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Bagge RO, Mikiver R, Marchetti MA, Lo SN, van Akkooi ACJ, Coit DG, Ingvar C, Isaksson K, Scolyer RA, Thompson JF, Varey AHR, Wong SL, Lyth J, Bartlett EK. Population-Based Validation of the MIA and MSKCC Tools for Predicting Sentinel Lymph Node Status. JAMA Surg 2024; 159:260-268. [PMID: 38198163 PMCID: PMC10782377 DOI: 10.1001/jamasurg.2023.6904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/13/2023] [Indexed: 01/11/2024]
Abstract
Importance Patients with melanoma are selected for sentinel lymph node biopsy (SLNB) based on their risk of a positive SLN. To improve selection, the Memorial Sloan Kettering Cancer Center (MSKCC) and Melanoma Institute Australia (MIA) developed predictive models, but the utility of these models remains to be tested. Objective To determine the clinical utility of the MIA and MSKCC models. Design, Setting, and Participants This was a population-based comparative effectiveness research study including 10 089 consecutive patients with cutaneous melanoma undergoing SLNB from the Swedish Melanoma Registry from January 2007 to December 2021. Data were analyzed from May to August 2023. Main Outcomes and Measures, The predicted probability of SLN positivity was calculated using the MSKCC model and a limited MIA model (using mitotic rate as absent/present instead of count/mm2 and excluding the optional variable lymphovascular invasion) for each patient. The operating characteristics of the models were assessed and compared. The clinical utility of each model was assessed using decision curve analysis and compared with a strategy of performing SLNB on all patients. Results Among 10 089 included patients, the median (IQR) age was 64.0 (52.0-73.0) years, and 5340 (52.9%) were male. The median Breslow thickness was 1.8 mm, and 1802 patients (17.9%) had a positive SLN. Both models were well calibrated across the full range of predicted probabilities and had similar external area under the receiver operating characteristic curves (AUC; MSKCC: 70.8%; 95% CI, 69.5-72.1 and limited MIA: 69.7%; 95% CI, 68.4-71.1). At a risk threshold of 5%, decision curve analysis indicated no added net benefit for either model compared to performing SLNB for all patients. At risk thresholds of 10% or higher, both models added net benefit compared to SLNB for all patients. The greatest benefit was observed in patients with T2 melanomas using a threshold of 10%; in that setting, the use of the nomograms led to a net reduction of 8 avoidable SLNBs per 100 patients for the MSKCC nomogram and 7 per 100 patients for the limited MIA nomogram compared to a strategy of SLNB for all. Conclusions and Relevance This study confirmed the statistical performance of both the MSKCC and limited MIA models in a large, nationally representative data set. However, decision curve analysis demonstrated that using the models only improved selection for SLNB compared to biopsy in all patients when a risk threshold of at least 7% was used, with the greatest benefit seen for T2 melanomas at a threshold of 10%. Care should be taken when using these nomograms to guide selection for SLNB at the lowest thresholds.
