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Publications (10 of 43) Show all publications
Rasmusson, E., Gunnlaugsson, A., Wieslander, E., Hoglund, P., Widmark, A., Fransson, P., . . . Nilsson, P. (2019). Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiotherapy for Prostate Cancer. Paper presented at 61st Annual Meeting of the American Society for Radiation Oncology (ASTRO), Chicago, Sep 15-18, 2019. International Journal of Radiation Oncology, Biology, Physics, 105(1), S133-S134
Open this publication in new window or tab >>Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiotherapy for Prostate Cancer
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2019 (English)In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 105, no 1, p. S133-S134Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Cancer and Oncology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-164419 (URN)10.1016/j.ijrobp.2019.06.122 (DOI)000485671502690 ()
Conference
61st Annual Meeting of the American Society for Radiation Oncology (ASTRO), Chicago, Sep 15-18, 2019
Note

Supplement S, Meeting Abstract 1042.

Available from: 2019-10-22 Created: 2019-10-22 Last updated: 2019-10-22Bibliographically approved
Langegård, U., Ahlberg, K., Fransson, P., Johansson, B., Sjövall, K., Bjork-Eriksson, T. & Ohlsson-Nevo, E. (2019). Evaluation of quality of care in relation to health-related quality of life of patients diagnosed with brain tumor: a novel clinic for proton beam therapy. Supportive Care in Cancer, 27(7), 2679-2691
Open this publication in new window or tab >>Evaluation of quality of care in relation to health-related quality of life of patients diagnosed with brain tumor: a novel clinic for proton beam therapy
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2019 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 27, no 7, p. 2679-2691Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Patients with brain tumors constitute a vulnerable group, and it is important that they receive the highest quality of care (QoC). The study aim was to describe the perceptions of QoC and its association with health-related quality of life in brain tumor patients undergoing proton beam therapy in a newly established clinic.

METHOD: Data were collected at the start of treatment and after 3 and 6 weeks. Adult patients (≥ 18 years old) with brain tumors (n = 186) completed two self-administered questionnaires: a modified Quality from the Patients' Perspective, which measures perceived reality and subjective importance of care, and the EORTC QLQ-C30. Data were analyzed using parametric and non-parametric statistical tests.

RESULTS: The perceived QoC was highest for treatment information and lowest for dietician and smoking information, whereas interaction with doctors and nurses was rated as the most important aspect of quality of care. Subjective importance ratings were significantly higher than perceived reality ratings for 60% of items. A better global health was moderately correlated with a higher perceived support for fatigue.

CONCLUSIONS: A need for quality improvement was identified for several aspects of patient care. Greater symptom distress during the treatment period led to greater perceived importance of symptom support. Ensuring QoC is complex and collaboration with other health care professionals is essential.

RELEVANCE TO CLINICAL PRACTICE: The clinic could improve QoC regarding information about possible symptoms, adjust care according to patient perceptions of importance, and involve patients in care decisions.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Brain tumor, Health-related quality of life, Proton beam therapy, Quality of care, Radiotherapy
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155312 (URN)10.1007/s00520-018-4557-7 (DOI)000469516100039 ()30484013 (PubMedID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-06-27Bibliographically approved
Byenfeldt, M., Elvin, A. & Fransson, P. (2019). Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology. Ultrasound in Medicine and Biology, 45(2), 411-428
Open this publication in new window or tab >>Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology
2019 (English)In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 45, no 2, p. 411-428Article in journal (Refereed) Published
Abstract [en]

