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Tavelin, Björn
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Elmstedt, S., Mogensen, H., Hallmans, D.-E., Tavelin, B., Lundström, S. & Lindskog, M. (2019). Cancer patients hospitalised in the last week of life risk insufficient care quality: a population-based study from the Swedish Register of Palliative Care. Acta Oncologica, 58(4), 432-438
Open this publication in new window or tab >>Cancer patients hospitalised in the last week of life risk insufficient care quality: a population-based study from the Swedish Register of Palliative Care
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2019 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 58, no 4, p. 432-438Article in journal (Refereed) Published
Abstract [en]

Background: One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown.

Methods: This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N = 41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with specialised palliative home care as reference.

Results: Preferred place of death was unknown for 63% of hospitalised patients and consistent with the actual place of death in 25% compared to 97% in palliative home care. Hospitalised patients were less likely to be informed when death was imminent (OR: 0.3; CI: 0.28-0.33) as were their families (OR: 0.51; CI: 0.46-0.57). Validated screening tools were less often used in hospitals for assessment of pain (OR: 0.32; CI: 0.30-0.34) or other symptoms (OR: 0.31; CI: 0.28-0.34) despite similar levels of EOL symptoms. Prescriptions of as needed drugs against anxiety (OR: 0.27; CI: 0.24-0.30), nausea (OR: 0.19; CI: 0.17-0.21), or pulmonary secretions (OR: 0.29; CI: 0.26-0.32) were less prevalent in hospitals. Bereavement support was offered after 57% of hospital deaths compared to 87-97% in palliative care units and 72% in nursing homes.

Conclusions: Dying in hospital was associated with inferior end-of-life care quality among cancer patients in Sweden.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Cancer and Oncology Nursing
Identifiers
urn:nbn:se:umu:diva-158729 (URN)10.1080/0284186X.2018.1556802 (DOI)000463726300006 ()30633611 (PubMedID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
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
Widmark, A., Gunnlaugsson, A., Beckman, L., Thellenberg-Karlsson, C., Hoyer, M., Lagerlund, M., . . . Nilsson, P. (2018). Ultrahypofractionation for prostate cancer: Outcome from the Scandinavian phase 3 HYPO-RT-PC trial. Paper presented at 37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), APR 20-24, 2018, Barcelona, SPAIN. Radiotherapy and Oncology, 127, S314-S314
Open this publication in new window or tab >>Ultrahypofractionation for prostate cancer: Outcome from the Scandinavian phase 3 HYPO-RT-PC trial
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2018 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 127, p. S314-S314Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-150492 (URN)10.1016/S0167-8140(18)30909-5 (DOI)000437723401204 ()
Conference
37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), APR 20-24, 2018, Barcelona, SPAIN
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2018-11-01Bibliographically approved
Lupo, P., Luna-Gierke, R., Tavelin, B., Scheurer, M., Melin, B. & Papworth, K. (2017). Perinatal and Familial Risk Factors for Soft-Tissue Sarcomas in Children, Adolescents, and Young Adults: A Population-Based Birth Cohort Study, Sweden, 1973-2012. Paper presented at 49th Congress of the International Society of Paediatric Oncology (SIOP) Washington, DC, USA October 12–15, 2017. Pediatric Blood & Cancer, 64, S4-S5
Open this publication in new window or tab >>Perinatal and Familial Risk Factors for Soft-Tissue Sarcomas in Children, Adolescents, and Young Adults: A Population-Based Birth Cohort Study, Sweden, 1973-2012
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2017 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 64, p. S4-S5Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background/Objectives: Perinatal factors have been associated with soft-tissue sarcomas (STS) in case-control studies. However, (1) the specific contributions of factors including fetal growth remain unknown, (2) these factors have not been examined in large cohort studies, and (3) few assessments have evaluated risk in specific STS subtypes. Therefore, we sought to identify the role of perinatal and familial factors on the risk of STS in a large population-based birth cohort. Design/Methods: We identified 5,063,499 individuals in the Swedish Birth Registry born during 1973-2012. Subjects were linked to the Swedish Cancer Registry, where incident STS cases were identified. We evaluated perinatal and familial factors obtained from Statistics Sweden, including: fetal growth, gestational age, presence of a congenital anomaly, and parental age. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for associations between selected factors and STS overall, as well as by common subtypes. Results: There were 673 children, adolescents, and young adults diagnosed with STS in 77.5 million person-years of follow-up. Having a congenital anomaly was associated with STS risk (IRR=1.70, 95% CI: 1.23-2.35). This association was stronger (IRR=2.89, 95% CI: 1.25-6.70) in more recent years (2000-2012). High fetal growth was also associated with STS during the same time period (IRR=1.87, 95% CI: 1.06-3.30). Being born preterm (35 years) was inversely associated with the risk of developing synovial sarcoma (IRR=0.50, 95% CI: 0.26-0.94). Conclusions: In this cohort study, those with congenital anomalies and other adverse birth outcomes were more likely to develop a STS compared to their unaffected contemporaries. These associations may point to disrupted developmental pathways influencing the risk of STS. Our findings could implicate novel mechanisms underlying susceptibility to STS and may inform future surveillance, prevention, and treatment efforts.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Cancer and Oncology Pediatrics
Identifiers
urn:nbn:se:umu:diva-141796 (URN)000408978201004 ()
Conference
49th Congress of the International Society of Paediatric Oncology (SIOP) Washington, DC, USA October 12–15, 2017
Note

