete a questionnaire. In the course of that day, 192 adult patients visited the Oncology Department, and the response rate was 74%. The patients had used an active informationseeking strategy, i.e., had sought information from the following sources, only to a limited degree: the Internet (6%) medical books (37%), narratives (32%) and telephone helplines (10%). A more passive information-seeking strategy was more common; the patients obtained information from television and radio (82%), newspapers (86%), other patients (46%) and friends (55%). There was a significant correlation between educational level and information-seeking from the Internet, medical books and telephone helplines. Persons with a higher level of formal education had used these sources more than people with less education (P~0.05). Younger patients (~60 years) and those with a higher level of formal education had greater access to the Internet (P~0.0001) and read about cancer in the papers to a greater degree than older ones (P~0.05). Younger patients (P~0.05) and women (P~0.01) had used narratives to a greater degree than older patients and men. The main finding of this study was that the patients actively sought information about cancer only to a limited degree, but the majority of patients take an interest when cancer issues are presented in newspapers and magazines, or on radio and television.

  • 3.
    Carlsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Strang, Peter
    Educational group support with gynaecological cancer and theire families1996In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 4, p. 102-109Article in journal (Refereed)
  • 4. Ehrsson, Ylva Tiblom
    et al.
    Hellström, Per M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Brismar, Kerstin
    Sharp, Lena
    Langius-Eklöf, Ann
    Laurell, Göran
    Explorative study on the predictive value of systematic inflammatory and metabolic markers on weight loss in head and neck cancer patients undergoing radiotherapy2010In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 18, no 11, p. 1385-1391Article in journal (Refereed)
    Abstract [en]

    Purpose

    This study aimed to explore the predictive value of systematic inflammatory and metabolic markers in head and neck (H&N) cancer patients during radiotherapy (RT).

    Methods

    Twenty-seven patients were evaluated. The protocol included serial blood tests [highly sensitive C-reactive protein (hsCRP), albumin, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1) and ghrelin], measurements of body weight and assessment of oral mucositis.

    Results

    The mean nadir of weight loss was observed at the end of RT. At the time of diagnosis, mean hsCRP was 5.2 +/- 1.0 mg/L. HsCRP significantly increased during RT and decreased during the post-RT period. Mean maximum hsCRP was 35.8 +/- 8.5 mg/L, with seven patients reaching >40 mg/L. A numerical decrease of albumin (by 18.2%) and only small changes in IGF-1, IGFBP-1 and ghrelin levels were observed. None of the metabolic parameters was significantly associated with weight loss.

    Conclusions

    HsCRP increased in response to RT for H&N cancer as a sign of irradiation-induced inflammation. Weight loss was not preceded by changes of the metabolic parameters, indicating that assessment of the blood markers used in this study is of little value. Regular body weight measurement and assessment of oral mucositis are feasible, cheap and important procedures to control the metabolic homeostasis during RT.

  • 5.
    Engvall, Gunn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skolin, Inger
    Department of Laboratory Medicine, Section of Clinical Physiology, Karolinska Institutet, Stockholm.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Are nurses and physicians able to assess which strategies adolescents recently diagnosed with cancer use to cope with disease- and treatment-related distress?2011In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 19, no 5, p. 605-611Article in journal (Refereed)
    Abstract [en]

    PURPOSE: It was examined whether nurses and physicians are able to identify whether adolescents with cancer have used certain strategies to cope with disease- and treatment-related distress. METHOD: Adolescents (N = 48) were asked whether they had used a number of strategies to cope with disease- and treatment-related distress and, if so, the extent to which they had used these. Nurses and physicians were asked to answer the same questions on behalf of a certain adolescent. RESULTS: Nurses overestimate the extent to which adolescents use strategies to cope with distress, and neither nurses nor physicians, physicians somewhat more, are successful in identifying the extent to which certain adolescents use strategies. CONCLUSION: Health-care staff's possibilities to assess how patients cope with disease- and treatment-related distress should be increased. A number of changes in education and the organization of clinical care, especially with regard to assessing patients' needs, are suggested.