It has been postulated that in the liver, applying increased probe pressure during ultrasound-based shear wave elastography (SWE) might lead to a false increase in the SWE result. We aimed to determine the influence of increased intercostal probe pressure when performing SWE of the liver. We also investigated the number of measurements required to achieve technically successful and reliable SWE examinations. This prospective, clinical study included 112 patients and 2240 SWE measurements of the liver. We applied probe pressure intercostally, to reduce the skin-to-liver capsule distance (SCD), which could stabilize the SWE signal and thus increase the number of technically successful measurements. We performed 10 measurements with maximum probe pressure and 10 with normal pressure in each patient. Thus, two analysis groups were compared for differences. Compared with normal pressure, maximum probe pressure significantly reduced the SCD (p < 0.001) and significantly increased the number of technically successful measurements from 981 to 1098, respectively (p < 0.001). The SWE results with normal and maximum probe pressure were 5.96 kPa (interquartile range: 2.41) and 5.45 kPa (interquartile range: 1.96), respectively (p < 0.001). In obese patients, a large SCD poses a diagnostic challenge for ultrasound SWE. We found that maximum intercostal probe pressure could reduce the SCD and increase the number of technically successful measurements, without falsely increasing the SWE result. Only three measurements were required to achieve technically successful and reliable SWE examinations.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Shear wave elastography, Skin-to-liver capsule distance, Probe pressure, Measurements, Obesity, Pre-compressive force, Applied transducer force, Subcutaneous fat, Steatosis
National Category
Radiology, Nuclear Medicine and Medical Imaging Nursing
Research subject
Radiology
Identifiers
urn:nbn:se:umu:diva-153992 (URN)10.1016/j.ultrasmedbio.2018.09.023 (DOI)000454875400012 ()30401508 (PubMedID)2-s2.0-85055907154 (Scopus ID)
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-06-27Bibliographically approved
Rönningås, U., Fransson, P., Holm, M. & Wennman-Larsen, A. (2019). Prostate-specific antigen (PSA) and distress: a cross-sectional nationwide survey in men with prostate cancer in Sweden. BMC Urology, 19, Article ID 66.
Open this publication in new window or tab >>Prostate-specific antigen (PSA) and distress: a cross-sectional nationwide survey in men with prostate cancer in Sweden
2019 (English)In: BMC Urology, ISSN 1471-2490, E-ISSN 1471-2490, Vol. 19, article id 66Article in journal (Refereed) Published
Abstract [en]

Background: The prostate-specific antigen (PSA) -value is often used during the prostate cancer trajectory as a marker of progression or response to treatment. Concerns about PSA-values are often expressed by patients in clinical situations. Today there is a lack of larger studies that have investigated the association between PSA-value and distress. The aim was to investigate the association between PSA-values and distress adjusted for sociodemographic factors, hormonal therapy and quality of life (QoL), among men with prostate cancer.

Methods: In this cross-sectional survey of 3165 men with prostate cancer, members of the Swedish Prostate Cancer Federation, answered questions about sociodemographic factors, PSA, distress, QoL and treatments. Descriptive statistics, and bivariate and multivariable analyses were performed. The result was presented based on four PSA-value groups: 0–19, 20–99, 100–999, and ≥ 1000 ng/ml.

Results: Of the men, 53% experienced distress. An association between distress and PSA-values was found where higher PSA-values were associated with higher OR:s for experiencing distress in the different PSA-groups: 0–19 ng/ml (ref 1), 20–99 ng/ml (OR 1.25, 95% CI 1.01–1.55), 100–999 ng/ml (OR 1.47, 95% CI 1.12–1.94), ≥1000 ng/ml (OR 1.77, 95% CI 1.11–2.85). These associations were adjusted for sociodemographic factors and hormonal therapy. In the multivariable analyses, beside PSA-values, higher levels of distress were associated with being without partner or hormonal therapy. When adding QoL in the multivariable analysis, the association between PSA and distress did not remain significant.

Conclusion: These results indicate that the PSA-values are associated with distress, especially for those with higher values. However, to be able to support these men, continued research is needed to gain more knowledge about the mechanisms behind the association between emotional distress and PSA-values.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Prostate cancer, Prostatic neoplasm, PSA, Prostate-specific antigen, Distress, Quality of life
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-161909 (URN)10.1186/s12894-019-0493-1 (DOI)000475542200001 ()31299962 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Stranne, J., Axen, E., Franck-Lissbrant, I., Fransson, P., Frånlund, M., Hugosson, J., . . . Bratt, O. (2019). Single institution followed by national implementation of systematic surgical quality control and feedback for radical prostatectomy: a 20-year journey. World journal of urology
Open this publication in new window or tab >>Single institution followed by national implementation of systematic surgical quality control and feedback for radical prostatectomy: a 20-year journey
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2019 (English)In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The demand for objective and outcome-based facts about surgical results after radical prostatectomy (RP) is increasing. Systematic feedback is also essential for each surgeon to improve his/her performance.

