| 31. |
- Högberg, Thomas, 1947-, et al.
(författare)
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A systematic overview of chemotherapy effects in ovarian cancer
- 2001
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 40:2-3, s. 340-360
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Tidskriftsartikel (refereegranskat)abstract
- A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001, 40: 155-65). This overview on chemotherapy for epithelial ovarian cancer is based on a total of 176 scientific reports. Five meta-analyses including 17 291 patients, 33 prospective randomised studies including 12 340 patients, 36 prospective studies including 3593 patients and one retrospective study including 421 patients. The studies include approximately 33 642 patients. The conclusions reached can be summarized into the following points: ò Radically operated patients with low-risk early ovarian cancer (stage IA or IB non-clear-cell well-differentiated carcinomas or borderline tumours) have a very good prognosis and there is no indication for adjuvant therapy. ò Radically operated patients with high-risk early ovarian cancer (clear cell carcinomas or FIGO stage IA or IB moderately or poorly differentiated carcinomas or stage IC) have a substantial risk for micrometastatic disease. However, the role of adjuvant chemotherapy is unclear and such therapy should, thus, only be used within clinical trials. ò The median overall survival for patients with advanced (FIGO stages II-IV) ovarian cancer randomised to paclitaxel/platinum-containing chemotherapy in three large studies ranged between 36-39 months. Compared with historical data, this represents a six to seven times longer median survival time than after surgery only. The probability for long-term survival for patients treated with a paclitaxel/platinum combination is too early to define. ò In two prospective randomised trials in advanced ovarian cancer, paclitaxel in combination with cisplatin has provided a survival benefit over cyclophosphamide/cisplatin. Based on these trials, paclitaxel/cisplatin is considered to be the standard treatment. ò This choice of standard therapy might, however, be questioned based on the results of the hitherto largest randomised study in advanced ovarian cancer, ICON3, which is, as yet only available in abstract form. It compared paclitaxel/carboplatin with carboplatin only or a platinum combination (cyclophosphamide/doxorubicin/cisplatin). There were no statistically significant differences in progression-free or overall survival. The drug regimen in the control arms of the previous studies showing superiority of the paclitaxel-cisplatin combination may not have been the optimal non-paclitaxel platinum-containing regimen. ò Three randomised studies have compared carboplatin/paclitaxel with cisplatin/paclitaxel. All three are hitherto only published as abstracts with short follow-up precluding survival analyses. None of them shows any difference in response rates. All three show less toxicity and one also better quality of life with carboplatin. Thus, there are preliminary data supporting the substitution of cisplatin with carboplatin. ò Intraperitoneal therapy with cisplatin caused improved survival compared with intravenous therapy in one ramdomised study. Further studies have shown trends to better survival and longer progression-free interval with intraperitoneal therapy. The accrual to studies on intraperitoneal chemotherapy has been poor reflecting that it is a cumbersome and not easily accepted treatment. ò In advanced ovarian cancer, no convincing advantage has been shown from more dose-intensive chemotherapy, without cytokines or bone marrow stem cell support, compared with standard doses. ò High response rates are achieved with high-dose chemotherapy with stem cell support in the salvage situation but response duration is short. Phase III studies evaluating high-dose chemotherapy in the first-line situation are ongoing. Until supportive controlled clinical trials are presented, high-dose chemotherapy should be confined to clinical trials. ò Tumour response is frequently observed on re-treatment with the same drugs as given first-line in patients sensitive to first-line platinum-based chemotherapy with a long progression-free interval. Thus, in these patients treatment with a platinum/ paclitaxel combination might be recommended, albeit based on limited data. In patients resistant to first-line therapy, a number of single agents induce tumour responses in the range of 10-30%. The literature does not permit general treatment recommendations in these patients, which are recommended to be included in controlled clinical trials.
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| 32. |
- Ihse, Ingemar, et al.