  • 6. Forinder, Ulla
    et al.
    Lindahl Norberg, Annika
    Karolinska institutet, Inst. för kvinnors och barns hälsa.
    "Now we have to cope with the rest of our lives". Existential issues related to parenting a child surviving a brain tumour.2010In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 18, no 5, p. 543-51Article in journal (Refereed)
    Abstract [en]

    The findings underscore the importance of the social network, validating and supporting parents through this process. Moreover, in this social network the paediatric oncology and neurology care is a significant part.

  • 7. Friedrichsen, Maria J
    et al.
    Strang, Peter M
    Carlsson, Maria E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Breaking bad news in the transition from curative to palliative cancer care: patient's view of the doctor giving the information.2000In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 8, no 6, p. 472-478Article in journal (Refereed)
    Abstract [en]

    In the transition from curative to palliative cancer care, communication is of special importance. The aim of this study was to explore how patients with a disseminated cancer disease experienced the information about their incurable state, focusing on the physician. The persons taking part were 30 patients admitted to a hospital-based home care unit in Sweden. Semi-structured interviews were conducted and analysed using a qualitative method. All patients described their doctors as experts, despite different qualities. Sire subcategories were identified: (1) the inexperienced messenger, (2) the emotionally burdened, (3) the rough and ready expert (4) the benevolent but tactless expert, (5) the "distanced" doctor and (6), the empathic professional. The relationship was described as very important to the patients' capacity to handle the information and was felt to have been built up during earlier meetings. The relationship was described in four subcategories: personal between well-acquainted individuals, impersonal between unacquainted individuals, personal between unacquainted individuals and impersonal between well-acquainted individuals. Both the character of the physician and his or her ability to create personal relationships influence patients' capacity to cope with this specific situation. Education and guidance are needed both in clinical practice and in medical schools.

  • 8.
    Godskesen, Tove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Ersta Sköndal University College.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kihlbom, Ulrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Phase 1 clinical trials in end-stage cancer: patient understanding of trial premises and motives for participation2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 11, p. 3137-3142Article in journal (Refereed)
    Abstract [en]

    In cancer, phase 1 clinical trials on new drugs mostly involve patients with advanced disease that is unresponsive to standard therapy. The purpose of this study was to explore the difficult ethical problems related to patient information and motives for participation in such trials. A descriptive and explorative qualitative design was used. Fourteen cancer patients from three different phase 1 trials in end-stage cancer were interviewed. The interviews were analysed using qualitative content analysis. The patients expressed unrealistic expectations of therapeutic benefit and inadequate understanding of the trials' purpose, so-called therapeutic misconception. However, they reported a positive attitude towards participation. Thus, the patients valued the close and unique medical and psychological attention they received by participating. Participation also made them feel unique and notable. Patients with end-stage cancer participating in phase 1 clinical trials are unaware of the very small potential for treatment benefit and the risk of harm. Trial participation may offer hope and social-emotional support and a strategy for coping with the emotional stress associated with advanced cancer and may, consequently, improve emotional well-being.

  • 9.
    Granstam Björneklett, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lindemalm, Christina
    Immune and Gene Therapy Laboratory,Cancer Centre,Karolinska,Karolinska University Hospital.
    Ojutkangas, Marja-Leena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Berglund, Anders
    Department of Medical Epidemiology and Biostatiststics.
    Letocha, Henry
    Onkologi kliniken Västerås.
    Strang, Peter
    Karolinska Institute,SSH Stockholm.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer2012In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 12, p. 3325-3334Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    When diagnosed with breast cancer, most women's lives change as well as their perspectives on and appreciation of life. The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life (HRQOL) and fatigue during the first year after diagnosis.

    MATERIAL AND METHODS:

    Of 382 patients with newly diagnosed breast cancer, 191 patients were randomized to an intervention group and 191 patients were randomized to a routine control group. The intervention group received support intervention that lasted 1 week on a residential basis, followed by 4 days of follow-up 2 months later. The support intervention included informative educational parts, relaxation training, mental visualization, and nonverbal communication. HRQOL was measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2, 6, and 12 months after intervention.