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Affiliation(s)
- Roger Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rasmus Mikiver
- Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Serigne N. Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander C. J. van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel G. Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christian Ingvar
- Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - John F. Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander H. R. Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sandra L. Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Edmund K. Bartlett
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Lundgren M, Segernäs A, Nord M, Alwin J, Lyth J. Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study. BMC Geriatr 2024; 24:176. [PMID: 38378482 PMCID: PMC10877827 DOI: 10.1186/s12877-024-04771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A small proportion of the older population accounts for a high proportion of healthcare use. For effective use of limited healthcare resources, it is important to identify the group with greatest needs. The aim of this study was to explore frequency and reason for hospitalisation and cumulative mortality, in an older population at predicted high risk of hospital admission, and to assess if a prediction model can be used to identify individuals with the greatest healthcare needs. Furthermore, discharge diagnoses were explored to investigate if they can be used as basis for specific interventions in the high-risk group. METHODS All residents, 75 years or older, living in Östergötland, Sweden, on January 1st, 2017, were included. Healthcare data from 2016 was gathered and used by a validated prediction model to create risk scores for hospital admission. The population was then divided into groups by percentiles of risk. Using healthcare data from 2017-2018, two-year cumulative incidence of hospitalisation was analysed using Gray´s test. Cumulative mortality was analysed with the Kaplan-Meier method and primary discharge diagnoses were analysed with standardised residuals. RESULTS Forty thousand six hundred eighteen individuals were identified (mean age 82 years, 57.8% women). The cumulative incidence of hospitalisation increased with increasing risk of hospital admission (24% for percentiles < 60 to 66% for percentiles 95-100). The cumulative mortality also increased with increasing risk (7% for percentiles < 60 to 43% for percentiles 95-100). The most frequent primary discharge diagnoses for the population were heart diseases, respiratory infections, and hip injuries. The incidence was significantly higher for heart diseases and respiratory infections and significantly lower for hip injuries, for the population with the highest risk of hospital admission (percentiles 85-100). CONCLUSIONS Individuals 75 years or older, with high risk of hospital admission, were demonstrated to have considerable higher cumulative mortality as well as incidence of hospitalisation. The results support the use of the prediction model to direct resources towards individuals with highest risk scores, and thus, likely the greatest care needs. There were only small differences in discharge diagnoses between the risk groups, indicating that interventions to reduce hospitalisations should be personalised. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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Affiliation(s)
- Moa Lundgren
- Primary Health Care Centre Finspång, Finspång, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Segernäs
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Ekholmen, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Valla, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Holmberg CJ, Mikiver R, Isaksson K, Ingvar C, Moncrieff M, Nielsen K, Ny L, Lyth J, Olofsson Bagge R. ASO Visual Abstract: Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm). Ann Surg Oncol 2023; 30:8034-8035. [PMID: 37605085 DOI: 10.1245/s10434-023-14106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Carl-Jacob Holmberg
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Rasmus Mikiver
- Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karolin Isaksson
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund University Cancer Centre, Lund University, Lund, Sweden
| | - Christian Ingvar
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Kari Nielsen
- Lund University Cancer Centre, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Division of Dermatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
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Holmberg CJ, Mikiver R, Isaksson K, Ingvar C, Moncrieff M, Nielsen K, Ny L, Lyth J, Olofsson Bagge R. Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm). Ann Surg Oncol 2023; 30:8026-8033. [PMID: 37574516 PMCID: PMC10625939 DOI: 10.1245/s10434-023-14050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/12/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1-4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors. METHODS Data for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status. RESULTS The study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6-3.5) for stage T4a and 2.0 (95% CI 1.6-2.5) for satage T4b. CONCLUSION Sentinel lymph node status gives important prognostic information also for patients with thick (> 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.
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Affiliation(s)
- Carl-Jacob Holmberg
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Rasmus Mikiver