Methods: RP outcome data (e.g., pT-stage and margin status) have been registered at Sahlgrenska University Hospital (SUH) since 1988 and patient-related outcome measures (PROM) have been registered since 2001. The National Prostate Cancer Registry (NPCR) has covered all Regions in Sweden since 1998 and includes PROM-data from 2008. Initially PROM was on-paper questionnaires but due since 2018 all PROMs are collected electronically. In 2014 an on-line “dashboard” panel was introduced, showing the results for ten quality-control variables in real-time. Since 2017 all RP data on hospital, regional, and national levels are publicly accessible on-line on “www.npcr.se/RATTEN”.

Results: The early PROM-data from SUH have been used for internal quality control. As national clinical and PROM-data from the NPCR have been made accessible on-line and in real-time we have incorporated this into our pre-existing protocol. Our data are now internally available as real-time NPCR reports on the individual surgeons’ results, as well as ePROM data. We can compare the results of each surgeon internally and to other departments’ aggregated data. The public can access data and compare hospital level data on “RATTEN”.

Conclusions: The process of quality control of RP locally at SUH, and nationally through the NPCR, has been long but fruitful. The online design, with direct real-time feedback to the institutions that report the data, is essential.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2019
Keywords
PROM, Prostate cancer, Quality control, Radical prostatectomy
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162732 (URN)10.1007/s00345-019-02887-4 (DOI)31388817 (PubMedID)2-s2.0-85070231510 (Scopus ID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30
Langegård, U., Johansson, B., Bjork-Eriksson, T., Fransson, P., Ohlsson-Nevo, E., Sjövall, K. & Ahlberg, K. (2019). Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy. Oncology Nursing Forum, 46(3), 349-363
Open this publication in new window or tab >>Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy
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2019 (English)In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 46, no 3, p. 349-363Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To explore symptom clusters during proton beam therapy in patients with primary brain tumors and investigate associations among symptom clusters, demographic variables, and comorbidity in this patient population.

SAMPLE & SETTING: Data were collected from 187 adult patients with primary brain tumors during their treatment periods in the Skandion Clinic in Uppsala, Sweden. Symptoms were assessed with the Radiotherapy-Related Symptoms Assessment Scale, and comorbidity was evaluated with the Self-Administered Comorbidity Questionnaire.

METHODS & VARIABLES: The study used a quantitative and longitudinal design. Exploratory factor analysis was used to determine the underlying structure of symptom clusters.

RESULTS: Three clusters were identified.

IMPLICATIONS FOR NURSING: Building knowledge about how these symptoms interact and are clustered will support healthcare professionals to more efficiently relieve symptom clusters during proton beam therapy.

Keywords
brain tumor, proton beam therapy, radiation therapy, symptom clusters
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158647 (URN)10.1188/19.ONF.349-363 (DOI)000465373100011 ()31007260 (PubMedID)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-06-27Bibliographically approved
Langegård, U., Ahlberg, K., Björk-Eriksson, T., Fransson, P., Johansson, B., Ohlsson-Nevo, E., . . . Sjövall, K. (2019). The art of living with symptoms: a qualitative study among patients with primary brain tumors receiving proton beam therapy. Cancer Nursing
Open this publication in new window or tab >>The art of living with symptoms: a qualitative study among patients with primary brain tumors receiving proton beam therapy
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2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Symptom management in conjunction with proton beam therapy (PBT) from patient's perspective has not been explored. Such knowledge is essential to optimize the care in this relatively new treatment modality.

Objective: The aim of this study was to explore the process of symptom management in patients with brain tumor receiving PBT.

Methods: Participants were 22 patients with primary brain tumor who received PBT, recruited in collaboration with a national center for proton therapy and 2 oncology clinics at 2 university hospitals in Sweden. Interviews using open-ended questions were conducted before, during, and/or after treatment. Verbatim interview transcripts were analyzed using classic Grounded Theory.

Results: The art of living with symptoms” emerged as the core concept. This encompassed 3 interconnected symptom management concepts: “Adapting to limited ability,” “Learning about oneself,” and “Creating new routines.” These concepts were summarized in a substantive theoretical model of symptom management. Despite the struggle to manage symptoms, participants lived a satisfactory life.

Conclusions: Symptom management in conjunction with PBT comprises a process of action, thoughts, and emotions. The concepts that emerged indicated patients' symptom management strategies were based on their own resources.

Implications for Practice: It is important that PBT facilities develop an approach that facilitates the symptom management process based on patients' experiences of symptoms, as well as their actions and available resources.

