| 1. |
- Johansson, Eva, et al.
(author)
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Time, Symptom Burden, Androgen Deprivation, and Self-Assessed Quality of Life after Radical Prostatectomy or Watchful Waiting : The Randomized Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) Clinical Trial
- 2009
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In: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 55:2, s. 422-432
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Journal article (peer-reviewed)abstract
- BACKGROUND: Quality-of-life outcomes are important in the choice of treatment strategy for men with localized prostate cancer.OBJECTIVE: To evaluate how follow-up time, number of physical symptoms, and presence of androgen deprivation affected quality of life among men randomized to radical prostatectomy or watchful waiting.DESIGN, SETTING, AND PARTICIPANTS: The study group was composed of all 376 living men included in the Swedish part of the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) between January 1, 1989, and February 29, 1996. Quality-of-life data were collected after a mean follow-up time of 4.1 yr.INTERVENTION: All patients were randomly assigned to radical prostatectomy or watchful waiting. Forty-five men were androgen deprived.MEASUREMENTS: Data of specific symptoms, symptom-induced stress, sense of well-being, and self-assessed quality of life were obtained by means of a questionnaire. Psychological symptoms were assessed using seven-point visual digital scales.RESULTS AND LIMITATIONS: In analyses stratified on the basis of the numbers of physical symptoms, anxiety and depressed mood were less common, and sense of well-being and self-assessed quality of life were better throughout in the radical prostatectomy group than in the watchful waiting group. As the number of physical symptoms increased, all psychological variables became worse and more prominent in the watchful waiting group. After a follow-up time of 6-8 yr, a significant decrease in quality of life (p=0.03) was seen in the watchful waiting group. Twenty-four percent of androgen-deprived patients assigned to watchful waiting reported high self-assessed quality of life compared with 60% in the radical prostatectomy group. Eighty-eight percent of patients had clinically detected tumors.CONCLUSIONS: Androgen deprivation negatively affected self-assessed quality of life in men assigned to watchful waiting. The number of physical symptoms was associated with the level of quality of life. Quality of life was lower with longer follow-up time in both groups and was statistically significant in the watchful waiting group (p=0.03).
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| 2. |
- Buntrock, Stefan, et al.
(author)
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The Internet and prostate cancer patients Searching for and finding information.
- 2007
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In: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 41:5, s. 367-74
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Journal article (peer-reviewed)abstract
- Objective. To define the characteristics of prostate cancer patients who use the Internet. Material and methods. In October 2002, 511 prostate cancer patients from Stockholm-Gotland County completed a postal questionnaire consisting of 146 questions regarding use of the Internet, demographic factors, level of information about the disease and its treatment, quality of life and trade-off possibilities. Results. The response rate was 86.5% (n=511) and the mean age of the respondents was 71 years. A total of 210 men (41.1%) had access to the Internet. Eighty-two men (16.4%) had looked for information on prostate cancer, either by themselves or with the aid of others. Among men aged 50-60 years, 39% were Internet users, compared to 8% among men aged 75-80 years; the figures for university graduates versus those who had only attended elementary school were 33% and 3%, respectively. Fifty of the 82 men (61%) who searched for information regarded themselves as being satisfactorily informed by online information. Conclusions. Of the men in this cohort, 16% searched the Internet for information regarding their prostate cancer. Young and well-educated men utilized the Internet more frequently than others, but they did not find information more often than older and less well-educated men. It is possible that the Internet promotes social inequality in obtaining healthcare in favor of well-educated, highly paid individuals.
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| 3. |
- Dunberger, Gail, et al.
(author)
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Loose stools lead to fecal incontinence among gynecological cancer survivors.
- 2011
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In: Acta oncologica (Stockholm, Sweden). - : Taylor & Francis. - 1651-226X .- 0284-186X. ; 50:2, s. 233-42
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Journal article (peer-reviewed)abstract
- Abstract Background. Many patients treated with radiotherapy to the pelvic region report a change in bowel habits. Loose stools, urgency and fecal incontinence may have a significant impact on daily life and social functioning. Material and methods. We attempted to follow up 789 women, treated with pelvic radiotherapy for a gynecological cancer during 1991 to 2003 at two departments of gynecological oncology in Sweden. A control group of 478 women from the Swedish Population Registry was also included. As a preparatory study, we made in-depth interviews with 26 women previously treated for gynecological cancer. Based on their narratives, we constructed a study-specific questionnaire including 351 questions and validated it face-to-face. The questionnaire covered questions of physical symptoms originating in the pelvis, demographics, psychological and quality of life factors. In relation to bowel symptoms, 60 questions were asked. Results. Six-hundred and sixteen (78%) gynecological cancer survivors and 344 (72%) control women participated. Two-hundred and twenty-six (37%) cancer survivors reported loose stools at least once a week. Eighty-three percent of the survivors with loose stools every day reported defecation urgency with fecal leakage, compared to 20% of cancer survivors without loose stools. Cancer survivors with loose stools at least once a week were 7.7 times more likely to suffer from defecation urgency with fecal leakage (95% CI 4.4-13.3) compared to those who had loose stools once a month or less. In order to avoid loose stools affected survivors with loose stools often skipped meals (13%), made an active choice of food (47%) and preferentially used prescribed medication (36%). Discussion. There is a relation between loose stools and defecation urgency with fecal leakage among long-term gynecological cancer survivors treated with pelvic radiotherapy. Targeting loose stools can possibly help survivors to decrease frequency of fecal leakage.