- Department of Clinical and Experimental Medicine, Regional Cancer Center Southeast Sweden, Linköping University, Linköping, Sweden
| | - Karolin Isaksson
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund University Cancer Centre, Lund University, Lund, Sweden
| | - Christian Ingvar
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Kari Nielsen
- Lund University Cancer Centre, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Division of Dermatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
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Vikström S, Mikiver R, Lapins J, Nielsen K, Vassilaki I, Lyth J, Isaksson K, Eriksson H. Increasing melanoma incidence and survival trend shifts with improved melanoma-specific survival between 1990 and 2020 in Sweden. Br J Dermatol 2023; 189:702-709. [PMID: 37463416 DOI: 10.1093/bjd/ljad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Melanoma-specific survival (MSS) is heterogenous between stages and is highly dependent on the T stage for primary localized disease. New systemic therapies for metastatic cutaneous melanoma (CM) have been introduced since 2012 in Sweden. OBJECTIVES To analyse the incidence and MSS time trends between 1990 and 2020 in Sweden. METHODS Nationwide, population-based and prospectively collected clinico-pathological data on invasive CM from the Swedish Melanoma Registry (SweMR) were analysed for survival trends between 1990 and 2020 using Kaplan-Meier curves and Cox proportional hazard ratios (HRs). RESULTS In total, 77 036 primary invasive CMs were diagnosed in 70 511 patients in Sweden between 1990 and 2020. The 5-year MSS [95% confidence interval (CI)] was 88.9% (88.3-89.4) for 1990-2000, 89.2% (88.7-89.6) for 2001-2010 and 93.0% (92.7-93.9) for 2011-2020. The odds ratios for being diagnosed with nodular melanoma (vs. superficial spreading melanoma) was significantly reduced by 20% (2001-2010) and by 46% (2011-2020) vs. the reference period 1990-2000. Overall, the MSS improved over both diagnostic periods (2001-2010 and 2011-2020) vs. the reference period 1990-2000 among men and women, respectively [HRmen: 2001-2010: 0.89 (95% CI 0.82-0.96) and 2011-2020: 0.62 (95% CI 0.56-0.67); HRwomen: 2001-2010: 0.82 (95% CI 0.74-0.91) and 2011-2020: 0.62 (95% CI 0.56-0.70)]. The risk of death from CM was significantly lower in all age groups for both men and women in the most recent diagnostic period (2011-2020 vs.1990-2000). CONCLUSIONS The results emphasize the improved MSS among men and women in Sweden. The MSS improvements, specifically for the period 2011-2020, may be correlated to the introduction of new systemic therapies and are here shown for the first time in detail for Sweden.
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Affiliation(s)
- Sofi Vikström
- Department of Oncology-Pathology
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rasmus Mikiver
- Department of Clinical and Experimental Medicine
- Regional Cancer Centre Southeast Sweden, Linköping, Sweden
| | - Jan Lapins
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology
| | - Kari Nielsen
- Dermatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ismini Vassilaki
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Lyth
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karolin Isaksson
- Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Hanna Eriksson
- Department of Oncology-Pathology
- Cancer Theme, Unit of Head-Neck-, Lung-, and Skin Cancer, Skin Cancer Centre, Karolinska University Hospital, Stockholm, Sweden
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Lyth J, Mikiver R, Nielsen K, Ingvar C, Olofsson Bagge R, Isaksson K. Population-based prognostic instrument (SweMR 2.0) for melanoma-specific survival - An ideal tool for individualised treatment decisions for Swedish patients. Eur J Surg Oncol 2023; 49:106974. [PMID: 37423872 DOI: 10.1016/j.ejso.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION The prognosis for patients with melanoma has improved due to better treatments in recent years and updated tools to accurately predict an individual's risk are warranted. This study aims to describe a prognostic instrument for patients with cutaneous melanoma and its potential as a clinical device for treatment decisions. METHODS Patients with localised invasive cutaneous melanoma diagnosed in 1990-2021 with data on tumour thickness were identified from the population-based Swedish Melanoma Registry. The parametric Royston-Parmar (RP) method was used to estimate melanoma-specific survival (MSS) probabilities. Separate models were constructed for patients (≤1 mm) and (>1 mm) and prognostic groups were created based on all combinations of age, sex, tumour site, tumour thickness, absence/presence of ulceration, histopathologic type, Clark's level of invasion, mitoses and sentinel lymph node (SLN) status. RESULTS In total, 72 616 patients were identified, 41 764 with melanoma ≤1 mm and 30 852 with melanoma >1 mm. The most important variable was tumour thickness for both (≤1 mm) and (>1 mm), that explained more than 50% of the survival. The second most important variables were mitoses (≤1 mm) and SLN status (>1 mm). The prognostic instrument successfully created probabilities for >30 000 prognostic groups. CONCLUSIONS The Swedish updated population-based prognostic instrument, predicts MSS survival up to 10 years after diagnosis. The prognostic instrument gives more representative and up-to-date prognostic information for Swedish patients with primary melanoma than the present AJCC staging. Additional to clinical use and the adjuvant setting, the information retrieved could be used to plan future studies.