    RESULT:

    There was a time-dependent improvement in both functional and symptom scales between baseline and 12 months as measured by the EORTC QLQ-C30 and BR23 questionnaires and there was a decrease in fatigue between baseline and after 2 months with further improvement up to 12 months in both groups, but there were no differences between the intervention and control groups at any point in time.

    CONCLUSION:

    HRQOL improves and symptoms of fatigue decrease over time, but we could not see any additional effect from the rehabilitation program in this setting.

  • 10. Gudmundsdóttir, Eygló
    et al.
    Hörnquist, Lina
    Boman, Krister K
    Psychological outcomes in Swedish and Icelandic parents following a child's cancer-in the light of site-related differences2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 6, p. 1637-45Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study determined the incidence of disease-related distress symptoms in parents from two treatment sites: a large specialized childhood cancer (CC) center in Sweden and a smaller pediatric unit in Iceland. The two groups were compared by considering differences in center type and care organization.

    METHODS: Participants were 328 parents of 211 CC patients, in or off treatment. Illness-specific distress was assessed using the multi-dimensional Parental Psychosocial Distress in Cancer (PPD-C) questionnaire. General psychiatric symptoms were assessed using the General Health Questionnaire (GHQ-12). Swedish and Icelandic groups were compared and outcomes studied with regard to site characteristics. Parents in the general population served as a reference group.

    RESULTS: Distress outcomes in both clinical groups exceeded the levels of the reference group. Systematic differences were found between the parent groups, Icelandic parents scoring higher on 5 of the 11 distress subscales of the PPD-C and in a majority of the illness-specific domains. A tendency towards more negatively affected general mental health was found in Swedish parents (GHQ, p = 0.059).

    CONCLUSIONS: Distress outcomes exceeding those of the comparison group were found in both clinical groups. Significant distress differences were found between the Swedish and the Icelandic parents. Analysis of the outcomes indicates that center type and related differences in patient influx rate and local organization of care are viable explanations of the findings. Methods are proposed for enhancing family care at small centers in order to compensate for conditions associated with burden on parents of the child's cancer.

  • 11. Hammarström, Viera
    et al.
    Pauksen, Karlis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Svensson, H.
    Öberg, G.
    Paul, C.
    Ljungman, P.
    Tetanus immunity in patients with hematological malignancies1998In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 6, no 5, p. 469-472Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate long-term immunity to tetanus toxoid among patients with hematological disease who had been treated with conventional doses of chemotherapy. Altogether 206 patients with different hematological malignancies were included in the study. There were marked differences between the rates of seronegativity against tetanus, varying from 20% to 70% in different groups of study patients. We found that 21 of 80 (36%) patients with AML, 45 of 80 (56%) with ALL, 12 of 22 (54%) with lymphoma, 4 of 13 (31%) with myeloma and 2 of 11 (18%) with CML were not immune to tetanus. In a multivariate logistic regression model increasing age (P = 0.0001), lymphoid malignancy (P = 0.0005) and advanced disease stage (P = 0.0001) were independent risk factors for loss of tetanus immunity in patients with hematological malignancies.

  • 12.
    Isaksson, Joakim
    et al.
    Umea Univ, Dept Social Work, SE-90187 Umea, Sweden.
    Wilms, Torben
    Umea Univ, Dept Med Biosci, SE-90187 Umea, Sweden;Umea Univ, Dept Clin Sci Otorhinolaryngol, SE-90187 Umea, Sweden.
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Fransson, Per
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Meaning of work and the process of returning after head and neck cancer2015In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 1, p. 205-213Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purposes of this study were (1) to investigate employment status at diagnosis, sick leave, and returning to work patterns in correlation to quality of life, anxiety, and depression in patients treated for head and neck cancer (HNC) and (2) to explore patients' experiences of the process of returning to work.

