| 1. |
- Bylund Grenklo, Tove, et al.
(author)
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Unresolved grief and its consequences : A nationwide follow-up of teenage loss of a parent to cancer 6-9 years earlier
- 2016
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 24:7, s. 3095-3103
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Journal article (peer-reviewed)abstract
- PurposeThe early loss of a parent is a tragedy and a serious life event. This study investigated grief resolution and morbidity in cancer-bereaved teenagers 6 to 9 years after the loss of a parent to cancer.MethodsIn a nationwide population-based study of 622 of 851 (73 %) youths who as teenagers 6 to 9 years earlier had lost a parent to cancer, we explored the magnitude of unresolved grief and its association with psychological and physiological morbidity. Participants answered a study-specific anonymous questionnaire including questions about if they had worked through their grief and about their current health. Results Six to nine years post-loss 49 % reported unresolved grief (8 % no and 41 % a little grief resolution). They had, in comparison with youths reporting resolved grief. statistically significantly elevated risks, e.g. for insomnia (sons' relative risk (RR) 2.3, 95 % CI 1.3-4.0; daughters' RR 1.7, 95 % CI 1.1-2.7), fatigue (sons' RR 1.8, 95 % CI 1.3-2.5; daughters' RR 1.4, 95 % CI 1.1-1.7) and moderate to severe depression, i.e. score >9, PHQ-9 (sons' RR 3.6, 95 % CI 1.4-8.8; daughters' RR 1.8, 95 % CI 1.1-3.1). Associations remained for insomnia in sons, exhaustion in daughters and fatigue in both sons and daughters when depression, negative intrusive thoughts and avoiding reminders of the parents' disease or death were included in a model. Conclusions Approximately half of cancer-bereaved youth report no or little grief resolution 6 to 9 years post-loss, which is associated with fatigue, sleeping problems and depressive symptoms.
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| 2. |
- Lindgren, Anna, et al.
(author)
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Experiences of incontinence and pelvic floor muscle training after gynaecologic cancer treatment
- 2017
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In: Supportive Care in Cancer. - : SPRINGER. - 0941-4355 .- 1433-7339. ; 25:1, s. 157-166
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Journal article (peer-reviewed)abstract
- The purpose of the present study is to describe how gynaecological cancer survivors (GCS) experience incontinence in relation to quality of life, their possibilities for physical activity and exercise and their perceptions and experiences of pelvic floor muscle training. This qualitative interview content analysis study included 13 women (48-82 age) with urinary (n = 10) or faecal (n = 3) incontinence after radiation therapy (n = 2), surgery (n = 5) and surgery and radiation therapy (n = 6) for gynaecological cancer, 0.5-21 years ago. Symptoms related to incontinence and restrictions in daily activities reduced physical quality of life. Emotions related to incontinence reduced psychological quality of life and social and existential quality of life, due to restrictions in activity and feelings of exclusion. Practical and mental strategies for maintaining quality of life were described, such as always bringing a change of clothes and accepting the situation. Possibilities for sexual and physical activity as well as exercise were also restricted by incontinence. The women had little or no experience of pelvic floor muscle training but have a positive attitude towards trying it. They also described a lack of information about the risk of incontinence. The women were willing to spend both money and time on an effective treatment for their incontinence. Nine out of 10 were willing to spend at least 7 h a week. GCS experienced that incontinence reduced quality of life and limited possibilities for sexual and physical activity as well as exercise. Coping strategies, both practical and emotional, facilitated living with incontinence. The women had a positive attitude towards pelvic floor muscle training. Lack of information had a negative impact on their way of dealing with the situation.
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| 3. |
- Kamsvåg, Tove, 1986-, et al.
(author)
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Prevention of oral mucositis with cryotherapy in children undergoing hematopoietic stem cell transplantations-a feasibility study and randomized controlled trial
- 2020
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339.