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Affiliation(s)
- Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Rasmus Mikiver
- Regional Cancer Center Southeast Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kari Nielsen
- Department of Dermatology, Skåne University Hospital, Lund, Sweden; Dermatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Lund University Cancer Centre, Lund University, Lund, Sweden
| | - Christian Ingvar
- Lund University Cancer Centre, Lund University, Lund, Sweden; Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karolin Isaksson
- Lund University Cancer Centre, Lund University, Lund, Sweden; Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
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Johansen K, Lindhoff Larsson A, Lundgren L, Gasslander T, Hjalmarsson C, Sandström P, Lyth J, Henriksson M, Björnsson B. Laparoscopic distal pancreatectomy is more cost-effective than open resection: results from a Swedish randomized controlled trial. HPB (Oxford) 2023:S1365-182X(23)00138-7. [PMID: 37198071 DOI: 10.1016/j.hpb.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/21/2023] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy is being implemented worldwide. The aim of this study was to perform a cost-effectiveness analysis from a health care perspective. METHODS This cost-effectiveness analysis was based on the randomized controlled trial LAPOP, where 60 patients were randomized to open or laparoscopic distal pancreatectomy. For the follow-up of two years, resource use from a health care perspective was recorded, and health-related quality of life was assessed using the EQ-5D-5L. The per-patient mean cost and quality-adjusted life years (QALYs) were compared using nonparametric bootstrapping. RESULTS Fifty-six patients were included in the analysis. The mean health care costs were lower, €3863 (95% CI: -€8020 to €385), for the laparoscopic group. Postoperative quality of life improved with laparoscopic resection and resulted in a gain in QALYs of 0.08 (95% CI: -0.09 to 0.25). The laparoscopic group had lower costs and improved QALYs in 79% of bootstrap samples. With a cost-per-QALY threshold of €50 000, 95.4% of the bootstrap samples were in favour of laparoscopic resection. CONCLUSION Laparoscopic distal pancreatectomy is associated with numerically lower health care costs and improvements in QALYs compared with the open approach. The results support the ongoing transition from open to laparoscopic distal pancreatectomies.
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Affiliation(s)
- Karin Johansen
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna Lindhoff Larsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Lundgren
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thomas Gasslander
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Per Sandström
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Martin Henriksson
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Nord M, Lyth J, Marcusson J, Alwin J. Cost-Effectiveness of Comprehensive Geriatric Assessment Adapted to Primary Care. J Am Med Dir Assoc 2022; 23:2003-2009. [PMID: 35577011 DOI: 10.1016/j.jamda.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To estimate the cost-effectiveness of a pragmatic trial of comprehensive geriatric assessment adapted to primary care, compared with care as usual. DESIGN Within-trial cost-effectiveness study of a prospective controlled multicenter trial. SETTING AND PARTICIPANTS Nineteen primary care practices in Sweden. The original trial included 1304 individuals aged ≥75 years at high risk of hospitalization selected using a prediction model. From the original trial, 369 individuals participated in the cost-effectiveness analysis, 185 in the intervention group and 184 in the control group. Mean age was 83.9 years and 57% of the participants were men. METHODS We obtained health care costs from administrative registries. Community costs and health-related quality of life data were obtained from a questionnaire sent to participants. Health-related quality of life was measured using EQ-5D-3L and quality-adjusted life years were calculated. We analyzed all outcomes according to intention to treat, and adjusted them to age, gender, and risk score (risk of hospitalization in the next 12 months). The primary outcome was the incremental cost-effectiveness ratio associated with the intervention at follow-up after 24 months. RESULTS The difference in total cost (incremental cost) between intervention and control groups was USD -11,275 (95% CI -407 to -22,142). The incremental effect in quality-adjusted life years was -0.05 (95% CI -0.17 to 0.08). In the cost-effectiveness plane that illustrates the uncertainty of the analysis, 77.9 of the observations were within the south-east quadrant, implying lower cost and greater effect in the intervention group. CONCLUSIONS AND IMPLICATIONS The results suggests that a primary care comprehensive geriatric assessment intervention delivered to older adults at high risk of hospitalization is cost-effective at follow-up after 24 months. The use of a prediction model to select participants and an intervention with a low cost is promising but requires further study.