(författare)
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Riktlinjer för handläggning av patienter med pankreascancer
- 2002
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Ingår i: Läkartidningen. - 0023-7205. ; 99:15, s. 1676-1683
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of pancreatic cancer has fallen during the last ten years in Sweden. Early signs and symptoms of the disease are still undiscovered and when diagnosis is made the disease is incurable in most patients. Transabdominal ultrasonography is the first-line imaging test followed by spiral computed tomography (CT) and magnetic resonance imaging (MRI) if required for definite diagnosis. Spiral CT is also the imaging test of choice for assessment of resectability of the tumor. Surgical removal of the tumor is the only chance of cure. Markedly improved hospital mortality after pancreaticoduodenectomy is reported and an association between hospital volume and outcome of the operation has been established. Longterm survival after attempted curative resection continues to be dismal, however. Adjuvant treatment should not be given outside clinical studies. Palliative treatment has improved thanks to progress in the field of endoscopy, interventional radiology and in management of pain and nutrition. Palliative chemotherapy should only be given selectively outside clinical studies. Radiotherapy has no proven effects on survival. Special pancreatic cancer treatment teams with catchment areas of 2-4 million inhabitants are recommended by international authorities.
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| 33. |
- Ihse, Ingemar, et al.
(författare)
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Riktlinjer för handläggning av patienter med pankreascancer [Guidelines for management of patients with pancreatic cancer]
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99:15, s. 1676-1685
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Transabdominellt ultraljud är förstahandsundersökning vid misstänkt pankreascancer, följt av spiral-DT eller MR för mer definitiv diagnos. Tumörmarkörer har ingen plats i rutindiagnostiken. Spiral-DT är basen i resektabilitetsbedömningen. Resektion av tumören är en förutsättning för bot. Ett samband har påvisats mellan antalet resektioner som görs vid ett sjukhus årligen och postoperativ mortalitet. Långtidsöverlevnaden efter resektion är oförändrat kort medan postoperativ mortalitet minskat dramatiskt vid enheter som rapporterat sina resultat. Adjuvant behandling efter resektion bör endast ges inom ramen för kliniska studier. Det palliativa omhändertagandet har förbättrats främst genom utveckling inom endoskopi, interventionell radiologi, smärt- och nutritionsbehandling. Palliativ cytostatikabehandling bör endast ges selektivt utanför kliniska studier. Radioterapi har ingen dokumenterad effekt på överlevnaden vid icke-resektabel pankreascancer. Internationellt rekommenderas speciella behandlingsteam för pankreascancer med tillräckliga upptagningsområden (2–4 miljoner invånare).
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| 34. |
- Jaeger, Ane Bonnerup, et al.
(författare)
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Correlates of heterosexual behavior among 23-87 year olds in Denmark and Sweden, 1992-1998
- 2000
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Ingår i: Archives of Sexual Behavior. - 0004-0002 .- 1573-2800. ; 29:1, s. 91-106
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Tidskriftsartikel (refereegranskat)abstract
- Correlates of heterosexual behavior, with a particular focus on early and high sexual activity, anal intercourse, prostitute visits, and HIV test activity, were studied. Telephone interviews were conducted with 852 randomly chosen persons who participated as controls in nationwide case-control studies of anogenital cancers in Denmark and Sweden, 1992-1998. While partner numbers and the practice of anal intercourse increased, age at sexual debut declined by 4-5 years (p < 0.001) and the maturation interval between menarche and first coitus halved (from 7 to 3 years, p < 0.001) between persons born in or before 1920 and those born in or after 1960. Women having high sexual activity were more often tested for HIV than less sexually active women, but men visiting prostitutes and those with prior STDs were not HIV tested more than other men. The increasing practice of anal intercourse, particularly among women with many partners, deserves attention, since this practice may erroneously be considered a safe sexual activity. Along with their partners, men with a history of STDs and those visiting prostitutes should be targeted in future safe sex campaigns, since these men appear to be inadequately HIV tested.
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| 35. |
- Jestin, P, et al.
(författare)
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Elective surgery for colorectal cancer in a defined Swedish population.
