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  • 1. Benedetti, Franzisca Domeisen
    et al.
    Ostgathe, Christoph
    Clark, Jean
    Costantini, Massimo
    Daud, Maria Laura
    Grossenbacher-Gschwend, Barbara
    Latten, Richard
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Peternelj, Andreja
    Schuler, Stefanie
    Tal, Kali
    van der Heide, Agnes
    Eychmueller, Steffen
    International palliative care experts' view on phenomena indicating the last hours and days of life2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 6, p. 1509-1517Article in journal (Refereed)
    Abstract [en]

    Providing the highest quality care for dying patients should be a core clinical proficiency and an integral part of comprehensive management, as fundamental as diagnosis and treatment. The aim of this study was to provide expert consensus on phenomena for identification and prediction of the last hours or days of a patient's life. This study is part of the OPCARE9 project, funded by the European Commission's Seventh Framework Programme. The phenomena associated with approaching death were generated using Delphi technique. The Delphi process was set up in three cycles to collate a set of useful and relevant phenomena that identify and predict the last hours and days of life. Each cycle included: (1) development of the questionnaire, (2) distribution of the Delphi questionnaire and (3) review and synthesis of findings. The first Delphi cycle of 252 participants (health care professionals, volunteers, public) generated 194 different phenomena, perceptions and observations. In the second cycle, these phenomena were checked for their specific ability to diagnose the last hours/days of life. Fifty-eight phenomena achieved more than 80 % expert consensus and were grouped into nine categories. In the third cycle, these 58 phenomena were ranked by a group of palliative care experts (78 professionals, including physicians, nurses, psycho-social-spiritual support; response rate 72 %, see Table 1) in terms of clinical relevance to the prediction that a person will die within the next few hours/days. Twenty-one phenomena were determined to have "high relevance" by more than 50 % of the experts. Based on these findings, the changes in the following categories (each consisting of up to three phenomena) were considered highly relevant to clinicians in identifying and predicting a patient's last hours/days of life: "breathing", "general deterioration", "consciousness/cognition", "skin", "intake of fluid, food, others", "emotional state" and "non-observations/expressed opinions/other". Experts from different professional backgrounds identified a set of categories describing a structure within which clinical phenomena can be clinically assessed, in order to more accurately predict whether someone will die within the next days or hours. However, these phenomena need further specification for clinical use.

  • 2.
    Ehrsson, Ylva Tiblom
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Hellström, Per M
    Department of Medical Science, Uppsala University Hospital, 751 85 Uppsala, Sweden.
    Brismar, Kerstin
    Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Sharp, Lena
    Department of Oncology, Karolinska University Hospital, 118 83 Stockholm, Sweden.
    Langius-Eklöf, Ann
    School of Medical and Health Sciences, Örebro University, 701 82 Örebro, Sweden.
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Explorative study on the predictive value of systematic inflammatory and metabolic markers on weight loss in head and neck cancer patients undergoing radiotherapy2010In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 18, no 11, p. 1385-1391Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to explore the predictive value of systematic inflammatory and metabolic markers in head and neck (H&N) cancer patients during radiotherapy (RT).

    METHODS: Twenty-seven patients were evaluated. The protocol included serial blood tests [highly sensitive C-reactive protein (hsCRP), albumin, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1) and ghrelin], measurements of body weight and assessment of oral mucositis.

    RESULTS: The mean nadir of weight loss was observed at the end of RT. At the time of diagnosis, mean hsCRP was 5.2 ± 1.0 mg/L. HsCRP significantly increased during RT and decreased during the post-RT period. Mean maximum hsCRP was 35.8 ± 8.5 mg/L, with seven patients reaching >40 mg/L. A numerical decrease of albumin (by 18.2%) and only small changes in IGF-1, IGFBP-1 and ghrelin levels were observed. None of the metabolic parameters was significantly associated with weight loss.