    METHODS: Sixty-six patients with HNC (aged 34-66 years) were repeatedly interviewed over a period of 24 months. Interview responses that concerned the patients' experiences and ideas about work were categorised using the similarities-differences technique. Questionnaires on quality of life, anxiety, and depression were used to describe the patient characteristics and the differences between groups.

    RESULTS: In total, 53 % of the patients had returned to work at 24 months after treatment, and 17 % were deceased. Several quality of life parameters were significantly worse for patients not working at 24 months after treatment. Nine categories were found to describe the return-to-work process starting with symptoms causing sick leave, thoughts about the sick leave, and ending with the return to work and/or retirement.

    CONCLUSIONS: Returning to work is an important part of life because it structures everyday life and strengthens the individual's identity. The quality of life results showed significant differences between workers and non-workers at the 24-month follow-up. The patients need to be both physically and mentally prepared for the process of returning to work. It is important to take an individual rehabilitation approach to guide and support the patients in returning to work and regaining an important aspect of their everyday life. In such an approach, it is vital to understand the patients' overall life context and the patients' own perspective on the process and meaning associated with work.

  • 13.
    Karlsson, Katarina
    et al.
    KI.
    Wallenius, Imke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nilsson-Wikmar, Lena
    KI.
    Lindman, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Lymphoedema and health-related quality of life by early treatment in long-term survivors of breast cancer. A comparative retrospective study up to 15 years after diagnosis2015In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 23, no 10, p. 2965-2972Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose was to compare progression/regression of arm lymphoedema, health-related quality of life and medical background data among women who discontinued their treatment (non-continued treatment group, NCTG) with these factors among women who continued treatment (continued treatment group, CTG).

    Methods Seventy-two women were included in the NCTG and 58 women in the CTG. Women in the NCTG were invited to an examination and measurement of affected arm volume at the clinic in 2008. Medical background data and arm volume values, measured using the water displacement method, were collected from patient records and the Breast Cancer Quality Register of the Uppsala Örebro Region. The functional assessment of cancer therapy for breast cancer (FACT-B) was used to assess health-related quality of life in both groups.

    Results There were no differences with regard to progression/regression of arm lymphoedema or health-related quality of life. The CTG had experienced more advanced disease and received more extensive surgical and oncological treatment. The CTG had significantly larger arm volume due to lymphoedema at diagnosis (mean 422 ml) compared to the NCTG (mean 283 ml; p < 0.001), and at the last visit at the clinic (CTG mean 414 ml versus NCTG mean 239 ml; p < 0.001).

    Conclusions The results indicate that there might be a spontaneous regression of lymphoedemas in the NCTG but there is a need for more research to make it possible to draw firm conclusions regarding this.

  • 14.
    Lindblad, Katarina
    et al.
    Västmanland Cty Hosp, Dept Surg, S-72189 Västeras, Sweden.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Johansson, Ann-Christin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Malardalen Univ, Clin Res Ctr, Vastmanland Cty Hosp, Dept Physiotherapy,Sch Hlth Care & Social Welf, S-72189 Vasteras, Sweden.
    Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: a randomized controlled trial.2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 6, p. 2523-2531Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose was to investigate the effects of long-wave diathermy in combination with interferential currents (interferential therapy and long-wave diathermy at high power (ITH)) in comparison with long-wave diathermy at a power below the active treatment dose (long-wave diathermy at low power (LDL), control group) on sensory and motor symptoms in patients with chronic chemotherapy-induced peripheral neuropathy (CIPN) in the lower extremities.

    METHODS: Sixty-seven patients with chronic CIPN were randomized to 12 weeks of either ITH or LDL. Follow-up assessments were performed after the treatment period and at 37 weeks after randomization. The primary outcome was pain (Numeric Rating Scale (NRS)), and the secondary outcomes were discomfort, nerve symptoms, subjective measurement of dizziness (Dizziness Handicap Inventory), and balance. Differences within and between groups were analyzed.

