| 1. |
- Carlander, Anders, 1979, et al.
(författare)
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The ever gap: The relationship between self-rated health and socio-economic inequalities in Sweden between 1999 and 2021
- 2023
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Ingår i: Social Sciences & Humanities Open. - 2590-2911. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Health inequality linked to socioeconomic status (SES) has increased in many parts of the world. Since economic inequality also has been reported to be on the rise, it is pivotal to investigate how socioeconomic inequality affects health disparities annually. The present study is based on a yearly repeated cross-sectional probability sample of Swedish citizens (N = 141 619) collected between 1999 and 2021. We show that the relative level of SES has increased significantly in Sweden. In addition, the level of economic inequality has also increased. Based on self-rated health (SRH), we report a clear disparity between low and high SES and subjective social class (SSS), where higher SES and SSS are associated with better SRH. We observe a stronger association between SRH and reported present SSS (i.e., subjective social class aimed at capturing current situation) than between SRH and reported childhood SSS (i.e., subjective social class focusing on the situation when growing up). We show that the annual marginal effect of SES is not increasing but instead contributes with a stable annual contribution on SRH. Interestingly, the annual effect of education on SRH was substantially attenuated when adjusting for income, whereas the effect of income on SRH was only moderately different when adjusting for education. Potential mechanisms and remedies are discussed.
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| 2. |
- Lindqvist Bagge, Ann-Sophie, et al.
(författare)
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Mental health, stress, and well-being measured before (2019) and during (2020) COVID-19 : a Swedish socioeconomic population-based study
- 2023
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Ingår i: Psychology and Health. - : Taylor & Francis Group. - 0887-0446 .- 1476-8321.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. Methods: Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy-General Population]) and self-rated health (SRH) was assessed with a single-item question. Results: When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M = 9.15 vs. 8.48, p < 0.01) and depression (M = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M = 76.40 vs. 77.92, p < 0.01) and SRH (M = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. Conclusions: The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.
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| 3. |
- Wesslau, Hanna, et al.
(författare)
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Tumor burden and health-related quality of life in patients with melanoma in-transit metastases
- 2023
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have investigated the health-related quality of life (HRQOL) in patients with melanoma in-transit metastases (ITM). The aim was to investigate the association between tumor burden and HRQOL, including disparities pertaining to sex and age, in treatment-naïve patients with ITM. Methods: Functional Assessment of Cancer Therapy-Melanoma (FACT-M) questionnaire was used to assess HRQOL Pairwise comparisons using t-tests between clinical cutoffs are presented and multiple linear regression analysis showing the unique associations of gender, age, number of tumors, tumor size, presence of lymph node metastases, and tumor localization. Results: A total of 95 patients, 47% females and 53% males (median age 72 years) were included between 2012 and 2021. Women scored significantly lower on emotional well-being (p = 0.038) and lower on FACT-M (p = 0.058). Patients who had ≥10 tumors scored significantly lower on FACT-M (p = 0.015), emotional- and functional well-being (p = 0.04, p = 0.004, respectively), melanoma scale (p = 0.005), and FACT-G (p = 0.027). There was no significant difference in HRQOL depending on age, size of tumors, localization, or presence of lymph node metastases. Conclusion: For patients with melanoma ITMs, the female sex and higher tumor burden (i.e., number of tumors) were significantly correlated with lower HRQOL. However, these findings do not fully explain HRQOL for this patient population, and future research should consider the possibility that there are specific questions for patients with ITM where current instruments might fail to measure their discomfort to the full extent.
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| 4. |
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| 5. |
- Corderfeldt, Anna, et al.