    CONCLUSIONS: HsCRP increased in response to RT for H&N cancer as a sign of irradiation-induced inflammation. Weight loss was not preceded by changes of the metabolic parameters, indicating that assessment of the blood markers used in this study is of little value. Regular body weight measurement and assessment of oral mucositis are feasible, cheap and important procedures to control the metabolic homeostasis during RT.

  • 3. Ehrsson, Ylva Tiblom
    et al.
    Langius-Eklöf, Ann
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Nutritional surveillance and weight loss in head and neck cancer patients2012In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 4, p. 757-765Article in journal (Refereed)
    Abstract [en]

    This retrospective single-institution cohort study aims to evaluate if therapeutic approach, tumour site, tumour stage, BMI, gender, age and civil status predict body weight loss and to establish the association between weight loss on postoperative infections and mortality. Consecutive patients with head and neck cancer were seen for nutritional control at a nurse-led outpatient clinic and followed-up for 2 years after radiotherapy. Demographic, disease-specific and nutrition data were collected from case records. The primary outcome measure was maximum body weight loss during the whole study period. The nadir of body weight loss was observed 6 months after radiotherapy. In total, 92 patients of 157 (59%) with no evidence of residual tumour after treatment received enteral nutrition. The mean maximum weight loss for patients receiving enteral nutrition and per oral feeding was 13% and 6%, respectively (p < 0.001). Using multivariate analysis, tumour stage (p < 0.001) was the only independent factor of maximum weight loss. Weight loss was not significantly related to risk for postoperative infection. Weight loss is frequently noted among head and neck cancer patients during and after treatment. Weight loss was not found to be associated with postoperative infections and mortality. Nutritional surveillance is important in all patients, but special attention should be given to those on enteral nutrition and those with more advanced disease.

  • 4.
    Fransson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Tavelin, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Reliability and responsiveness of a prostate cancer questionnaire for radiotherapy-induced side effects2001In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 9, no 3, p. 187-198Article in journal (Refereed)
    Abstract [en]

    Few self-assessment cancer-specific questionnaires / modules have yet been developed for radiotherapy-induced side effects. The aim of the present study was to test the reliability and responsiveness of a prostate cancer (PC)specific questionnaire. Thirty-one patients with PC graded their urinary and intestinal symptoms and their sexual function on the questionnaire. A doctor and a nurse performed a structured interview and graded the patient's symptoms with the same questions. The procedure was performed at both the start and the end of the treatment. A high concordance regarding symptom detection was seen between the patient, nurse and the doctor. The inter-rater test shows intraclass correlation coefficient (ICC) values above 0.60 in all scales. The internal reliability exceeded the lower limit (Cronbach alpha > 0.70) for all scales. The test-retest gave acceptable reliability for all scales (ICC greater than or equal to 0.60). All scales indicated increased problems during radiotherapy. The questionnaire was proven to be valid for the evaluations of urinary and intestinal problems and for sexual function in PC patients.

  • 5. Hovan, Allan J
    et al.
    Williams, P Michele
    Stevenson-Moore, Peter
    Wahlin, Ylva Britt
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ohrn, Kirsten EO
    Elting, Linda S
    Spijkervet, Fred KL
    Brennan, Michael T
    A systematic review of dysgeusia induced by cancer therapies2010In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 18, no 8, p. 1081-1087Article in journal (Refereed)
    Abstract [en]

    Dysgeusia is a common oral side effect of cancer therapy (radiotherapy, chemotherapy, or combined modality therapy) and often impacts negatively on quality of life. From the current literature, there does not appear to be a predictable way of preventing or treating dysgeusia.

  • 6.
    Isaksson, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Wilms, Torben
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Laurell, Göran
    Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar, Uppsala universitet.
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tiblom Ehrsson, Ylva
    Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar, Uppsala universitet.
    Meaning of work and the process of returning after head and neck cancer2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 1, p. 205-213Article in journal (Refereed)
    Abstract [en]

    Purpose: The purposes of this study were (1) to investigate employment status at diagnosis, sick leave, and returning to work patterns in correlation to quality of life, anxiety, and depression in patients treated for head and neck cancer (HNC) and (2) to explore patients' experiences of the process of returning to work.