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Journal article (peer-reviewed)abstract
- Purpose To evaluate the feasibility of oral cryotherapy (OC) in children and to investigate if OC reduces the incidence of severe oral mucositis (OM), oral pain, and opioid use in children undergoing hematopoietic stem cell transplantation (HSCT). Methods Fifty-three children, 4-17 years old, scheduled for HSCT in Sweden were included and randomized to OC or control using a computer-generated list. OC instructions were to cool the mouth with ice for as long as possible during chemotherapy infusions with an intended time of >= 30 min. Feasibility criteria in the OC group were as follows: (1) compliance >= 70%; (2) considerable discomfort during OC < 20%; (3) no serious adverse events; and (4) ice administered to all children. Grade of OM and oral pain was recorded daily using the WHO-Oral Toxicity Scale (WHO-OTS), Children's International Oral Mucositis Evaluation Scale, and Numerical Rating Scale. Use of opioids was collected from the medical records. Results Forty-nine children (mean age 10.5 years) were included in analysis (OC = 26, control = 23). The feasibility criteria were not met. Compliance was poor, especially for the younger children, and only 15 children (58%) used OC as instructed. Severe OM (WHO-OTS >= 3) was recorded in 26 children (OC = 15, control = 11). OC did not reduce the incidence of severe OM, oral pain, or opioid use. Conclusion The feasibility criteria were not met, and the RCT could not show that OC reduces the incidence of severe OM, oral pain, or opioid use in pediatric patients treated with a variety of conditioning regimens for HSCT.
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| 4. |
- Ottosson, Sandra, 1981-, et al.
(author)
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Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer : a long-term follow-up
- 2014
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In: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 22:9, s. 2361-2369
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Journal article (peer-reviewed)abstract
- PURPOSE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
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| 5. |
- Phoosuwan, Nitikorn, et al.
(author)
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Psychological distress and health-related quality of life among women with breast cancer : a descriptive cross-sectional study
- 2022
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In: Supportive Care in Cancer. - : Springer Nature. - 0941-4355 .- 1433-7339. ; 30:4, s. 3177-3186
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Journal article (peer-reviewed)abstract
- Purpose Breast cancer is the most common type of cancer found in women in Sweden and worldwide. Treatment leads to increased survival of patients, but they are at risk to experience psychological distress, including anxiety and depressive symptoms, and decreased health-related quality of life (HRQoL). This study investigated relationship between psychological distress and HRQoL, and related factors among women with breast cancer in Sweden.Methods This descriptive cross-sectional study was conducted in Sweden. A total of 481 women with breast cancer answered voluntarily a questionnaire about sociodemographic and support factors, psychological distress and HRQoL. Data were subjected to Pearson’s correlation and linear regression analyzes.Results Psychological distress was related to HRQoL in terms of body image, future perspective, side effects of systemic therapy, breast symptoms, arm symptoms, and hair loss. Women with lower age were associated with increased symptoms of anxiety, while those having undergone breast reconstruction were associated with increased symptoms of depression. Breast reconstruction and chemotherapy worsened body image, low support from partner decreased sexual functioning and enjoyment, and low support from physicians and nurses worsened future perspective, side effects of systemic therapy, breast symptoms and indignation about hair loss.Conclusions Psychological distress was correlated with the HRQoL. Increased support from physicians, nurses, and husband/partner may increase the HRQoL among women with breast cancer. Breast cancer treatments such as breast reconstruction and chemotherapy were factors that decreased the psychological distress and increased the HRQoL.
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| 6. |
- Ax, Anna-Karin, et al.
