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- Abe, O, et al.
(författare)
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Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials
- 2005
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Ingår i: The Lancet. - 1474-547X. ; 365:9472, s. 1687-1717
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Tidskriftsartikel (refereegranskat)abstract
- Background Quinquennial overviews (1985-2000) of the randomised trials in early breast cancer have assessed the 5-year and 10-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival. Here, we report the 10-year and 15-year effects. Methods Collaborative meta-analyses were undertaken of 194 unconfounded randomised trials of adjuvant chemotherapy or hormonal therapy that began by 1995. Many trials involved CMF (cyclophosphamide, methotrexate, fluorouracil), anthracycline-based combinations such as FAC (fluorouracil, doxombicin, cyclophosphamide) or FEC (fluorouracil, epirubicin, cyclophosphamide), tamoxifen, or ovarian suppression: none involved taxanes, trastuzumab, raloxifene, or modem aromatase inhibitors. Findings Allocation to about 6 months of anthracycline-based polychemotherapy (eg, with FAC or FEC) reduces the annual breast cancer death rate by about 38% (SE 5) for women younger than 50 years of age when diagnosed and by about 20% (SE 4) for those of age 50-69 years when diagnosed, largely irrespective of the use of tamoxifen and of oestrogen receptor (ER) status, nodal status, or other tumour characteristics. Such regimens are significantly (2p=0 . 0001 for recurrence, 2p<0 . 00001 for breast cancer mortality) more effective than CMF chemotherapy. Few women of age 70 years or older entered these chemotherapy trials. For ER-positive disease only, allocation to about 5 years of adjuvant tamoxifen reduces the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age (<50, 50-69, &GE; 70 years), progesterone receptor status, or other tumour characteristics. 5 years is significantly (2p<0 . 00001 for recurrence, 2p=0 . 01 for breast cancer mortality) more effective than just 1-2 years of tamoxifen. For ER-positive tumours, the annual breast cancer mortality rates are similar during years 0-4 and 5-14, as are the proportional reductions in them by 5 years of tamoxifen, so the cumulative reduction in mortality is more than twice as big at 15 years as at 5 years after diagnosis. These results combine six meta-analyses: anthracycline-based versus no chemotherapy (8000 women); CMF-based versus no chemotherapy (14 000); anthracycline-based versus CMF-based chemotherapy (14 000); about 5 years of tamoxifen versus none (15 000); about 1-2 years of tamoxifen versus none (33 000); and about 5 years versus 1-2 years of tamoxifen (18 000). Finally, allocation to ovarian ablation or suppression (8000 women) also significantly reduces breast cancer mortality, but appears to do so only in the absence of other systemic treatments. For middle-aged women with ER-positive disease (the commonest type of breast cancer), the breast cancer mortality rate throughout the next 15 years would be approximately halved by 6 months of anthracycline-based chemotherapy (with a combination such as FAC or FEC) followed by 5 years of adjuvant tamoxifen. For, if mortality reductions of 38% (age <50 years) and 20% (age 50-69 years) from such chemotherapy were followed by a further reduction of 31% from tamoxifen in the risks that remain, the final mortality reductions would be 57% and 45%, respectively (and, the trial results could well have been somewhat stronger if there had been full compliance with the allocated treatments). Overall survival would be comparably improved, since these treatments have relatively small effects on mortality from the aggregate of all other causes. Interpretation Some of the widely practicable adjuvant drug treatments that were being tested in the 1980s, which substantially reduced 5-year recurrence rates (but had somewhat less effect on 5-year mortality rates), also substantially reduce 15-year mortality rates. Further improvements in long-term survival could well be available from newer drugs, or better use of older drugs.
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- Bernhardt, J, et al.
(författare)
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CASE Needs Analysis. Summary. Findings on Competencies for Sustainability-driven Entrepreneurship. Based on interviews with partners from sustainability-driven enterprises and universities.
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The report represents the main outputs of the needs analysis of work package 1 (WP1) within the CASE project. The specific aim of the report and WP1 is to summarize concrete needs and necessary competencies for sustainability-driven entrepreneurship. For this purpose a qualitative research approach was chosen to bring together perspectives of enterprises and universities concerning a future collaboration as a possible starting-point for a long-lasting multistakeholder network. Furthermore an analysis of best practice examples was necessary in order to create synergies and use existing knowledge and good experiences of teaching towards sustainability-driven entrepreneurship. As the results show, both, companies and universities, are highly aware of the huge challenges for society, economy and natural environment on a global and regional level. That calls for integrated, holistic approaches and for comprehensive socio-economic transformation processes, involving various stakeholders from entrepreneurial, societal and educational contexts. As disciplinary analysis quickly reach their limits, research and practice for sustainability-driven entrepreneurship require comprehensive and integrated approaches. Multistakeholder networks could provide the right learning environments for complex sustainability issues.
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- Hansson, Karin, et al.
(författare)
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Provocation, conflict, and appropriation : The role of the designer in making publics
- 2018
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Ingår i: Design Issues. - : MIT Press Journals. - 0747-9360 .- 1531-4790. ; 34:4, s. 3-7
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Tidskriftsartikel (refereegranskat)abstract
- The role and embodiment of the designer/artist in making publics is significant. This special issue draws attention to reflexive practices in Art & Design, and questions how these practices are embedded in the formations and operations of publics, grounded in six cases of participatory design conducted in the United States, India, Turkey, England, Denmark, and Belgium. From these design practices, typologies of participation are formulated that describe the role of the designer. These typologies describe different and sometimes conflicting epistemologies—providing designers with a vocabulary to communicate a diversity of participatory settings and supporting reflexive practices.
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