    Methods: Sixty-six patients with HNC (aged 34-66 years) were repeatedly interviewed over a period of 24 months. Interview responses that concerned the patients' experiences and ideas about work were categorised using the similarities-differences technique. Questionnaires on quality of life, anxiety, and depression were used to describe the patient characteristics and the differences between groups.

    Results: In total, 53 % of the patients had returned to work at 24 months after treatment, and 17 % were deceased. Several quality of life parameters were significantly worse for patients not working at 24 months after treatment. Nine categories were found to describe the return-to-work-process starting with symptoms causing sick leave, thoughts about the sick leave, and ending with the return to work and/or retirement.

    Conclusions: Returning to work is an important part of life because it structures everyday life and strengthens the individual's identity. The quality of life results showed significant differences between workers and non-workers at the 24 month follow-up. The patients need to be both physically and mentally prepared for the process of returning to work. It is important to take an individual rehabilitation approach to guide and support the patients in returning to work and regaining an important aspect of their everyday life. In such an approach, it is vital to understand the patients' overall life context and the patients' own perspective on the process and meaning associated with work.

  • 7.
    Lalos, A
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eisemann, M
    Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses.1999In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 7, no 2, p. 75-8Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to investigate possible relationships between quantitative and qualitative social support measures and mood in cervical (n = 30) and endometrial (n = 30) cancer patients and their spouses before and after treatment. Furthermore, the experience of locus of control was studied in light of mood and social support in women after treatment. The first interview with the patients was conducted on the day before the women started treatment, a second interview, 6 months later and a third one, 12-15 months after the initiation of treatment. The interviews with the spouses were conducted on the telephone before the initiation of their partners' treatment and 12-15 months later. Social support was assessed by the Interview Schedule for Social Interaction (ISSI), the Beck Depression Inventory (BDI) was used to measure the level of depressive symptomatology, and the locus of control orientation was assessed by the Locus of Control (LOC) scale. Women with cervical cancer reported BDI values that were significantly higher than in the endometrial group both before and after treatment. Women with cervical cancer also showed a significantly higher level on the BDI score on both occasions than did the corresponding group of spouses. The scores for ISSI were within normal limits in both groups of women. Furthermore, LOC was significantly correlated with adequacy of social interaction in women when controlled for social desirability, whereas LOC was unrelated to BDI. No significant correlations were found among the spouses concerning social network variables and dysphoric mood. The necessity of developing models for the psychological and behavioural risk assessment and for the elaboration of adequate treatment strategies is emphasized.

  • 8. Langegård, Ulrica
    et al.
    Ahlberg, Karin
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing. Cancercentrum, Norrlands University Hospital, Umeå, Sweden.
    Johansson, Birgitta
    Sjövall, Katarina
    Bjork-Eriksson, Thomas
    Ohlsson-Nevo, Emma
    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 therapy2019In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 27, no 7, p. 2679-2691Article in journal (Refereed)
    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.

  • 9.
    Lehuluante, Abraraw
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Are there specific health-related factors that can accentuate the risk of suicide among men with prostate cancer?2014In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 22, no 6, p. 1673-1678Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to explore if there were some specific factors pertinent to health-related quality of life (HRQoL) that could affect self-experienced suicide ideation in men with prostate cancer (PCa).

    METHODS: Questionnaires containing 45 items were distributed to members of the Swedish Prostate Cancer Federation in May 2012. Out of 6,400 distributed questionnaires, 3,165 members (50 %) with PCa completed the questionnaires. Those members expressed their experienced HRQoL and experienced suicide ideation using VAS-like scales as well as multiple-choice questions. Both descriptive and analytical statistical methods were employed. A regression model was used to explore the relationship between experienced health-related quality of life and experienced suicide ideation.

