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- Bergh, Jonas, et al.
(författare)
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Tailored fluorouracil, epirubicin, and cyclophosphamide compared with marrow-supported high-dose chemotherapy as adjuvant treatment for high-risk breast cancer : A randomised trial
- 2000
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 356:9239, s. 1384-1391
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chemotherapy drug distribution varies greatly among individual patients. Therefore, we developed an individualised fluorouracil, epirubicin, cyclophosphamide (FEC) regimen to improve outcomes in patients with high-risk early breast cancer. We then did a randomised trial to compare this individually tailored FEC regimen with conventional adjuvant chemotherapy followed by consolidation with high-dose chemotherapy with stem-cell support. Methods: 525 women younger than 60 years of age with high-risk primary breast cancer were randomised after surgery to receive nine cycles of tailored FEC to haematological equitoxicity with granulocyte colony-stimulating factor (G-CSF) support (n=251), or three cycles of FEC at standard doses followed by high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin (CTCb), and peripheral-blood stem-cell or bone-marrow support (n=274). Both groups received locoregional radiation therapy and tamoxifen for 5 years. The primary outcome measure was relapse-free survival, and analysis was by intention to treat. Findings: At a median follow-up of 34.3 months, there were 81 breast-cancer relapses in the tailored FEC group versus 113 in the CTCb group (double triangular method p=0.04). 60 deaths occurred in the tailored FEC group and 82 in the CTCb group (log-rank p=0.12). Patients in the CTCb group experienced more grade 3 or 4 acute toxicity compared with the tailored FEC group (p<0.0001). Two treatment-related deaths (0.7%) occurred in the CTCb group. Six patients in the tailored FEC group developed acute myeloid leukaemia and three developed myelodysplastic syndrome. Interpretation: Tailored FEC with G-CSF support resulted in a significantly improved relapse-free survival and fewer grade 3 and 4 toxicities compared with marrow-supported high-dose chemotherapy with CTCb as adjuvant therapy of women with high-risk primary breast cancer.
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| 5. |
- Cernvall, Martin, et al.
(författare)
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Experiential avoidance and rumination in parents of children on cancer treatment : relationships with posttraumatic stress symptoms and symptoms of depression
- 2016
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Ingår i: Journal of clinical psychology in medical settings. - : Springer Science and Business Media LLC. - 1068-9583 .- 1573-3572. ; 23:1, s. 67-76
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a cross-sectional survey study to investigate whether there is a relationship between experiential avoidance (EA), rumination, post-traumatic stress symptoms (PTSS), and symptoms of depression, in parents of children on cancer treatment. Data from 79 parents (55 mothers) of 79 children with a median of three months since their cancer diagnosis were included in cross-sectional analyses. EA and rumination were positively correlated with PTSS and symptoms of depression. EA and rumination did not provide incremental explained variance in PTSS over and above that explained by symptoms of depression, while controlling for symptoms of anxiety and demographic characteristics. However, EA and rumination provided incremental explained variance in symptoms of depression over and above that explained by PTSS, while controlling for symptoms of anxiety and demographic characteristics. Rumination and EA are important constructs in the understanding of PTSS and symptoms of depression in parents of children on cancer treatment. Future research should delineate the temporal relationships between these constructs.
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- Cernvall, Martin, et al.
(författare)
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Internet-based guided self-help for parents of children diagnosed with cancer : Long-term follow-up of a randomized controlled trial
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 470-470
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: A considerable proportion of parents of children on cancer treatment experience distress such as symptoms of posttraumatic stress (PTSS), depression and anxiety. The purpose was to investigate the long-term efficacy of Internetbased guided self-help for these parents.Methods: 58 parents of children on cancer treatment (median months since diagnosis = 3) were randomized to receive 10 weeks of guided self-help via the Internet or to wait-list (intervention n = 31, wait-list n = 27). The intervention utilized principles from cognitive behavior therapy and included psychoeducation, relaxation training, coping with thoughts and feelings, problem solving, and emotional writing. Weekly support via e-mail was provided. Outcomes included PTSS (PCL-C), depression (BDI-II) and anxiety (BAI) and were assessed at pre and post intervention and at one-year follow-up.Results: 18 participants completed the intervention. 16 participants in the intervention condition and 16 participants in the wait-list condition participated in the one-year follow-up. Intention-to-treat analyses indicated significant time*group interactions for all three outcomes with reductions favoring the intervention group: PCL-C; F = 10.9, < .001, BDI-II; F = 12.0, < .001, BAI; F = 14.6, < .001. At the one-year follow-up there were large between-group effect sizes for all three outcomes (Cohens d 0.8 to 1.1).Conclusions: The high drop-out rate warrants caution in interpretation of the findings. However, Internet-based guided self-help may be an accessible alternative for some parents of children on cancer treatment and findings indicate that short-term efficacy can be maintained in the long term.
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| 10. |
- Cernvall, Martin, et al.
(författare)
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Internet‐based guided self‐help for parents of children on cancer treatment : a randomized controlled trial
- 2015
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 24:9, s. 1152-1158
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim of the study was to investigate the feasibility and preliminary efficacy of an Internet‐based guided self‐help intervention for posttraumatic stress symptoms (PTSS) and related symptoms in parents of children on cancer treatment.MethodsParents of children on cancer treatment, who fulfilled the modified symptom criteria on the PTSD Checklist, were randomly allocated to the intervention or to a wait‐list control condition. The intervention group accessed a 10‐week guided self‐help program via the Internet based on principles from cognitve behavior therapy. The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self‐report preintervention and postintervention.ResultsSeven hundred forty‐seven parents were approached and informed about the study, 92 were assessed for eligibility, and 58 were included and randomized to the intervention (n = 31) or wait list (n = 27). Eightteen participants completed the intervention. Intention‐to‐treat analyses indicated a significant effect of the intervention on PTSS with a large between‐group effect size at postassessment (Cohen's d = 0.88). The intervention group reported reductions in PTSS with a large within‐group effect size (d = 1.62) compared with a minimal reduction in the wait‐list group (d = 0.09). There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within‐group effect sizes (d = 0.85–1.09).ConclusionsFindings indicate a low enrollment rate and considerable attrition but also that Internet‐based guided self‐help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet‐based intervention.
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