Place, publisher, year, edition, pages
Philadelphia: Lippincott Williams & Wilkins, 2019
Keywords
Symptom experience, Symptom management, Proton beam therapy, Brain tumor, Qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-156994 (URN)10.1097/NCC.0000000000000692 (DOI)30688666 (PubMedID)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-06-27
Widmark, A., Gunnlaugsson, A., Beckman, L., Thellenberg-Karlsson, C., Hoyer, M., Lagerlund, M., . . . Nilsson, P. (2019). Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. The Lancet, 394(10196), 385-395
Open this publication in new window or tab >>Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10196, p. 385-395Article in journal (Refereed) Published
Abstract [en]

Background: Hypofractionated radiotherapy for prostate cancer has gained increased attention due to its proposed high radiation-fraction sensitivity. Recent reports from studies comparing moderately hypofractionated and conventionally fractionated radiotherapy support the clinical use of moderate hypofractionation. To date, there are no published randomised studies on ultra-hypofractionated radiotherapy. Here, we report the outcomes of the Scandinavian HYPO-RT-PC phase 3 trial with the aim to show non-inferiority of ultra-hypofractionation compared with conventional fractionation.

Methods: In this open-label, randomised, phase 3 non-inferiority trial done in 12 centres in Sweden and Denmark, we recruited men up to 75 years of age with intermediate-to-high-risk prostate cancer and a WHO performance status between 0 and 2. Patients were randomly assigned to ultra-hypofractionation (42·7 Gy in seven fractions, 3 days per week for 2·5 weeks) or conventional fractionated radiotherapy (78·0 Gy in 39 fractions, 5 days per week for 8 weeks). No androgen deprivation therapy was allowed. The primary endpoint was time to biochemical or clinical failure, analysed in the per-protocol population. The prespecified non-inferiority margin was 4% at 5 years, corresponding to a critical hazard ratio (HR) limit of 1·338. Physician-recorded toxicity was measured according to the Radiation Therapy Oncology Group (RTOG) morbidity scale and patient-reported outcome measurements with the Prostate Cancer Symptom Scale (PCSS) questionnaire. This trial is registered with the ISRCTN registry, number ISRCTN45905321.

Findings: Between July 1, 2005, and Nov 4, 2015, 1200 patients were randomly assigned to conventional fractionation (n=602) or ultra-hypofractionation (n=598), of whom 1180 (591 conventional fractionation and 589 ultra-hypofractionation) constituted the per-protocol population. 1054 (89%) participants were intermediate risk and 126 (11%) were high risk. Median follow-up time was 5·0 years (IQR 3·1–7·0). The estimated failure-free survival at 5 years was 84% (95% CI 80–87) in both treatment groups, with an adjusted HR of 1·002 (95% CI 0·758–1·325; log-rank p=0·99). There was weak evidence of an increased frequency of acute physician-reported RTOG grade 2 or worse urinary toxicity in the ultra-hypofractionation group at end of radiotherapy (158 [28%] of 569 patients vs 132 [23%] of 578 patients; p=0·057). There were no significant differences in grade 2 or worse urinary or bowel late toxicity between the two treatment groups at any point after radiotherapy, except for an increase in urinary toxicity in the ultra-hypofractionation group compared to the conventional fractionation group at 1-year follow-up (32 [6%] of 528 patients vs 13 [2%] of 529 patients; (p=0·0037). We observed no differences between groups in frequencies at 5 years of RTOG grade 2 or worse urinary toxicity (11 [5%] of 243 patients for the ultra-hypofractionation group vs 12 [5%] of 249 for the conventional fractionation group; p=1·00) and bowel toxicity (three [1%] of 244 patients vs nine [4%] of 249 patients; p=0·14). Patient-reported outcomes revealed significantly higher levels of acute urinary and bowel symptoms in the ultra-hypofractionation group compared with the conventional fractionation group but no significant increases in late symptoms were found, except for increased urinary symptoms at 1-year follow-up, consistent with the physician-evaluated toxicity.

Interpretation: Ultra-hypofractionated radiotherapy is non-inferior to conventionally fractionated radiotherapy for intermediate-to-high risk prostate cancer regarding failure-free survival. Early side-effects are more pronounced with ultra-hypofractionation compared with conventional fractionation whereas late toxicity is similar in both treatment groups. The results support the use of ultra-hypofractionation for radiotherapy of prostate cancer.