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Affiliation(s)
- Magnus Nord
- Primary Health Care Center Valla, Valla, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Marcusson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lyth J, Svennberg E, Bernfort L, Aronsson M, Frykman V, Al-Khalili F, Friberg L, Rosenqvist M, Engdahl J, Levin LÅ. Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study. Eur Heart J 2022; 44:196-204. [PMID: 36349968 PMCID: PMC9839418 DOI: 10.1093/eurheartj/ehac547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. METHODS AND RESULTS The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): -22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: -1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: -18.2 to 13.1) fewer bleedings associated with hospitalization. CONCLUSION Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation.
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Affiliation(s)
- Johan Lyth
- Corresponding authors. Tel: +46739584822, (E.S.); Tel: +46 13 28 29 84, (J.L.)
| | - Emma Svennberg
- Corresponding authors. Tel: +46739584822, (E.S.); Tel: +46 13 28 29 84, (J.L.)
| | - Lars Bernfort
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Mattias Aronsson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden,AstraZeneca Nordics, SE-18257 Södertälje, Sweden
| | - Viveka Frykman
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Faris Al-Khalili
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Mårten Rosenqvist
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Ennab Vogel N, Tatlisumak T, Wester P, Lyth J, Levin LÅ. Prediction modelling the impact of onset to treatment time on the modified Rankin Scale score at 90 days for patients with acute ischaemic stroke. BMJ Neurol Open 2022; 4:e000312. [PMID: 36072349 PMCID: PMC9386213 DOI: 10.1136/bmjno-2022-000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/20/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Shortening the time from stroke onset to treatment increases the effectiveness of endovascular stroke therapies. Aim This study aimed to predict the modified Rankin Scale score at 90 days post-stroke (mRS-90d score) in patients with acute ischaemic stroke (AIS) with respect to four types of treatment: conservative therapy (CVT), intravenous thrombolysis only (IVT), mechanical thrombectomy only (MT) and pretreatment with IVT before MT (IVT+MT). Patients and methods This nationwide observational study included 124 484 confirmed cases of acute stroke in Sweden over 6 years (2012–2017). The associations between onset-to-treatment time (OTT), patient age and hospital admission National Institutes of Health Stroke Scale (NIHSS) score with the five-levelled mRS-90d score were retrospectively studied. A generalised linear model (GLM) was fitted to predict the mRS-90d scores for each patient group. Results The fitted GLM for CVT patients is a function of age and NIHSS score. For IVT, MT and IVT+MT patients, GLMs additionally employed OTT variables. By reducing the mean OTTs by 15 min, the number needed-to-treat (NNT) for one patient to make a favourable one-step shift in the mRS was 30 for IVT, 48 for MT and 21 for IVT+MT. Discussion and conclusion This study demonstrates linear associations of mRS-90d score with OTT for IVT, MT and IVT+MT, and shows in absolute effects measures that OTT reductions for IVT and/or MT produces substantial health gains for patients with AIS. Even moderate OTT reductions led to sharp drops in the NNT.
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Affiliation(s)
- Nicklas Ennab Vogel
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Turgut Tatlisumak
- Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Göteborg, Sweden
| | - Per Wester
- Department of Public Health and Clinical Science, Umeå University, Umeå, Sweden
- Department of Clinical Science, Karolinska Institute Danderyds Hospital, Stockholm, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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11
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Nilsson A, Ibounig T, Lyth J, Alkner B, von Walden F, Fornander L, Rämö L, Schmidt A, Schilcher J. BioFACTS: biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome - protocol for a prospective multinational, multicentre study involving patients with tibial fractures. BMJ Open 2022; 12:e059918. [PMID: 35501102 PMCID: PMC9062790 DOI: 10.1136/bmjopen-2021-059918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The ischaemic pain of acute compartment syndrome (ACS) can be difficult to discriminate from the pain linked to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is based on clinical findings and performed at a low level of suspicion. Biomarkers of muscle cell damage may help to identify and monitor patients at risk, similar to current routines for patients with acute myocardial infarction. This study will test the hypothesis that biomarkers of muscle cell damage can predict ACS in patients with tibial fractures. METHODS AND ANALYSIS Patients aged 15-65 years who have suffered a tibial fracture will be included. Plasma (P)-myoglobin and P-creatine phosphokinase will be analysed at 6-hourly intervals after admission to the hospital (for 48 hours) and-if applicable-after surgical fixation or fasciotomy (for 24 hours). In addition, if ACS is suspected at any other point in time, blood samples will be collected at 6-hourly intervals. An independent expert panel will assess the study data and will classify those patients who had undergone fasciotomy into those with ACS and those without ACS. All primary comparisons will be performed between fracture patients with and without ACS. The area under the receiver operator characteristics curves will be used to identify the success of the biomarkers in discriminating between fracture patients who develop ACS and those who do not. Logistic regression analyses will be used to assess the discriminative abilities of the biomarkers to predict ACS corrected for prespecified covariates. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Boards in Linköping (2017/514-31) and Helsinki/Uusimaa (HUS/2500/2000). The BioFACTS study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology recommendations. TRIAL REGISTRATION NUMBER NCT04674592.
