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  • 1.
    Drury, Amanda
    et al.
    School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
    Sulosaari, Virpi
    Turku University of Applied Sciences, Turku, Finland; University of Turku, Turku, Finland.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Center Stockholm- Gotland, Stockholm, Sweden.
    Ullgren, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, Stockholm, Sweden.
    de Munter, Johan
    Cancer Centre University Hospital Ghent, Ghent, Belgium.
    Oldenmenger, Wendy
    Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Netherlands.
    The future of cancer nursing in Europe: Addressing professional issues in education, research, policy and practice2023Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 63, artikel-id 102271Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Cancer nursing has evolved to meet the demands of rising cancer incidence, newer and more complex treatment options, and the emergence of specialist roles supporting patients from pre-diagnosis, through treatment, survivorship and end of life care. Nurses are involved in direct and in-direct care of people at risk of, and living with and after cancer in diverse contexts. As a result, nurses are positioned to have a significant influence on the processes and outcomes of cancer care, through education, research, policy, practice and leadership. However, nursing and cancer care face challenges, arising from workforce shortages, under-investment in services and under-representation in decision-making. This paper discusses the evolution of cancer nursing across education, policy, research, profession and practice, and sets an agenda for innovation and disruption across these domains to ensure sustainability of cancer care services and care for people living with and after cancer. We argue for the continued advancement of cancer nursing with critical focus on identifying and addressing inequities in role recognition and access to specialist cancer nursing education throughout Europe. Partnership, exchange of learning, and co-design will be central to progressing education, evidence and policy to support future growth in the cancer nursing workforce and embed cancer nurses in research and policy setting at local, national and international levels.

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  • 2.
    Karlsson Rosenblad, Andreas
    et al.
    Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden; Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Statistics, Uppsala University, Uppsala, Sweden.
    Westman, Bodil
    Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden; Department of Care Science, Sophiahemmet University, Stockholm, Sweden.
    Bergkvist, Karin
    Department of Care Science, Sophiahemmet University, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Segersvärd, Ralf
    Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden; Department of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Roos, Nathalie
    Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden; Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bergenmar, Mia
    Department of Care Science, Sophiahemmet University, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.
    Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden: a five-year cross-sectional study2024Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 33, s. 667-678Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors.

    Methods: The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal–Wallis test and linear regression.

    Results: The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items.

    Conclusion: HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.

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  • 3.
    Oliva, Delmy
    et al.
    Department of Oncology, Ryhov County Hospital, Jönköping, Sweden; delmy.oliva@rjl.se.
    Andersson, Bengt-Åke
    Department of Natural Science and Biomedicine, School of Welfare, Jönköping University, Sweden.
    Shamoun, Levar
    Department of Laboratory Medicine and Pathology, Region Jönköping County, Sweden.
    Lewin, Nongnit
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Nilsson, Mats P.
    Futurum, Academy of Health and Care, Region Jönköping County, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Schildt, Elsy-Britt
    Department of Oncology, Kalmar County Hospital, Kalmar, Sweden.
    Fust, Lisa
    Department of Oncology, Kalmar County Hospital, Kalmar, Sweden.
    Åsenlund, Ulrika
    Trial Unit, Department of Oncology, Gävle County Hospital, Gävle, Sweden.
    Sellerstam, Gunilla
    Trial Unit, Department of Oncology, Stockholm, Sweden.
    Elinder, Ellinor
    Trial Unit, Department of Oncology, Stockholm, Sweden.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.
    Lewin, Freddi
    Department of Natural Science and Biomedicine, School of Welfare, Jönköping University, Sweden; Department of Oncology, Ryhov County Hospital, Sweden.
    Single nucleotide polymorphism directed antiemetic treatment in women with breast cancer treated with neo- or adjuvant chemotherapy: a randomised multicentre phase II study. (EudraCT: 2015–000658-39)2023Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 43, nr 6, s. 2671-2681Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/aim: The role of single nucleotide polymorphisms (SNPs) in the frequency and intensity of chemotherapy-induced nausea and vomiting (CINV) in women with breast cancer (BC) is unclear. The primary purpose of this study was to compare/evaluate the effect of SNP-guided antiemetic treatment versus standard CINV treatment.

    Patients and methods: A randomised, factorial, phase II multicentre study design was used. Women planned for neoadjuvant or adjuvant chemotherapy with epirubicin, cyclophosphamide and fluorouracil (FEC /EC, with or without fluorouracil) for BC were randomised to SNP-guided antiemetic treatment (based on the results of SNP analyses) versus standard CINV treatment. Blood samples were taken before the treatment was initiated. Patient-reported data on CINV (during 10 days from onset of cancer treatment) and health-related quality of life (HRQoL), were collected before and after the first cancer treatment.

    Results: A total of 188 women were included. Overall, nausea was reported by 86% (n=129) of the patients during the ten-day period from the start of cancer treatment. The SNP genotype studied varied. In FAS-CD95, the genotypes AG and GG were overrepresented; in RB1-LPAR6, GG was overrepresented, and in CCL2, both AA and GG were overrepresented. We found no statistically significant difference in CINV between SNP-guided antiemetic treatment versus standard CINV treatment.

    Conclusion: SNP-guided antiemetic treatment could be as effective as standard treatment. SNP-guided antiemetic treatment of CINV is possibly useful in detecting patients with a higher or lower risk for CINV and thus may help in avoiding over-treatment with toxic components. CINV negatively affects the HRQL.Keywords: Breast cancer; chemotherapy-induced nausea and vomiting; single nucleotide polymorphism.