(author)
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Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment-results from the Phys-Can project
- 2022
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In: Supportive Care in Cancer. - Heidelberg, Germany : Springer Nature. - 0941-4355 .- 1433-7339. ; 30:7, s. 5949-5963
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Journal article (peer-reviewed)abstract
- PURPOSE: This study aimed to evaluate the effect of high intensity (HI) vs low-to-moderate intensity (LMI) exercise on health-related quality of life (HRQoL) up to 18 months after commencement of oncological treatment in patients with breast, colorectal or prostate cancer. In addition, we conducted a comparison with usual care (UC).METHODS: Patients scheduled for (neo)adjuvant oncological treatment (n = 577) were randomly assigned to 6 months of combined resistance and endurance training of HI or LMI. A longitudinal descriptive study (UC) included participants (n = 89) immediately before the RCT started. HRQoL was assessed by EORTC QLQ-C30 at baseline, 3, 6 and 18 months (1 year after completed exercise intervention) follow-up. Linear mixed models were used to study the groups over time.RESULTS: Directly after the intervention, HI scored significant (P = 0.02), but not clinically relevant, higher pain compared with LMI. No other significant difference in HRQoL was found between the exercise intensities over time. Clinically meaningful improvements in HRQoL over time were detected within both exercise intensities. We found favourable significant differences in HRQoL in both exercise intensities compared with UC over time.CONCLUSION: This study adds to the strong evidence of positive effect of exercise and shows that exercise, regardless of intensity, can have beneficial effects on HRQoL during oncological treatment and also for a substantial time after completion of an exercise intervention. In this study, for one year after.IMPLICATIONS FOR CANCER SURVIVORS: Patients can be advised to exercise at either intensity level according to their personal preferences, and still benefit from both short-term and long-term improvements in HRQoL.
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| 7. |
- Bergström, Liza, 1974, et al.
(author)
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Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being
- 2017
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 25:9, s. 2683-2690
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Journal article (peer-reviewed)abstract
- Purpose Psychological distress after laryngeal cancer treatment is prevalent. Although voice rehabilitation has shown to improve functional outcomes and positively affect health-related quality of life, to date, there has been limited study of the associated effect of behavioural voice intervention on psychological well-being/distress post laryngeal cancer. Method Sixty-three patients with Tis-T4 laryngeal cancer treated with (chemo)radiotherapy were prospectively recruited and randomised to either a voice rehabilitation (VR, n = 31) or control group (n = 32). The VR group received 10 speech pathology sessions consisting of both direct and indirect voice intervention post (chemo)radiotherapy. The control group received general voice education but not specific intervention. As part of a multidisciplinary assessment battery, psychological well-being/distress was measured using the Hospital Anxiety and Depression Scale (HADS) pre, six and 12 months post VR. Results Within-group analysis revealed a significant (p = 0.03) reduction in the proportion of patients with anxiety in the VR group between baseline and 12 months. No change over time was observed in controls. Between-group analysis revealed a trend for fewer VR cases demonstrating anxiety (p = 0.06) or depression (p = 0.08) at 6 months and significantly fewer demonstrating anxiety (p = 0.04) and depression (p = 0.04) at 12 months, compared to controls. Significant correlations were observed between patients' voice perceptions and reduced anxiety (r(pb) = -0.38) and depression (r(pb) = -0.66) within the VR group at 12 months. Conclusions The positive correlations and between-group analyses indicate a positive effect on psychological well-being associated with completing voice rehabilitation. Results highlight potential additional benefits of behavioural voice intervention beyond achieving direct change to voice function.
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| 8. |
- Einarsson, Sandra, 1981-, et al.
(author)
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Mapping the impact of malnutrition as defined by the Global Leadership Initiative on Malnutrition and nutrition impact symptoms on the possibility of returning to work after treatment for head and neck cancer
- 2024
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In: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 32
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Journal article (peer-reviewed)abstract
- Purpose: This study aimed to investigate whether malnutrition or nutrition impact symptoms (NIS) affect the possibility of returning to work after treatment for head and neck cancer.Methods: Patients of working age with head and neck cancer were followed up from treatment initiation to 3 months (n = 238), 1 year (n = 182), and 2 years (n = 130) after treatment completion. The observed decrease in the number of patients over time was due to retirement, lack of follow-up, or death. Returning to work was dichotomised as yes or no. Malnutrition was diagnosed 7 weeks after treatment initiation using the Global Leadership Initiative on Malnutrition (GLIM) criteria. This time-point corresponds to the end of chemoradiotherapy or radiotherapy (with or without prior surgery), except for patients who underwent exclusive surgery. NIS were scored on a Likert scale (1-5) at each follow-up using the Head and Neck Patient Symptom Checklist (c) (HNSC (c)). Nonparametric tests were used to analyse the ability of patients with/without malnutrition and high/low NIS scores to return to work.Results: At 3 months, 1 year, and 2 years after treatment completion, 135/238 (56.7%), 49/182 (26.9%), and 23/130 (17.7%) patients had not returned to work. Patients with malnutrition at 7 weeks after treatment initiation were more likely to not return to work at 3 months than those without malnutrition, 70.5% compared to 47.1% (p < 0.001). At all three follow-up time-points, patients reporting high scores for a number of NIS had more often not returned to work, with this pattern being most distinct at 2 years.Conclusion: Malnutrition according to the GLIM criteria at 7 weeks after treatment initiation and NIS assessed by the HNSC (c) at subsequent follow-ups were predictors of the return-to-work process after treatment for up to 2 years.