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Affiliation(s)
- Abraham Nilsson
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
| | - Thomas Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Johan Lyth
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Björn Alkner
- Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ferdinand von Walden
- Division of Pediatric Neurology, Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Fornander
- Department of Orthopaedics, Norrköping, Östergötland County and Department of Biomedical and Clinical Sciences in Norrköping, Linköping University, Linköping, Sweden
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Andrew Schmidt
- Department of Orthopaedics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Jörg Schilcher
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
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12
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Classon E, van den Hurk W, Lyth J, Johansson MM. Montreal Cognitive Assessment: Normative Data for Cognitively Healthy Swedish 80- to 94-Year-Olds. J Alzheimers Dis 2022; 87:1335-1344. [PMID: 35431248 PMCID: PMC9198733 DOI: 10.3233/jad-215629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The Montreal Cognitive Assessment (MoCA) is sensitive to cognitive impairment; however, it is also sensitive to demographic and socio-cultural factors. This necessitates reliable sub-population norms, but these are often lacking for older adults. Objective: To present demographically adjusted regression-based MoCA norms for cognitively healthy Swedish older adults. Methods: A pseudo-random sample of community-dwelling 80- to 94-year-olds, stratified by age and gender, was invited to the study. Initial telephone interviews and medical records searches (n = 218) were conducted to screen for cognitive impairment. N = 181 eligible participants were administered a protocol including the Swedish version of the MoCA and assessment of global cognition (Mini-Mental State Examination, MMSE) and depression (Patient Health Questionnaire-9, PHQ-9). Individuals scoring in the range of possible cognitive impairment on the MMSE or more than mild depression on the PHQ-9 were excluded (n = 23); three discontinued the test-session. Results: Norms were derived from the remaining n = 158. They were evenly distributed by gender, on average 85 years old, and with a mean education of 11 years. MoCA scores were independently influenced by age and education, together explaining 17.2% of the total variance. Higher age and lower education were associated with lower performance and 46% performed below the original cut-off (< 26/30). Conclusion: The negative impact of increasing age on MoCA performance continues linearly into the nineties in normal aging. Demographic factors should be considered when interpreting MoCA performance and a tool for computing demographically corrected standard scores is provided.
