| 1. |
- Wikman, Anna, et al.
(författare)
-
Presence of symptom clusters in surgically treated patients with esophageal cancer
- 2014
-
Ingår i: Cancer. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1097-0142 .- 0008-543X.
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is not known whether symptoms cluster together after esophageal cancer surgery or whether such symptom clusters are associated with survival in patients with esophageal cancer who are treated surgically. METHODS: Data from a prospective Swedish nationwide cohort study of surgically treated patients with esophageal cancer recruited between 2001 and 2005 were used. General and esophageal cancer-specific symptoms were assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire and the QLQ-OES18 module at 6 months after surgery. Associations between symptom clusters and survival were analyzed using Cox proportional hazards models, providing hazards ratios with 95% confidence intervals, adjusted for other known prognostic factors. RESULTS: Among 402 patients reporting symptoms 6 months after surgery, 3 symptom clusters were identified. The first symptom cluster (“fatigue/pain”) was characterized by symptoms of pain, fatigue, insomnia, and dyspnea and was present in 30% of patients. The second symptom cluster (“reflux/cough”) was characterized by symptoms of dry mouth, problems with taste, coughing, and reflux and was present in 27% of patients. The third symptom cluster (“eating difficulties”) was characterized by appetite loss, dysphagia, eating difficulties, and nausea/vomiting and was present in 28% of patients. The presence of the reflux/cough and eating difficulties symptom clusters was associated with a statistically significantly increased risk of mortality (adjusted hazards ratio, 1.43 [95% confidence interval, 1.08-1.89] and adjusted HR, 1.41 [95% confidence interval, 1.06-1.87], respectively). CONCLUSIONS: Symptoms experienced by surgically treated patients with esophageal cancer appear to cluster together, and the presence of these symptom clusters appears to have strong prognostic value.
|
|
| 2. |
- Boman, Krister K., et al.
(författare)
-
Long-term outcomes of childhood cancer survivors in Sweden : a population-based study of education, employment, and income
- 2010
-
Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 116:5, s. 1385-1391
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied. METHODS: The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households. RESULTS: Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation. CONCLUSIONS : CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.
|
|
| 3. |
- Bredberg, Anders
(författare)
-
Cancer: More of polygenic disease and less of multiple mutations? A quantitative viewpoint.
- 2011
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; Okt, s. 440-445
-
Tidskriftsartikel (refereegranskat)abstract
- The focus of cancer research is on cancer-specific mutations, with most clinical trials involving targeted drugs. Huge numbers of DNA lesions and tumor resistance events, in each of the >10(13) cells of a human individual, form a striking contrast to the low, and also very narrow, cancer incidence window (10(-1)-10(0)). A detailed consideration of these quantitative observations seems to question the present paradigm, while suggesting that a systemic regulatory network mechanism is a stronger determinant for overt cancer disease, as compared with cancer-specific gene products. If we shall ever achieve major improvements in survival, we must gain understanding of this systemic network, rather than targeting therapy to a limited set of molecules or mutations. This may give us new opportunities for development of highly potent therapeutic tools. Cancer 2010. © 2010 American Cancer Society.
|
|
| 4. |
- Brodin, N. Patrik, et al.
(författare)
-
Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale
- 2012
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 118:21, s. 5432-5440
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The authors developed a framework for estimating and comparing the risks of various long-term complications on a common scale and applied it to 3 different techniques for craniospinal irradiation in patients with pediatric medulloblastoma. METHODS: Radiation dose-response parameters related to excess hazard ratios for secondary breast, lung, stomach, and thyroid cancer; heart failure, and myocardial infarction were derived from large published clinical series. Combined with age-specific and sex-specific hazards in the US general population, the dose-response analysis yielded excess hazards of complications for a cancer survivor as a function of attained age. After adjusting for competing risks of death, life years lost (LYL) were estimated based on excess hazard and prognosis of a complication for 3-dimensional conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT). RESULTS: Lung cancer contributed most to the estimated LYL, followed by myocardial infarction, and stomach cancer. The estimates of breast or thyroid cancer incidence were higher than those for lung and stomach cancer incidence, but LYL were lower because of the relatively good prognosis. Estimated LYL ranged between 1.90 years for 3D CRT to 0.28 years for IMPT. In a paired comparison, IMPT was associated with significantly fewer LYL than both photon techniques. CONCLUSIONS: Estimating the risk of late complications is associated with considerable uncertainty, but including prognosis and attained age at an event to obtain the more informative LYL estimate added relatively little to this uncertainty. Cancer 2012. (c) 2012 American Cancer Society.