    RESULTS: Generally, the respondents rated their self-experienced health-related quality of life as good. About 40 % of the participants had experienced problem with incontinence, and 23 % had obstructions during miction. About 7 % of the respondents experienced suicidal ideation, at least sometime. The regression model showed statistically significant relationships between suicide ideation, on the one hand, and lower self-rated health-related quality of life (P < 0.001), physical pain (P = 0.04), pain during miction (P = 0.03), and low-rated mental / physical energy (P = 0.03), on the other.

    CONCLUSION: It is quite necessary to know which specific disease and treatment-related problems can trigger suicide ideations in men with prostate cancer and to try to direct treatment, care, and psychosocial resources to alleviate these problems in time.

  • 10. Omar, Mohammed Taher Ahmed
    et al.
    Shaheen, Afaf Ahmed Mohamed
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema2012In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 11, p. 2977-2984Article, review/survey (Refereed)
    Abstract [en]

    The purpose of this study was to review the effect of low-level laser therapy (LLLT) in the management of breast cancer-related lymphedema (BCRL). A systematic review of seven databases for clinical trials for LLLT in the management of BCRL published between 1990 and 2011 was performed. A total of eight studies on 230 patients were found. The methodological qualities of the selected studies were assessed with the Physiotherapy Evidence Database scale, and the studies were categorized according to Sackett's levels of evidence. Five studies were graded at evidence level II. Two studies were graded at evidence level III, and the remaining study was graded at evidence level V. There is moderate to strong evidence for the effectiveness of LLLT for the management of BCRL from five small studies of acceptable methodological quality. A dose of 1-2 J/cm(2) per point applied to several points covering the fibrotic area can reduce limb volume following BCRL. Further well-designed, large-scale studies are required to determine more precisely how effective LLLT may be in BCRL.

  • 11.
    Ottosson, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Lindblom, Ulrika
    Lunds universitet.
    Wahlberg, Peter
    Lunds universitet.
    Nilsson, Per
    Lunds universitet.
    Kjellén, Elisabeth
    Lunds universitet.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Laurell, Göran
    Uppsala universitet.
    Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up2014In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 22, no 9, p. 2361-2369Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

    METHODS: Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

    RESULTS: Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (-10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (-2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

    CONCLUSIONS: Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

  • 12.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Scientific rigour is far more than a matter of sample size2015In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 23, no 4, p. 901-902Article in journal (Refereed)
  • 13.
    Skolin, Inger
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Wahlin, Ylva Britt
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Broman, Daniel A
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Koivisto Hursti, Ulla-Kaisa
    Vikström Larsson, Marita
    Hernell, Olle
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Altered food intake and taste perception in children with cancer after start of chemotherapy: perspectives of children, parents and nurses.2006In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 14, no 4, p. 369-378Article in journal (Refereed)
    Abstract [en]

    GOALS OF WORK: The purpose of this study was to better understand various variables related to food intake and eating problems in children with cancer during their chemotherapy. PATIENTS AND METHODS: Twenty-two consecutively admitted children, diagnosed with cancer and undergoing chemotherapy, participated in this study. Twenty-one of them, their parents and attending nurses participated in semi-structured interviews. Ten of the children underwent a taste acuity test, and recognition thresholds for the four basic tastes were determined. MAIN RESULTS: The shared view of both children and parents was that altered taste was the predominant cause of the eating problems. In contrast, the nurses perceived that nausea was the most important cause of the children's eating problems. In addition, psychological aspects such as learned food aversions and negative attitudes towards hospital food were regarded as important by children, parents and nurses. The taste test showed that the patients had higher thresholds for bitter taste and made more taste recognition errors compared to controls. CONCLUSIONS: Changes seem to exist both in the primary gustatory sense as well as in food perception in paediatric cancer patients undergoing chemotherapy. Single solutions, such as efforts to serve "tasty food", do not suffice alone. A more effective solution may be to combine different strategies and combinations of oral, enteral and parenteral nutrition should be considered to prevent malnutrition.

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