    RESULTS: Pain intensity decreased significantly only in the LDL group directly after the treatment period from NRS median 25 to median 12.5 (P = 0.017). At the 37-week follow-up, no changes were detected, irrespective of group (NRS 13 vs. 20, P = 0.885). Discomfort decreased significantly in both groups at both 12 and 37 weeks after the baseline (P < 0.05). Balance disability showed significant declines in both groups at 12 and 37 weeks (P = 0.001/0.025 in the ITH group vs P = 0.001/<0.001 in the LDL group). Balance ability (tightened Romberg test) increased significantly at both 12 and 37 weeks in both groups (P = 0.004/<0.040 in the ITH group) but did not improve in the LDL group at any of the follow-up time points (P = 0.203 vs P = 0.383). The one-legged stance test was unchanged in the ITH group after 12 weeks but improved 37 weeks after baseline (P = 0.03). No significant changes were observed in the LDL group at any of the follow-up time points.

    CONCLUSION: This study provides no support for the use of a combination of long-wave diathermy and ITH as a treatment option for patients with chronic CIPN. However, the chronic CIPN symptoms decreased with time irrespective of the treatment.

  • 15. Lindemalm, Christina
    et al.
    Mozaffari, Fariba
    Choudhury, Aniruddha
    Granstam-Björneklett, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Lekander, Mats
    Nilsson, Bo
    Ojutkangas, Marja-Leena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Österborg, Anders
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Mellstedt, Håkan
    Immune response, depression and fatigue in relation to support intervention in mammary cancer patients2008In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 16, no 1, p. 57-65Article in journal (Refereed)
    Abstract [en]

    Goal of work To study the effect of support intervention on immune function in breast cancer patients. Materials and methods Breast cancer patients from an ongoing prospective randomised quality-of -life study were chosen for assaying immune functions in relation to a support-group intervention program running on a residential basis. Twenty-one women received adjuvant-combined radio-chemotherapy (CT-RT) and 20 women radiotherapy (RT). Eleven CT-RT and ten RT patients were randomised to support-group intervention, the rest served as controls. Immune tests for NK cells and NK-cell cytotoxicity, as well as lymphocyte subpopulations and response to antigen were performed before intervention, 2, 6, and 12 months later, in parallel to controls and healthy volunteers (n=11). Depression, anxiety and fatigue were evaluated by the Hospital Anxiety and Depression (HAD) and the Norwegian Fatigue questionnaire. The density of NK cell receptors and in vitro quantitation of functional NK cytotoxicity against K562 cell line were evaluated. Four-colour flow cytometry was used to detect signal transduction molecules and cytokine expression. T-cell proliferate response to purified protein derivate (PPD) antigen was evaluated. Results No significant immune effect of support intervention could be found. The immune variables were severely disarranged compared to healthy volunteers but showed a statistically significant improvement over time. The majority of patients suffered from fatigue but had low scores for depression and anxiety. Conclusion No effect on immune parameters could be detected from support intervention. The long-lasting immune suppression might override a putative effect of the intervention. Low depression scores may contribute to the absence of a detectable effect.

  • 16.
    Martinsson, Ulla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Oncology.
    Lundström, Staffan
    The use of blood transfusions and erythropoietin-stimulating agents in Swedish palliative care2009In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 17, no 2, p. 199-203Article in journal (Refereed)
    Abstract [en]

    To outline the use of blood transfusions and erythropoietin-stimulating agents (ESAs) in palliative care in Sweden and to get an idea of whether or not these usually very sick patients benefit from the treatment. An internet-based questionnaire was sent out to 24 specialized palliative care units within the Swedish palliative research network. All data were registered by each member directly into a web-based survey generator from which the results were extracted and analyzed. Twenty-two units registered 1,046 patients (median age 68 years, 87% had a cancer diagnosis). Among these patients, 900 were enrolled in advanced home care and the others were treated in in-patient units. Erythrocyte transfusions were given to 174 patients (17%) during the month before registration with a mean amount of 2.9 units (range 1-18) given to each patient. Erythrocyte transfusions were given to 18% of the patients with a malignancy and to 11% of the patients with a non-malignant disease. Six patients also received thrombocyte transfusions. One hundred seventeen patients (68%) were judged to benefit from the erythrocyte transfusions. Eighty-two (58%) of the 141 transfused patients enrolled in advanced home care received their transfusions in their homes. ESAs was given to 127 patients (12%). Transfusions are not uncommon in Swedish palliative care. A majority seemed to benefit from the transfusions. Since they are expensive and time consuming, the effect should, however, be carefully evaluated in every individual in order to avoid ineffective treatment.