(författare)
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A prospective feasibility trial exploring novel biomarkers for neurotoxicity after isolated limb perfusion
- 2023
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Ingår i: Perfusion-Uk. - 0267-6591.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated limb perfusion (ILP) is a regional cancer treatment in which high-dose chemotherapy is administered in an isolated extremity. The main side effect is regional toxicity, which occasionally leads to nerve damage. Measuring neuroaxonal biomarkers, might be a method predicting such complications. Therefore, the primary aim of the study is to investigate if neuronal biomarkers are measurable and alters in an isolated extremity during ILP. Secondly, if postoperative regional toxicity, alterations in sensitivity, and/or muscle strength are correlated to the biomarker levels.Methods: Eighteen scheduled ILP-patients were included in the study. Glial fibrillary acidic protein (GFAP), neurofilament light (NfL), and tau concentrations were measured in plasma sampled preoperatively, at the start and end of the ILP, on days 3 and 30, using ultrasensitive Single molecule array (Simoa) technology. The patients were assessed by a physiotherapist pre- and postoperatively.Results: At ILP end, significantly higher NfL and tau levels were measured in the extremity than in the corresponding systemic circulation (NfL; 17 vs 6 ng/L, p < .01, tau; 1.8 vs 0.6 ng/L, p < .01), and the extremity levels were significantly increased at ILP end (NfL; 66 +/- 37%, p < .001, tau; 75 +/- 45%, p = .001). On days 3 and 30, significantly increased NfL and GFAP levels were measured systemically (NfL day 3: 69 +/- 30%, p < .001; day 30: 76 +/- 26%, p < .001; GFAP day 3: 33 +/- 22%, p < .002; day 30: 33 +/- 23%, p <= .004). Finally, no significant correlations were found between regional toxicity or between postoperative muscle or sensitivity decrease and biomarker release.Conclusion: During ILP, NfL and tau levels increased significantly. No obvious correlations were observed between biomarker release and regional toxicity or decreased muscle strength or sensitivity, although large-scale studies are warranted.
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| 6. |
- Corderfeldt, Anna, et al.
(författare)
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Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion
- 2023
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Ingår i: Perfusion-Uk. - : SAGE Publications. - 0267-6591. ; 38:5, s. 1019-1028
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated limb perfusion (ILP) is a regional surgical treatment for localized metastatic disease. High doses of chemotherapeutic agents are administered within an extracorporeal circulated isolated extremity, treating the metastasis, while systemic toxicity is avoided. To our knowledge, indexed oxygen supply/demand relationship during ILP has not previously been described. Our aim was to measure and describe oxygen metabolism, specifically oxygen delivery, consumption, and extraction, in an isolated leg/arm during ILP. Also investigate whether invasive oxygenation measurement during ILP correlates and can be used interchangeable with the non-invasive method, near infrared spectroscopy (NIRS). Methods: Data from 40 patients scheduled for ILP were included. At six time points blood samples were drawn during the procedure. DO2, VO2, and O2ER were calculated according to standard formulas. NIRS and hemodynamics were recorded every 10 min. Results: For all observations, the mean of DO2 was 190 +/- 59 ml/min/m(2), VO2 was 35 +/- 8 ml/min/m(2), and O2ER was 21 +/- 8%. VO2 was significantly higher in legs compared to arms (38 +/- 8 vs. 29 +/- 7 ml/min/m(2), p=0.02). Repeated measures showed a significant decrease in DO2 in legs (209 +/- 65 to 180 +/- 66 ml/min/m(2), p=<0.01) and in arms (252 +/- 72 to 150 +/- 57 ml/min/m(2), p=<0.01). Significant increase in O2ER in arms was also found (p=0.03). Significant correlation was detected between NIRS and venous extremity oxygen saturation (SveO(2)) (r(rm)=0.568, p=<. 001, 95% CI 0.397-0.701). When comparing SveO(2) and NIRS using a Bland-Altman analysis, the mean difference (bias) was 8.26 +/- 13.03 (p=<. 001) and the limit of agreement was - 17.28-33.09, with an error of 32.5%. Conclusion: DO2 above 170 ml/min/m(2) during ILP kept O2ER below 30% for all observations. NIRS correlates significant to SveO(2); however, the two methods do not agree sufficiently to work interchangeable.
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| 7. |
- DePalo, D. K., et al.
(författare)
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Oncolytic intralesional therapy for metastatic melanoma
- 2023
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Ingår i: Clinical & Experimental Metastasis. - 0262-0898.
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Forskningsöversikt (refereegranskat)abstract
- In-transit metastasis (ITM) develop in approximately 1 in 10 patients with melanoma and the disease course can vary widely. Surgical resection is the gold-standard treatment; however, ITM are often surgically unresectable due to size, distribution, and/or anatomic involvement. Oncolytic viral therapies are one category of non-surgical treatment options available for ITM. They induce tumor cell lysis and systemic anti-tumor activity through selective infection of tumor cells by naturally occurring or genetically modified factors. While there are numerous oncolytic viral therapies in various stages of development for the treatment of ITM, this discussion focuses on the mechanism and available literature for the two most established herpes virus-based therapies.
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| 8. |
- Forsberg, Elin, et al.