|
|
| 5. |
- Carneiro, Ana, et al.
(författare)
-
A prognostic model for soft tissue sarcoma of the extremities and trunk wall based on size, vascular invasion, necrosis, and growth pattern.
- 2011
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; Dec, s. 1279-1287
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: In soft tissue sarcoma, better distinction of high-risk and low-risk patients is needed to individualize treatment and improve survival. Prognostic systems used in clinical practice identify high-risk patients based on various factors, including age, tumor size and depth, histological type, necrosis, and grade. METHODS:: Whole-tumor sections from 239 soft tissue sarcomas of the extremities were reviewed for the following prognostic factors: size, vascular invasion, necrosis, and growth pattern. A new prognostic model, referred to as SING (Size, Invasion, Necrosis, Growth), was established and compared with other clinically applied systems. RESULTS:: Size, vascular invasion, necrosis, and peripheral tumor growth pattern provided independent prognostic information with hazard ratios of 2.2-2.6 for development of metastases in multivariate analysis. When these factors were combined into the prognostic model SING, high risk of metastasis was predicted with a sensitivity of 74% and a specificity of 85%. Moreover, the prognostic performance of SING compared favorably with other widely used systems. CONCLUSIONS:: SING represents a promising prognostic model, and vascular invasion and tumor growth pattern should be considered in soft tissue sarcoma prognostication. Cancer 2010. © 2010 American Cancer Society.
|
|
| 6. |
- Dahl, Christian A. Falk, et al.
(författare)
-
A Study of Body Image in Long-Term Breast Cancer Survivors
- 2010
-
Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 116:15, s. 3549-3557
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In this controlled postdiagnosis study, the authors examined various aspects of body image of breast cancer survivors in cross-sectional and longitudinal designs. METHODS: In 2004 and 2007 the Body Image Scale (BIS) was completed by the same 248 disease-free women who had been treated for stage II and III breast cancer between 1998 and 2002. "Poorer" body image was defined as greater than the 70th percentile (N = 76 women) of the BIS scores in contrast to "better" body image (N = 172 women). Breast cancer survivors were examined clinically in 2004, and their BIS scores were compared with the scores from an age-matched group of women from the general population. RESULTS: In this cross-sectional study, poorer body image in 2004 was associated significantly with modified radical mastectomy, undergoing or planning to undergo breast-reconstructive surgery, a change in clothing, poor physical and mental health, chronic fatigue, and reduced quality of life (QoL). In univariate analyses, most of these factors and manually planned radiotherapy were significant predictors of poorer body image in 2007. In multivariate analyses, manually planned radiotherapy, poor physical QoL and high BIS score in 2004 remained independent predictors of a poorer body image in 2007. Body image ratings were relatively stable from 2004 to 2007. Twenty-one percent of breast cancer survivors reported body image dissatisfaction, similar to the proportion of dissatisfaction in controls. CONCLUSIONS: In this cross-sectional analysis, body image in breast cancer survivors was associated with the types of surgery and radiotherapy and with mental distress, reduced health, and impaired QoL. Body image ratings were relatively stable over time, and the antecedent body image score was a strong predictor of body image at follow-up. Body image in breast cancer survivors differed very little from that in controls.
|
|
| 7. |
- Garkavij, Michael, et al.