Supplement: 3

Meeting Abstract: AW-04

Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2018-06-09Bibliographically approved
Sjöström, O., Lindholm, L., Tavelin, B. & Melin, B. (2016). Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer. Familial Cancer, 15(4), 543-551
Open this publication in new window or tab >>Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer
2016 (English)In: Familial Cancer, ISSN 1389-9600, E-ISSN 1573-7292, Vol. 15, no 4, p. 543-551Article in journal (Refereed) Published
Abstract [en]

Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012–0.5299) and 0.11 (CI 95 % 0.0014–0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Colorectal cancer, Surveillance colonoscopy, Cancer prevention, Hereditary colorectal
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-126293 (URN)10.1007/s10689-016-9867-7 (DOI)000382681500007 ()26935832 (PubMedID)2-s2.0-84959568831 (Scopus ID)
Available from: 2016-11-08 Created: 2016-10-03 Last updated: 2019-05-09Bibliographically approved
Martinsson, L., Heedman, P.-A., Eriksson, M., Tavelin, B. & Axelsson, B. (2016). Increasing the number of patients receiving information about transition to end-of-life care: the effect of a half-day physician and nurse training. BMJ Supportive & Palliative Care, 6(4), 452-458
Open this publication in new window or tab >>Increasing the number of patients receiving information about transition to end-of-life care: the effect of a half-day physician and nurse training
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2016 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 6, no 4, p. 452-458Article in journal (Refereed) Published
Abstract [en]

Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life (ITEOL care).

Method: Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population and proportion of patients receiving ITEOL at baseline.

Results: The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a 6-month period before the intervention) to 42% (during a 6-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in a multivariable model adjusted for time, age, gender and cause of death.

Conclusion: More patients at end-of-life received ITEOL after an educative half-day intervention directed to physicians and nurses.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016
Keywords
Communication, Hospital care, Nursing Home care
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-101433 (URN)10.1136/bmjspcare-2014-000688 (DOI)000390589300008 ()25588878 (PubMedID)
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2018-06-07Bibliographically approved
Fritzson, A., Tavelin, B. & Axelsson, B. (2015). Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients. BMJ Supportive & Palliative Care, 5(2), 160-168
Open this publication in new window or tab >>Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients
2015 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 5, no 2, p. 160-168Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate whether dying patients receiving parenteral fluids (PF) suffer from more or less symptoms than patients who do not receive PF. Today's evidence on how PF affects palliative patients' symptoms is very scarce. Nevertheless, 40% of the patients who die expectedly in Swedish hospitals receive PF during their last 24 h of life.

METHODS: A historical cohort study of medical records was performed. Of the 530 patients who were reported to have died expectedly at hospital in Västerbotten county (Sweden) between 1 January 2011 and 30 June 2012, 140 cases who had received PF and 140 controls who had not received PF were identified by stratified randomisation and matched by age, sex and main disease. The groups were compared regarding documented presence of dyspnoea, respiratory secretions, anxiety, nausea and confusion during the last 24 h and the last week of life.

RESULTS: The prevalence of documented dyspnoea in the PF groups was higher than in the non-PF groups (51% vs 22% last 24 h, p<0.0001; 70% vs 45% last 7 days, p<0.001). The proportions of patients suffering from dyspnoea increased with larger administered volume. Although our main hypothesis--that the prevalence of respiratory secretions would be higher in the PF group--was not confirmed, we found a tendency in that direction (63% vs 50% last week, p=0.072). No clinically significant differences in anxiety, nausea or confusion were found.

CONCLUSIONS: There is an association between PF administration and increased frequency of documented dyspnoea for terminally ill patients in their last week of life.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-109657 (URN)10.1136/bmjspcare-2013-000501 (DOI)000360580700008 ()24644196 (PubMedID)
Available from: 2015-10-02 Created: 2015-10-02 Last updated: 2018-06-07Bibliographically approved
Svensk, A. C., Öster, I., Emilsson, S., Hedestig, O., Tavelin, B., Parfa, A. & Lindh, J. (2015). Conversational support group participation during radiotherapy period helps women with breast cancer and men with prostate cancer. European Journal of Cancer, 51, S232-S232
Open this publication in new window or tab >>Conversational support group participation during radiotherapy period helps women with breast cancer and men with prostate cancer
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2015 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, p. S232-S232Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-111017 (URN)000361887401078 ()
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2018-06-07Bibliographically approved
Nyström, H., Tavelin, B., Björklund, M., Naredi, P. & Sund, M. (2015). Improved tumour marker sensitivity in detecting colorectal liver metastases by combined type IV collagen and CEA measurement. Tumor Biology, 36(12), 9839-9847
Open this publication in new window or tab >>Improved tumour marker sensitivity in detecting colorectal liver metastases by combined type IV collagen and CEA measurement
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2015 (English)In: Tumor Biology, ISSN 1010-4283, E-ISSN 1423-0380, Vol. 36, no 12, p. 9839-9847Article in journal (Refereed) Published
Abstract [en]