(författare)
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Treatment with Anti-HER2 Chimeric Antigen Receptor Tumor-Infiltrating Lymphocytes (CAR-TILs) Is Safe and Associated with Antitumor Efficacy in Mice and Companion Dogs
- 2023
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 15:3
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Tidskriftsartikel (refereegranskat)abstract
- Simple Summary CAR-T cells are immune cells equipped with a claw that enable them to bind cancer cells. Usually, CAR-T cells are made using immune cells from blood. Here, we tested the hypothesis that also immune cells that reside in the tumor, so called tumor-infiltrating lymphocytes, can also be modified to carry the claw. This may mean that these cells, called CAR-TILs, will be able to attack cancer cells in two ways, using the claw or binding using its normal protein on the cell surface, the so-called T cell receptor. We show that CAR-TILs can be generated, and that they can kill melanoma cells in cell culture and in mice. Finally, to prepare for clinical trials, we also assess if CAR-TILs can be safe in a human cancer patient-like model, a companion dog suffering from cancer. Our data suggest that CAR-TILs may be a way to treat patients with melanoma but human clinical trials are needed. Patients with metastatic melanoma have a historically poor prognosis, but recent advances in treatment options, including targeted therapy and immunotherapy, have drastically improved the outcomes for some of these patients. However, not all patients respond to available treatments, and around 50% of patients with metastatic cutaneous melanoma and almost all patients with metastases of uveal melanoma die of their disease. Thus, there is a need for novel treatment strategies for patients with melanoma that do not benefit from the available therapies. Chimeric antigen receptor-expressing T (CAR-T) cells are largely unexplored in melanoma. Traditionally, CAR-T cells have been produced by transducing blood-derived T cells with a virus expressing CAR. However, tumor-infiltrating lymphocytes (TILs) can also be engineered to express CAR, and such CAR-TILs could be dual-targeting. To this end, tumor samples and autologous TILs from metastasized human uveal and cutaneous melanoma were expanded in vitro and transduced with a lentiviral vector encoding an anti-HER2 CAR construct. When infused into patient-derived xenograft (PDX) mouse models carrying autologous tumors, CAR-TILs were able to eradicate melanoma, even in the absence of antigen presentation by HLA. To advance this concept to the clinic and assess its safety in an immune-competent and human-patient-like setting, we treated four companion dogs with autologous anti-HER2 CAR-TILs. We found that these cells were tolerable and showed signs of anti-tumor activity. Taken together, CAR-TIL therapy is a promising avenue for broadening the tumor-targeting capacity of TILs in patients with checkpoint immunotherapy-resistant melanoma.
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| 9. |
- Helgadottir, H., et al.
(författare)
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Survival after introduction of adjuvant treatment in stage III melanoma: a nationwide registry-based study
- 2023
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Ingår i: Jnci-Journal of the National Cancer Institute. - : Oxford University Press. - 0027-8874 .- 1460-2105. ; 41:16
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Tidskriftsartikel (refereegranskat)abstract
- Background Adjuvant treatments with PD-1 and BRAF+MEK inhibitors statistically significantly prolong recurrence-free survival in stage III cutaneous melanoma. Yet, the effect on overall survival is still unclear. Based on recurrence-free survival outcomes, these treatments have been approved and widely implemented. The treatments have considerable side effects and costs, and overall survival effect remains a highly anticipated outcome. Methods Clinical and histopathological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with stage III melanoma between 2016 and 2020. The patients were divided depending on if they were diagnosed before or from July 2018, based on the timepoint when adjuvant treatment was introduced in Sweden. Patients were followed up until the end of 2021. In this cohort study, melanoma-specific and overall survival were calculated using the Kaplan-Meier method and Cox-regression analyses. Results There were 1371 patients diagnosed with stage III primary melanoma in Sweden in 2016-2020. The 2-year overall survival rates, comparing the 634 patients in the precohort and the 737 in the postcohort, were 84.3% (95% confidence interval [CI] = 81.4% to 87.3%) and 86.1% (95% CI = 83.4% to 89.0%), respectively, with an adjusted hazard ratio of 0.91 (95% CI = 0.70 to 1.19, P = .51). Further, no statistically significant overall or melanoma-specific survival differences were seen when comparing the precohort and the postcohort in different subgroups for age, sex, or tumor characteristics. Conclusions In this nationwide population-based and registry-based study, no survival benefit was detected in patients diagnosed before or after the implementation of adjuvant treatment in stage III melanoma. These findings encourage a careful assessment of the current recommendations on adjuvant treatment.
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