  • 17. Orrevall, Y
    et al.
    Tishelman, C
    Permert, J
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Nutritional support and risk status among cancer patients in palliative home care services2009In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 17, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    GOAL OF WORK: The aim of this study was to investigate the nutritional risk status and use of nutritional support among cancer patients enrolled in palliative home care services. Differences in the use of nutritional support in relation to nutritional, social and clinical factors, as well as survival were also investigated. PATIENTS AND METHODS: Structured telephone interviews were conducted with cancer patients enrolled in all 21 palliative home care services in the Stockholm region. An interview guide was designed to investigate topics related to the patient's nutritional situation. MAIN RESULTS: Interviews with 621 patients were analysed. Sixty-eight percent of the patients were scored as at nutritional risk according on a modified version of NRS-2002. Nutritional support was used by 55% of the patients, with oral nutritional supplements most common and 14% using artificial nutrition. Use of nutritional support was related to low BMI and severe weight loss and was more common in patients with shorter survival times. CONCLUSIONS: These findings demonstrate that nutritional support is used to treat already malnourished patients with shorter survival time, rather than to prevent malnutrition. A more structured approach to nutritional issues for patients in palliative phases, which considers life expectancy and psycho-social aspects of nutritional issues, could help identify potential candidates for nutritional support.

  • 18. Ottosson, Sandra
    et al.
    Lindblom, Ulrika
    Wahlberg, Peter
    Nilsson, Per
    Kjellen, Elisabeth
    Zackrisson, Bjorn
    Jaghagen, Eva Levring
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up2014In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 22, no 9, p. 2361-2369Article in journal (Refereed)
    Abstract [en]

    Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment. Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures. Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (-10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (-2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up. Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

  • 19.
    Röing, Marta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ways of understanding the encounter with head and neck cancer patients in the hospital dental team - a phenomenographic study2006In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 14, no 10, p. 1046-1054Article in journal (Refereed)
    Abstract [en]

    Introduction: Head and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care. Background: The aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs. Methods: Twenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

  • 20. Sorbe, Bengt
    et al.
    Andersson, Håkan
    Schmidt, Margareta
    Söderberg, Martin
    Högberg, Thomas
    Wernstedt, Lars
    Tiensuu Janson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ehrnström, Bengt
    Kjaer, Mogens
    Havsteen, Hanne
    Tropisetron (Navoban) in the prevention of chemotherapy-induced nausea and vomiting: the Nordic experience1994In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 2, no 6, p. 393-399Article in journal (Refereed)
    Abstract [en]

    An open, noncomparative, Nordic multicenter study was carried out during 1991-1992 to evaluate the 5-HT3 receptor antagonist tropisetron (Navoban) as an antiemetic agent for various types of cancer chemotherapy. A total of 630 patients were recruited from 15 centers in Sweden, Denmark, and Finland. Gynecological cancers (60%), breast cancer (15%), and lung cancer (10%) were the main diagnoses. Prior experience of chemotherapy was documented in 338 patients (54%). In 260 patients (41%), cisplatin was part of the cytostatic regimen. Carboplatin (23%), doxorubicin (27%), and epidoxorubicin (24%) were also frequently included. In all, 23 cytostatic agents were used in various combinations. The mean number of courses studied was 4.6 (range 1-19). Altogether, 394 of 619 evaluable patients (64%) were completely protected from acute nausea and vomiting during the first course of chemotherapy. Delayed nausea and vomiting were completely prevented in 45%-73% (days 2-6) in the complete series. Treatment efficacy remained stable (60%-79%) during ten consecutive courses of chemotherapy. With noncisplatin regimens, complete protection from acute nausea and vomiting was achieved in 72% compared with 52% for cisplatin regimens (P < 0.0001). Patients without prior experience of chemotherapy had higher control rates of acute nausea and vomiting (72%) compared to patients treated before (57%) during the first course, but not later on. There were no differences in delayed nausea and vomiting.