(författare)
-
Lu-177-[DOTA0,Tyr3] Octreotate Therapy in Patients With Disseminated Neuroendocrine Tumors: Analysis of Dosimetry With Impact on Future Therapeutic Strategy
- 2010
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 116:4, s. 1084-1092
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Lu-177-(DOTAO,Tyr3) octreotate is a new treatment modality for disseminated neuroendocrine tumors. According to a consensus protocol, the calculated maximally tolerated absorbed dose to the kidney should not exceed 27 Gy. In commonly used dosimetry methods, planar imaging is used for determination of the residence time, whereas the kidney mass is determined from a computed tomography (CT) scan. METHODS: Three different quantification methods were used to evaluate the absorbed dose to the kidneys. The first method involved common planar activity imaging, and the absorbed dose was calculated using the medical internal radiation dose (MIRD) formalism, using CT scan-based kidney masses. For this method, 2 region of interest locations for the background correction were investigated. The second method also included single-photon emission computed tomography (SPECT) data, which were used to scale the amplitude of the time-activity curve obtained from planar images. The absorbed dose was calculated as in the planar method. The third method used quantitative SPECT images converted to absorbed dose rate images, where the median absorbed dose rate in the kidneys was calculated in a volume of interest defined over the renal cortex. RESULTS: For some patients, the results showed a large difference in calculated kidney-absorbed doses, depending on the dosimetry method. The 2 SPECT-based methods generally gave consistent values, although the calculations were based on different assumptions. Dosimetry using the baseline planar method gave higher absorbed doses in all patients. The values obtained from planar imaging with a background region of interest placed adjacent to the kidneys were more consistent with dosimetry also including SPECT. For the accumulated tumor absorbed dose, the first 2 of the 4 planned therapy cycles made the major contribution. CONCLUSIONS: The results suggested that patients evaluated according to the conventional planar-based dosimetry method may have been undertreated compared with the other methods. Hematology and creatinine did not indicate any restriction for a more aggressive approach, which would be especially useful in patients with more aggressive tumors where there is not time for more protracted therapy. Cancer 2010;116(4 suppl):1084-92. (C) 2010 American Cancer Society.
|
|
| 8. |
|
|
| 9. |
- Hayes, S C, et al.
(författare)
-
Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care.
- 2012
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 118:8, s. 2237-2249
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.
|
|
| 10. |
- Hemminki, Kari, et al.
(författare)
-
Incidence and mortality in epithelial ovarian cancer by family history of any cancer.
- 2011
-
Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 117, s. 3972-3980
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Practically all data on familial risk in ovarian and other cancers are based on incident cancer, whereas familiality in cancer mortality is largely unknown. If fatal forms of cancer are a highly familial subtype, then familial risk for mortality may exceed that of incidence, which is relevant for clinical decision making and counseling. METHODS: Ovarian cancer patients in the nationwide Swedish Family Cancer Database were classified according to fatal and nonfatal (incident) family history. Familial risks for incident and fatal ovarian cancer were calculated for offspring based on their parental or sibling family history of any cancer using standardized incidence ratios (SIRs) for incidence and standardized mortality ratios (SMRs) for mortality. Offspring without family history were referents. RESULTS: The database included 24,757 mothers and 8138 daughters with ovarian cancer. When a mother had ovarian cancer, the SIR for incident ovarian cancer in daughters was 2.69, and when a sister had ovarian cancer it was 3.49. The SMRs for fatal cancer by fatal cancer in probands were 3.39 and 5.80, respectively. For fatal serous cancers among siblings, the SMR was 6.16, compared with 10.01 for the endometrioid type. Ovarian cancer was associated with maternal (SIR, 1.22; SMR, 1.56) and sororal breast cancer (SIR, 1.27). Another discordant association was between ovarian and paternal prostate cancer (SIR, 1.12; SMR, 1.66). CONCLUSIONS: Fatal familial risks were higher for concordant ovarian, ovarian-breast, and ovarian-prostate cancers than the corresponding incident risks. This may suggest that highly fatal subtypes exist for these cancers, calling for genetic dissection. Cancer 2011. © 2011 American Cancer Society.
|
|