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Affiliation(s)
- Elisabet Classon
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Wobbie van den Hurk
- Mindmore AB, Stockholm, Sweden, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Maria M. Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
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13
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Eriksson H, Nielsen K, Vassilaki I, Lapins J, Mikiver R, Lyth J, Isaksson K. Trend Shifts in Age-Specific Incidence for In Situ and Invasive Cutaneous Melanoma in Sweden. Cancers (Basel) 2021; 13:2838. [PMID: 34200396 PMCID: PMC8201382 DOI: 10.3390/cancers13112838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The incidence of invasive cutaneous melanoma (CM) is increasing in Sweden. The aim was to present age- and sex-specific trends of the age-standardised incidence and the average annual percentage change (AAPC) for in situ and invasive CM. METHODS Joinpoint regression models were used to analyse data from the Swedish Cancer Register and the Swedish Melanoma Registry 1997-2018 (N = 35,350 in situ CM; 59,932 CM). RESULTS The AAPC of CM for women was 4.5 (4.1-5.0; p < 0.001) for the period 1997-2018. For men, the APCC was 4.2 (3.0-5.4; p < 0.001), with a significantly higher annual percentage change (APC) for the period 2000-2018 (5.0; 4.6-5.4; p < 0.001) compared to 1997-1999. An increasing annual incidence of CM ≤ 0.6 mm and 0.7 mm Breslow tumour thickness was found for men with a significant incidence shift for the period 2006-2015, respectively. Similarly for women, with a significantly higher APC for CM ≤ 0.6 mm from 2005. The incidence of intermediate thick CM (2.1-4.0 mm) has not increased since 2011. The incidence of CM > 4.0 mm has been increasing among both sexes, with a significantly lower APC among women from 2005. CONCLUSIONS The incidence of in situ and low-risk CM ≤ 1.0 mm in tumour thickness has been rising among both sexes since the 2000s.
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Affiliation(s)
- Hanna Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
- Cancer Theme, Department of Oncology, Skin Cancer Center, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Kari Nielsen
- Department of Clinical Sciences, Dermatology, Lund University, 221 84 Lund, Sweden;
- Department of Dermatology, Skane University Hospital, 221 85 Lund, Sweden
- Department of Dermatology, Helsingborg Hospital, 251 87 Helsingborg, Sweden
| | - Ismini Vassilaki
- Department of Pathology and Cytology, Karolinska University Laboratories, 171 76 Stockholm, Sweden;
| | - Jan Lapins
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, 171 76 Stockholm, Sweden;
- Department of Dermatology, Skin Cancer Center, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Rasmus Mikiver
- Regional Cancer Center South East Sweden, 581 85 Linköping, Sweden;
- Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden;
| | - Karolin Isaksson
- Department of Clinical Sciences, Surgery, Lund University, 221 84 Lund, Sweden
- Department of Surgery, Kristianstad Hospital, 291 33 Kristianstad, Sweden
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14
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Eriksson H, Utjés D, Olofsson Bagge R, Gillgren P, Isaksson K, Lapins J, Schultz IL, Lyth J, Andersson TML. The Proportion Cured of Patients with Resected Stage II-III Cutaneous Melanoma in Sweden. Cancers (Basel) 2021; 13:cancers13102456. [PMID: 34070092 PMCID: PMC8158378 DOI: 10.3390/cancers13102456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Simple summary Patients diagnosed with stage II–III cutaneous melanoma (CM) are at high risk of recurrences, but the CM-specific survival ranges from approximately 40–70%. Here, the cure proportions and survival among uncured stage II–III CM patients were estimated. The 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II–III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005–2013 with a follow-up through 2018. Proportions cured by surgery are low for sub-groups of stage II–III cutaneous melanoma showing that cure analyses can serve as a complement to established survival analyses. Abstract Background: Cure proportion represents the proportion of patients who experience the same mortality rate as the general population and can be estimated together with the survival of the proportion experiencing excess mortality (the uncured). The aim was to estimate the cure proportions and survival among uncured stage II–III cutaneous melanoma (CM) patients. Methods: 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II–III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005–2013 with a follow-up through 2018. Results: Stages IIB and IIC showed significant differences in standardized cure proportions vs. stage IIA CM (0.80 (95% CI 0.77–0.83) stage IIA; 0.62 (95% CI 0.59–0.66) stage IIB; 0.42 (95% CI 0.37–0.46) for stage IIC). Significant differences in standardized cure proportions were found for stages IIIB and IIIC-D CM vs. stage IIIA (0.76 (95% CI 0.68–0.84) stage IIIA; 0.52 (95% CI 0.45–0.59) stage IIIB; 0.35 (95% CI 0.30–0.39) for stage IIIC–D). Conclusions: The results are emphasizing the poor prognosis with low proportions cured by surgery only for sub-groups of stage II–III CM, specifically within stages IIB–C CM.