  • 21.
    Svanberg, Anncarin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Öhrn, Kerstin
    Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy-a randomized controlled trial2007In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 15, no 10, p. 1155-1161Article in journal (Refereed)
    Abstract [en]

    Introduction: Mucositis is a major complication in myeloablative therapy, which often necessitates advanced pharmacological pain treatment, including i.v. opioids. Attempts to prevent oral mucositis have included oral cryotherapy, which has been shown to reduce mucositis, but there is a lack of knowledge concerning the effect of oral cryotherapy on opioid use by reducing the mucositis for patients treated with myeloablative therapy before bone marrow transplantation (BMT). Aim: The aim of the present study was to evaluate if oral cryotherapy could delay or alleviate the development of mucositis and thereby reduce the number of days with i.v. opioids among patients who receive myeloablative therapy before BMT. Materials and methods: Eighty patients 18 years and older, scheduled for BMT, were included consecutively and randomised to oral cryotherapy or standard oral care. A stratified randomisation was used with regard to type of transplantation. Intensity of pain, severity of mucositis and use of opioids were recorded using pain visual analogue scale (VAS) scores, mucositis index scores and medical and nursing charts. Results: This study showed that patients receiving oral cryotherapy had less pronounced mucositis and significantly fewer days with i.v. opioids than the control group. In the autologous setting, cryotherapy patients also needed significantly lower total dose of opioids. Conclusion: Oral cryotherapy is an effective and well-tolerated therapy to alleviate mucositis and consequently reduce the number of days with i.v. opioids among patients treated with myeloablative therapy before BMT.

  • 22.
    von Essen, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Enskär, Karin
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Skolin, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Important aspects of care and assistance for children 0-7 years of age being treated for cancer: Parent and nurse perceptions2002In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 10, no 8, p. 601-612Article in journal (Refereed)
    Abstract [en]

    Aspects of care and assistance that are important for children aged 0-7 years who are being treated for cancer were examined. Parents ( N=57) and nurses ( N=59) were asked: "What caring aspects are important in ensuring that your child/the child feels cared for?" and "What help, if any, does your child/the child need outside the hospital?". Data were analysed by content analysis. The following aspects of care were identified: amusement, clinical competence, continuity, emotional support, family participation, honest communication, information, participation in decision making, satisfaction of basic needs, social competence, the parents are well cared for, and time. Parents most frequently mentioned social competence and amusement, while nurses most frequently mentioned continuity and information. The following aspects of assistance were identified: accessible care, amusement, emotional support, family life, meeting friends, normal life, practical support, rehabilitation and school support. At least a third of the children did not need any assistance, according to parents and nurses. Parents most frequently mentioned family life, meeting friends and practical support. Nurses most frequently mentioned normal life and family life. Taken together, the results indicate that not only a family but many more people need to be involved to help children with cancer to be cured not only in a biological but also a psychosocial sense.

  • 23. Vrijmoet-Wiersma, C M J
    et al.
    Egeler, R M
    Koopman, H M
    Lindahl Norberg, Annika
    Karolinska institutet, Inst för kvinnors och barns hälsa.
    Grootenhuis, M A
    Parental stress before, during, and after pediatric stem cell transplantation: a review article.2009In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 17, no 12, p. 1435-43Article in journal (Refereed)
    Abstract [en]

    Psychosocial assessment before SCT, during the acute phase and in the longer term, is necessary to identify parents in need for support and follow-up care.