Carcinoembryonic antigen (CEA) is the best circulating tumour marker for colorectal liver metastasis (CLM) but has suboptimal sensitivity and specificity. Circulating type IV collagen (COLIV) is a new potential CLM marker. Here, COLIV and CEA were measured in patients with resectable CLM. COLIV levels were also related to the type of CLM. The prognostic value of these markers and the type of CLM on survival was evaluated. Preoperative plasma samples (n = 94) from patients (n = 85) with CLM undergoing liver resection were used. Seven patients underwent repeated liver resection. Samples from 118 healthy individuals served as control. Samples after liver resection (n = 27) were analysed and related to recurrence. COLIV and CEA levels were analysed, and the type of CLM was classified using paraffinated tissue. Results were analysed by logistic regression and receiver operating characteristic (ROC) curve analysis. CLM patients had significantly elevated levels of COLIV compared to controls (p = 0.001). The sensitivity of COLIV was not better than CEA, but improved sensitivity for detecting CLM was observed with a combination of the two markers compared to using either marker alone (p = 0.001). Circulating COLIV was elevated in 81 % and CEA in 56 % of CLM patients at diagnosis, and high marker levels were related to poor survival. In follow-up samples (n = 27), patients with CLM recurrence (n = 14) had significantly elevated COLIV levels compared to patients without postoperative recurrence (n = 10) (p = 0.001). COLIV is a promising tumour marker for CLM and can possibly be used to detect postoperative CLM recurrence. The combination of COLIV and CEA is superior to either marker alone in detecting CLM.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Colorectal liver metastases, Circulating biomarkers, CEA, Type IV collagen, Extracellular matrix
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-114582 (URN)10.1007/s13277-015-3729-z (DOI)000367329300082 ()26162539 (PubMedID)
Available from: 2016-02-16 Created: 2016-01-25 Last updated: 2018-06-07Bibliographically approved
Lindskog, M., Tavelin, B. & Lundström, S. (2015). Old age as risk indicator for poor end-of-life care quality: a population-based study of cancer deaths from the Swedish Register of Palliative Care. European Journal of Cancer, 51(10), 1331-1339
Open this publication in new window or tab >>Old age as risk indicator for poor end-of-life care quality: a population-based study of cancer deaths from the Swedish Register of Palliative Care
2015 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, no 10, p. 1331-1339Article in journal (Refereed) Published
Abstract [en]

Background: If patient age affects the quality of end-of-life care in cancer is unknown. Using data from a population-based register of palliative care in Sweden, we addressed this question. Methods: This nation-wide study focused on the last week of life of adults dying from cancer in 2011-2012, based on data reported to a national quality register for end-of-life care (N = 26,976). We specifically investigated if age-dependent differences were present with respect to thirteen indicators of palliative care quality. Patients were categorised in one out of five pre-defined age groups. Odds ratios (OR) with 95% confidence intervals (CIs), adjusted for type of end-of-life care unit, were calculated using logistic regression, with the oldest group as reference. Findings: Age-dependent differences in implementation rate were detected for ten out of thirteen end-of-life care quality indicators, most of which were progressively less well met with each increment in age group. Compared to elderly cancer patients, young patients were more often informed about imminent death, (OR, 3.9; 95% CI 2.5-5.9, p < 0.001), were more often systematically assessed for the presence and severity of pain (OR, 1.6; 95% CI 1.2-2.1, p < 0.001) or other symptoms (OR, 1.4; 95% CI 1.0-1.9, p = 0.044), were more likely to be assessed by palliative care consultation services (OR, 4.3; 95% CI 3.3-5.7, p < 0.001) and to have injections prescribed as needed against pain (OR, 3.4; 95% CI 1.3-9.4, p = 0.016), anxiety (OR, 3.8; 95% CI 2.0-7.1, p < 0.001) or nausea (OR, 3.6; 95% CI 2.3-5.7, p < 0.001). The families of young patients were more likely to be informed about imminent death ( OR, 2.6; 95% CI 1.5-4.3, p = 0.001) and to be offered bereavement support ( OR, 4.6; 95% CI 2.7-7.8, p < 0.001). Interpretation: Old age is a risk indicator for poor end-of-life care quality among cancer patients in Sweden. Funding: The executive committee of the National Quality Registries in Sweden.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
palliative care, end-of-life, quality, cancer, age, old age
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-105240 (URN)10.1016/j.ejca.2015.04.001 (DOI)000355332000014 ()25958036 (PubMedID)
Available from: 2015-06-24 Created: 2015-06-22 Last updated: 2018-06-07Bibliographically approved
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