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  • 4.
    Scott Duncan, Therese
    et al.
    Karolinska Institutet, Stockholm, LIME, Sweden.
    Riggare, Sara
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Bylund, Ami
    Karolinska Institutet, Stockholm, LIME, Sweden; Sophiahemmet University, Stockholm, Sweden.
    Hägglund, Maria
    Karolinska Institutet, Stockholm, LIME, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Stenfors, Terese
    Karolinska Institutet, Stockholm, LIME, Sweden.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Centre Stockholm - Gotland, Stockholm Region, Sweden.
    Koch, Sabine
    Karolinska Institutet, Stockholm, LIME, Sweden.
    Empowered patients and informal care-givers as partners?: A survey study of healthcare professionals' perceptions2023Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikel-id 404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: More knowledge is needed regarding the perceptions of healthcare professionals when encountering empowered patients and informal caregivers in clinical settings. This study aimed to investigate healthcare professionals' attitudes towards and experiences of working with empowered patients and informal caregivers, and perception of workplace support in these situations. METHODS: A multi-centre web survey was conducted using a non-probability sampling of both primary and specialized healthcare professionals across Sweden. A total of 279 healthcare professionals completed the survey. Data was analysed using descriptive statistics and Thematic analysis. RESULTS: Most respondents perceived empowered patients and informal caregivers as positive and had to some extent experience of learning new knowledge and skills from them. However, few respondents stated that these experiences were regularly followed-up at their workplace. Potentially negative consequences such as increased inequality and additional workload were, however, mentioned. Patients' engagement in the development of clinical workplaces was seen as positive by the respondents, but few had own experience of such engagement and considered it difficult to be achieved. CONCLUSION: Overall positive attitudes of healthcare professionals are a fundamental prerequisite to the transition of the healthcare system recognizing empowered patients and informal caregivers as partners.

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  • 5.
    Sharp, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden.
    Dodlek, Nikolina
    Department for Oncology, University Hospital Center Osijek, Osijek, Croatia; Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; Nursing and Palliative Care, Faculty for Medicine and Dental Health, Osijek, Croatia.
    Willis, Diane
    School of Health & Social Care, Edinburgh Napier University, Edinburgh, United Kingdom.
    Leppänen, Arja
    Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden.
    Ullgren, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
    Cancer prevention literacy among different population subgroups: challenges and enabling factors for adopting and complying with cancer prevention recommendations2023Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, nr 10, artikel-id 5888Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.

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  • 6.
    Sharp, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Center, Stockholm-Gotland, Sweden; European Oncology Nursing Society (EONS), Advocacy Working Group, Belgium.
    Fransson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fowler, Matthew
    Department of Oncology, University Hospitals of Derby and Burton NHS Foundation Trust, United Kingdom; European Oncology Nursing Society (EONS), Advocacy Working Group, Belgium.
    Ullgren, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Center, Stockholm-Gotland, Sweden; Theme Cancer, ME Head and Neck, Lung and Skin Cancer, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Karolinska Institute, Department of Oncology-Pathology, Stockholm, Sweden; European Oncology Nursing Society (EONS), Advocacy Working Group, Belgium.
    Aspects of occupational safety: a survey among European cancer nurses2024Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 70, artikel-id 102595Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Nurses are particularly at risk for occupational exposure to hazardous cancer drugs, risking both acute and chronic health effects. Knowledge on the implemented safety precautions into minimizing these risks is limited.

    Methods: The European Cancer Nursing Index (ECNI) was developed by the European Oncology Nursing Society (EONS) to illustrate the development and status of this profession. In this study, anonymous online survey data on occupational safety reported by European cancer nurses as part of the ECNI 2022, was analysed.

    Results: A total of 630 cancer nurses from 29 countries responded to the survey. A majority reported that written guidelines (n = 553, 88%) on safe handling and administration of hazardous drugs, personal protection equipment (PPE) and cytotoxic spillage kits (n = 514, 82%) were available at their workplaces. 130 (21%) nurses reported that wipe testing to assess any residual hazardous drugs on workplace surfaces were conducted systematically at their workplaces. 185 (29%) nurses reported that nurses sometimes or always continued with their regular tasks (including handling hazardous cancer drugs) during pregnancy and breast feeding. 185 (29%) also responded that nurses at their workplaces did not receive an introductory education program before handling hazardous drugs. In total, 346 (55%) of the nurses reported that their workplace had a freedom to speak-up guardian or whistle blower policy for members of staff.

    Conclusions: Even if most nurses report that there are safety routines in place at their workplaces, the results reveal several serious occupational risks for European nurses handling hazardous cancer drugs. Actions are needed to improve and optimize occupational safety for nursing staff.

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  • 7.
    Ullgren, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, Stockholm, Sweden.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Center, Stockholm, Sweden.
    Fransson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bergkvist, Karin
    Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Exploring health care professionals’ perceptions regarding shared clinical decision-making in both acute and palliative cancer care2022Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 23, artikel-id 16134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home. Methods: Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Results: Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Conclusions: Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).

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  • 8.
    Wode, Kathrin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.
    Sharp, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.
    Fransson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hök Nordberg, Johanna
    Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.
    Communication about complementary and alternative medicine when patients decline  conventional cancer treatment: patients' and physicians' experiences2023Ingår i: The Oncologist, ISSN 1083-7159, E-ISSN 1549-490X, Vol. 28, nr 9, s. e774-e783Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients' and physicians' experiences from situations when patients decline recommended cancer treatment and consider using CAM.

    Materials and methods: Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used.

    Results: Regarding treatment choices, there was a dissonance between physicians' focus on medical reasoning and patients' expression of complex values. Physicians' difficulty in understanding patients' treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial.

    Conclusions: This study highlights the difficulty of shared decision-making in practice when patients' and physicians' views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients' values, and improve knowledge among physicians about CAM.

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