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| 5. |
- Enblom, Anna, et al.
(author)
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Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care : Effects of Unspecific Acupuncture Mechanisms
- 2010
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Journal article (other academic/artistic)abstract
- Background: It is not known if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methods: Cancer patients were randomized to verum (skin penetrating) acupuncture (n = 109) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106) performed with a telescopic nonpenetrating needle at a sham point during the whole radiotherapy period. The verum and sham treated patients were compared to a reference cohort receiving standard care only (n = 62). All patients received radiotherapy over abdominal or pelvic regions. The occurrence of emesis in each group was compared using replies documented in questionnaires after a mean dose of 27 Gray. Findings: Nausea (p=0.001) and vomiting were experienced during the preceding week by 37 and 7%, respectively, in the verum group, 38 and 7% in the sham group and 63 and 15% in the standard care group. The nausea intensity in the acupuncture cohort was lower (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p=0.002). Almost all the verum and sham treated patients (95%) expected antiemetic effects from their treatment. Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (relative risk 1.6; 95 % confidence interval 1.2-2.4). Interpretations: Both verum acupuncture and nonpenetrating sham acupuncture seem to reduce nausea and vomiting during radiotherapy, possibly by psychobiological mechanisms related to the extra care and expectancy.
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| 6. |
- Ideström, Maja, et al.
(author)
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Pediatric Crohn's disease from onset to adulthood : granulomas are associated with an early need for immunomodulation
- 2014
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 49:8, s. 950-7
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Childhood onset Crohn's disease (CD) is considered more aggressive than adult onset disease. Epithelioid cell granulomas in intestinal biopsies are one, non-obligate, criterion of CD. We investigated granulomas as markers of CD severity in children followed to adulthood.MATERIAL AND METHODS: Forty-five individuals with childhood onset CD were studied from diagnosis until attainment of final height, with data on disease location, medical and surgical management and with detailed growth data analyses. A blinded review of diagnostic biopsies was also performed.RESULTS: We found granulomas in 22/45 (49%) children at diagnosis, altogether in 28/45 (62%) patients during the disease course (median overall follow-up - 12.3 years, range 9.3-18). Granulomas were found in 9/11 (82%) with upper gastrointestinal involvement (cumulatively 17/20, 85%) (p = 0.017 and p = 0.006, respectively). The time from diagnosis to initiating immune modulating treatment (median 4.5 months, range 0-75) was shorter in the granuloma-positive group (16/22) compared to the granuloma-negative group (18/23) (median 33 months, range 2-105; p = 0.01). The median standard deviation score height at diagnosis and final adult height (both adjusted for target height) did not correlate to findings of granulomas.CONCLUSIONS: Epithelioid cell granulomas were associated with a shorter time to initiating immune modulating drugs, as a possible sign of more severe disease, but growth was not affected.
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| 10. |
- Kreicbergs, Ulrika, et al.
(author)
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Talking about death with children who have severe malignant disease.
- 2004
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 351:12, s. 1175-1186
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Journal article (peer-reviewed)abstract
- BACKGROUND: One of the questions faced by the parents of a child who is terminally ill with a malignant disease is whether or not they should talk about death with their child.METHODS: In 2001, we attempted to contact all parents in Sweden who had lost a child to cancer between 1992 and 1997. Among 561 eligible parents, 449 answered a questionnaire, and 429 stated whether or not they had talked about death with their child.RESULTS: None of the 147 parents who talked with their child about death regretted it. In contrast, 69 of 258 parents (27 percent) who did not talk with their child about death regretted not having done so. Parents who sensed that their child was aware of his or her imminent death were more likely to regret not having talked about it (47 percent, as compared with 13 percent of parents who did not sense this awareness in their child; relative risk, 3.7; 95 percent confidence interval, 2.3 to 6.0). The same variable was related to having talked about death (50 percent vs. 13 percent; relative risk, 3.8; 95 percent confidence interval, 2.6 to 5.6), as was being religious (42 percent vs. 25 percent; relative risk, 1.7; 95 percent confidence interval, 1.2 to 2.3). The child's age was related to both having talked about death and the parents' regretting not having talked about it.CONCLUSIONS: Parents who sense that their child is aware of his or her imminent death more often later regret not having talked with their child than do parents who do not sense this awareness in their child; overall, no parent in this cohort later regretted having talked with his or her child about death.
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