- 2004
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 30:1, s. 26-33
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this study was to describe variability in compliance to clinical guidelines in colorectal cancer surgery related to hospital structure.METHODS: All patients registered in the databases of the Regional Oncologic Centre, operated upon electively for colon cancer between the start of the register in 1997 until 2000 (n=1771) and for rectal cancer between the start of the register in 1995 until 2000 (n=1841) were selected for analysis.RESULTS: There was no difference in 5-year survival rate between colon and rectal cancer (mean follow-up 2.6 and 3.0 years, respectively; p=0.22). There was a significant difference in frequency of preoperative liver scan depending on hospital category with an increase in colon cancer from 39 to 46% (p=0.02) and in rectal cancer from 42 to 64% (p<0.001). For colon cancer there was no difference, according to hospital category, in quotient sigmoid and high anterior resection to left-sided resection. Furthermore, high anterior resection was more common at university and general district hospitals (8%) compared with district hospitals (4%) (p=0.01). Sphincter-saving surgery was more common at university hospitals and district general hospitals than at district hospitals (low anterior/abdomino-perineal resection quotients 2.3, 2.4 and 1.6, respectively; p<0.001).CONCLUSIONS: Population-based audit forms an appropriate and valuable basis for quality assurance projects. In addition to describing compliance to guidelines and pointing to process steps that can be improved, such investigations may also indicate changes due to scientific development. Linked to case-costing data, such results may form an important basis for decisions about modifications in health care.
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| 36. |
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| 37. |
- Johansson, Birgitta, et al.
(författare)
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Hemsjukvård för äldre cancerpatienter : Utökad uppföljning och stöd i hemmet minskar behov av specialistsjukvård
- 2003
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 100:17, s. 1524-1531
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The effects of intensified primary health care were examined in the »Support-Care-Rehabilitation« project conducted in Uppsala county 1993-1997. Intensified primary health care was one part of an individual support intervention and comprised extended information about patients from the specialist clinics, and education and supervision in cancer care for GPs and home care nurses. The aim was to improve the ability of general practitioners and home care nurses to monitor and support cancer patients. A total of 485 newly diagnosed cancer patients were randomized to intensified primary health care or to a control group (standard care). The intervention group showed a marked increase in follow-up contacts. About 90% of intensified primary health care patients reported such contacts, compared to 26% of control patients. The number of days of hospitalization at the specialist clinics for elderly patients (Ž70 yr.) randomized to the intervention group were 393 less than for elderly controls three months after diagnosis. The conclusion is that intensified primary health care constitutes a cost-effective strategy for enhancing co-operation between home care, primary health care and specialist clinics.
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| 38. |
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| 39. |
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| 40. |
- Johansson, Birgitta, et al.
(författare)
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Reduced utilisation of specialist care among elderly cancer patients : a randomised study of a primary healthcare intervention
- 2001
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Ingår i: European Journal of Cancer. - 0959-8049 .- 1879-0852. ; 37:17, s. 2161-2168
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the effect of an individual support (IS) intervention including intensified primary healthcare on the utilisation of specialist care among cancer patients, and to investigate if such an effect was modified by the patient's age (less than 70 years or 70 years and more). Newly diagnosed cancer patients (n=416) were randomised between the intervention and a control condition, and data were collected on the utilisation of specialist care within 3 months from inclusion. Intensified primary healthcare comprised extended information from the specialist clinics, and education and supervision in cancer care for general practitioners (GPs) and home-care nurses. The support given also included interventions designed to diminish problems of weight loss and psychological distress. The intervention reduced the number of admissions (NoA) and the days of hospitalisation (DoH) after adjustment for weight loss and psychological distress, but only for older patients. Older patients randomised to the intervention (n=82) experienced 393 fewer DoH than the older control patients (n=79). In addition, the proportion of older patients in the IS group who utilised acute specialist care was smaller compared with older control patients group. The conclusion is that older cancer patients' utilisation of specialist care may be reduced by intensified primary healthcare services.
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