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| 9. |
- Lindgren, Anna, 1981-, et al.
(author)
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Identifying female pelvic cancer survivors with low levels of physical activity after radiotherapy: women with fecal and urinary leakage need additional support
- 2020
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 28, s. 2669-81
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Journal article (peer-reviewed)abstract
- ObjectiveTo investigate the frequency of physical activity among female pelvic cancer survivors (i.e., gynecological, rectal, and anal cancer survivors) and to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood.MethodsFemale pelvic cancer survivors (n=578, mean age 64 years) answered a questionnaire 6-48 months after radiotherapy. A multivariable regression model analyzed factors covarying with frequency of physical activity. We compared QoL and depressed and anxious mood between women practicing physical activity at least or less than once a week.ResultsOf 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p=0.01), had just elementary school level of education (p<0.001), smokers (p=0.049), or had lymphedema without receiving lymphedema treatment (p=0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45%, and 37%, respectively) compared with other women. Women practicing physical activity at least weekly reported better QoL (p<0.001) and lower frequency of depressed mood (p=0.044) compared with the others.ConclusionsFemale cancer survivors experiencing fecal leakage were less likely to practice weekly physical activity than survivors without leakage. The survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others.
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| 10. |
- Strandberg, Emelie, et al.
(author)
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Who makes it all the way? : Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT
- 2022
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In: Supportive Care in Cancer. - : Springer Nature. - 0941-4355 .- 1433-7339. ; 30:2, s. 1739-1748
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Journal article (peer-reviewed)abstract
- Purpose To compare sociodemographic, health- and exercise-related characteristics of participants vs. decliners, and completers vs. drop-outs, in an exercise intervention trial during cancer treatment.Methods Patients with newly diagnosed breast, prostate, or colorectal cancer were invited to participate in a 6-month exercise intervention. Background data for all respondents (n = 2051) were collected at baseline by questionnaire and medical records. Additional data were collected using an extended questionnaire, physical activity monitors, and fitness testing for trial participants (n = 577). Moreover, a sub-group of decliners (n = 436) consented to additional data collection by an extended questionnaire . Data were analyzed for between-group differences using independent t-tests and chi2-tests.Results Trial participants were younger (59 ± 12yrs vs. 64 ± 11yrs, p < .001), more likely to be women (80% vs. 75%, p = .012), and scheduled for chemotherapy treatment (54% vs. 34%, p < .001), compared to decliners (n = 1391). A greater proportion had university education (60% vs 40%, p < .001), reported higher anxiety and fatigue, higher exercise self-efficacy and outcome expectations, and less kinesiophobia at baseline compared to decliners. A greater proportion of trial participants were classified as ‘not physically active’ at baseline; however, within the group who participated, being “physically active” at baseline was associated with trial completion. Completers (n = 410) also reported less kinesiophobia than drop-outs (n = 167).Conclusion The recruitment procedures used in comprehensive oncology exercise trials should specifically address barriers for participation among men, patients without university education and older patients. Individualized efforts should be made to enroll patients with low exercise self-efficacy and low outcome expectations of exercise. To retain participants in an ongoing exercise intervention, extra support may be needed for patients with kinesiophobia and those lacking health-enhancing exercise habits at baseline.
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