  • 24.
    Winterling, Jeanette
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Wasteson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Oncology.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Oncology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Factors associated with psychological distress and grief resolution in surviving spouses of patients with advanced gastrointestinal cancer2010In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 18, no 11, p. 1377-1384Article in journal (Refereed)
    Abstract [en]

    GOALS OF WORK:

    Patients with advanced gastrointestinal cancer often have a short survival time. This means that spouses only have a short time to adjust to the approaching death. The aim was to explore whether psychological distress at diagnosis, the course of the illness (anti-tumour treatment, respite period and survival time), the spouses' experience of the care and of losing a loved one were related to distress and grief resolution after the patient had deceased.

    MATERIALS AND METHODS:

    Twenty-one spouses were followed prospectively from the patient's diagnosis of advanced gastrointestinal cancer to 6 months after the patient death. Spouses' experiences were measured with an interview, psychological distress with the Hospital Anxiety and Depression Scale and grief resolution with the Grief Resolution Index. MAIN

    RESULTS:

    The spouses' anxiety at the time of diagnosis was related to their anxiety and grief resolution at follow-up. Two additional factors were associated with higher levels of anxiety at follow-up; the patient having received anti-tumour treatment and the spouse having experienced stress as a caregiver.

    CONCLUSIONS:

    The study indicates that anti-tumour treatment, though it has the potential to prolong life, does not positively influence spouses' psychological distress and bereavement after the death of the patient.

  • 25. Witkowski, Åsa
    et al.
    Carlsson, Maria E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Support group programme for relatives of terminally ill cancer patients.2004In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 12, no 3, p. 168-175Article in journal (Refereed)
    Abstract [en]

    GOALS

    In order to improve the support for family of terminally ill patients who cared for a dying relative at home, a project with a group programme was started. This article is an evaluation of the programme. The aims of this study were to describe the opinions of participants in a support group programme about the programme and how they felt they had benefited from it.

    PATIENTS AND METHODS

    All subjects (n=39) who completed the programme answered five open-ended questions, and 12 of them were interviewed in semi-structured interviews that were analysed using the phenomenographic method.

    RESULTS

    Three main categories were identified in the interviews: (1) Practical condition and external circumstance--which condition had to be met for participation in the programme. (2) Group effects--the subjects felt that the programme was helpful in several respects, they perceived the programme being an important complement to the palliative home care, they benefited from mutual experiences shared among group members, the programme was also beneficial to the patients and was perceived to have had a health-promoting effect on the relatives. (3) The disease--the issue of how much the patients disease affecting the relatives situation were raised in the groups.

    CONCLUSION

    The results showed the value of the programme for relatives of terminally ill patients nursed in their home. The subjects emphasised the importance of the opportunity to meet people who are in a similar situation.

  • 26.
    Östlund, Ulrika
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23300, Huddinge, Sweden.
    Wennman-Larsen, Agneta
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23300, Huddinge, Sweden.
    Gustavsson, Petter
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23300, Huddinge, Sweden.
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23300, Huddinge, Sweden.
    What symptom and functional dimensions can be predictors for global ratings of overall quality of life in lung cancer patients?2007In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 15, no 10, p. 1199-1205Article in journal (Refereed)
    Abstract [en]

    Purpose This study explores what dimensions of a health-related quality of life (HRQOL) questionnaire predict global ratings of overall quality of life (QOL) in lung cancer patients in assessments by patients and significant others, respectively. Materials and methods The analyses were based on dyadic assessments from lung cancer patients and their significant others. A subset of scales and items from the Swedish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the lung-cancer-specific module, LC-13, was selected. Using multiple regression procedures, the relative importance of different symptoms and of functional impairments in predicting overall QOL was examined. Results The multiple regressions revealed that emotional functioning and fatigue were the only significant predictors of overall QOL for both the patients and the significant others' assessments. In addition, physical functioning was found to be another predictor in the significant others' assessments. Conclusion The results emphasize that it is essential to consider both emotional functioning and fatigue as important areas for overall QOL in lung cancer patients.

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