Funding: The Nordic Cancer Union, the Swedish Cancer Society, and the Swedish Research Council.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162730 (URN)10.1016/S0140-6736(19)31131-6 (DOI)000478698300023 ()31227373 (PubMedID)2-s2.0-85069673767 (Scopus ID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30Bibliographically approved
diva2:1242518
Open this publication in new window or tab >>On patient related factors and their impact on ultrasound-based shear wave elastography of the liver
2018 (English)In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 44, no 8, p. 1606-1615Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to investigate patient-related factors associated with either reliable or poorly reliable measurement results of ultrasound-based shear wave elastography (SWE) of the liver. A total of 188 patients were analyzed prospectively with binary logistic regression using the interquartile range/median as cutoff to define two groups based on reliable and poorly reliable SWE results. SWE results correlated significantly with liver biopsy. Factors associated with reliable SWE results (i.e., no negative impact on measurements) were age, sex, cirrhosis, antiviral and/or cardiovascular medication, smoking habits and body mass index. Factors associated with poorly reliable SWE results were increased skin-to-liver capsule distance (odds ratio = 3.08, 95% confidence interval: 1.70-5.60) and steatosis (odds ratio =2.89, 95% confidence interval: 1.33-6.28). These findings indicate that the interquartile range/median as a quality parameter is useful in avoiding poorly reliable SWE results. How best to examine patients with increased skin-to-liver capsule distance is a matter of some controversy, as the incidences of obesity, diabetes and metabolic syndrome are increasing worldwide; however, our results indicate that reliable SWE results can be obtained in this group of patients by using ultrasound-based SWE. (Email: marie.byenfeldt@umu.se, Marie.byenfeldt@aleris.se ) 

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Shear wave elastography, Liver fibrosis, Skin-to-liver capsule distance, Interquartile range, Quality parameter, Reliability, Steatosis, Liver biopsy
National Category
Radiology, Nuclear Medicine and Medical Imaging Nursing
Identifiers
urn:nbn:se:umu:diva-150663 (URN)10.1016/j.ultrasmedbio.2018.03.031 (DOI)000436561500004 ()29735314 (PubMedID)2-s2.0-85046697393 (Scopus ID)
Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2019-06-27Bibliographically approved
Holm, M., Doveson, S., Lindqvist, O., Wennman-Larsen, A. & Fransson, P. (2018). Quality of life in men with metastatic prostate cancer in their final years before death: a retrospective analysis of prospective data. BMC Palliative Care, 17, Article ID 126.
Open this publication in new window or tab >>Quality of life in men with metastatic prostate cancer in their final years before death: a retrospective analysis of prospective data
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2018 (English)In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, article id 126Article in journal (Refereed) Published
Abstract [en]

Background: Quality of Life (QoL) is the most important outcome for patients in palliative care along with symptom alleviation. Metastatic prostate cancer (mPC) is a life-threatening illness, and hence, a palliative care approach may be beneficial to this group. Over time, new life-prolonging treatments have been developed for men with mPC, but the possibility to prolong life should also be balanced against the men’s QoL, particularly because there are side effects involved with these treatments. The aim of this study was to evaluate QoL, functioning and symptoms in men with mPC during their final years before death.

Methods: This is a retrospective analysis of data from a long-term prospective study of men (n = 3885) with prostate cancer from two regions in Sweden. Validated questionnaires asking about participants’ QoL, functioning and symptoms were used to collect data. From the overall study, 190 men with mPC were identified. They were stratified into three groups, depending on the amount of time that had passed between the last questionnaire and their death; < 6 months, 6–18 months and > 18 months before death.

Results: Men with mPC generally rated their QoL poorly compared to established clinically significant threshold values. The group of men that were < 6 months before death rated their QoL, functioning and several symptoms significantly worse than the two other groups. Men that died after the year 2006 reported lower QoL and functioning and more pain and fatigue than those who died before 2006.

Conclusion: The results in this study indicate that men with mPC have unmet needs with regards to QoL and symptoms. A palliative care approach, alongside possible life-prolonging treatments, that focuses on QoL and symptom relief, may serve as an important frame to give the best support to these men in their final years of life.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Prostate cancer, Metastatic disease, Palliative care, Quality of life, Life-prolonging treatment
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-154876 (URN)10.1186/s12904-018-0381-6 (DOI)000451986900001 ()30509249 (PubMedID)2-s2.0-85057615797 (Scopus ID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-06-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1248-5581

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