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Affiliation(s)
- Hanna Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, 17177 Stockholm, Sweden
- Cancer Theme, Medical Unit Head-Neck-, Lung- and Skin Cancer, Skin Cancer Center, Karolinska University Hospital, 17164 Stockholm, Sweden
- Correspondence:
| | - Deborah Utjés
- Children and Women’s Health Theme, Karolinska University Hospital, 17164 Stockholm, Sweden;
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden;
- Department of Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Peter Gillgren
- Department of Clinical Science and Education, Karolinska Institutet, 17177 Stockholm, Sweden;
- Department of Surgery, Södersjukhuset, 11883 Stockholm, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences, Surgery, Lund University, 22100 Lund, Sweden;
- Department of Surgery, Central Hospital Kristianstad, 29133 Kristianstad, Sweden
| | - Jan Lapins
- Department of Dermatology, Karolinska Institutet, 17177 Stockholm, Sweden;
- Department of Dermatology, Skin Cancer Center, Theme Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Inkeri Leonardsson Schultz
- Division of Reconstructive Plastic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden;
- Clinic of Reconstructive Plastic Surgery, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Therese M.-L. Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden;
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15
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Nord M, Lyth J, Alwin J, Marcusson J. Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation. BMC Geriatr 2021; 21:263. [PMID: 33882862 PMCID: PMC8059006 DOI: 10.1186/s12877-021-02166-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background The healthcare system needs effective strategies to identify the most vulnerable group of older patients, assess their needs and plan their care proactively. To evaluate the effectiveness of comprehensive geriatric assessment (CGA) of older adults with a high risk of hospitalisation we conducted a prospective, pragmatic, matched-control multicentre trial at 19 primary care practices in Sweden. Methods We identified 1604 individuals aged 75 years and older using a new, validated algorithm that calculates a risk score for hospitalisation from electronic medical records. After a nine-month run-in period for CGA in the intervention group, 74% of the available 646 participants had accepted and received CGA, and 662 participants remained in the control group. Participants at intervention practices were invited to CGA performed by a nurse together with a physician. The CGA was adapted to the primary care context. The participants thereafter received actions according to individual needs during a two-year follow-up period. Participants at control practices received care as usual. The primary outcome was hospital care days. Secondary outcomes were number of hospital care episodes, number of outpatient visits, health care costs and mortality. Outcomes were analysed according to intention to treat and adjusted for age, gender and risk score. We used generalised linear mixed models to compare the intervention group and control group regarding all outcomes. Results Mean age was 83.2 years, 51% of the 1308 participants were female. Relative risk reduction for hospital care days was − 22% (− 35% to − 4%, p = 0.02) during the two-year follow-up. Relative risk reduction for hospital care episodes was − 17% (− 30% to − 2%, p = 0.03). There were no significant differences in outpatient visits or mortality. Health care costs were significantly lower in the intervention group, adjusted mean difference was € − 4324 (€ − 7962 to − 686, p = 0.02). Conclusions and relevance Our findings indicate that CGA in primary care can reduce the need for hospital care days in a high-risk population of older adults. This could be of great importance in order to manage increasing prevalence of frailty and multimorbidity. Trial registration clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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Affiliation(s)
- Magnus Nord
- Primary Health Care Center Valla, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Marcusson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
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16
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Guorgis G, Anderson CD, Lyth J, Falk M. Actinic Keratosis Diagnosis and Increased Risk of Developing Skin Cancer: A 10-year Cohort Study of 17,651 Patients in Sweden. Acta Derm Venereol 2020; 100:adv00128. [PMID: 32314794 PMCID: PMC9128984 DOI: 10.2340/00015555-3486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/16/2022] Open
Abstract
Actinic keratosis is the most common actinic lesion in fair-skinned populations. It is accepted as an indicator of actinic skin damage and as an occasional precursor of squamous cell carcinoma. The aim of this study was to investigate, in a cohort of patients with a diagnosis of actinic keratosis, the relative risk of developing skin cancer during a follow-up period of 10 years. This registry-based cohort study compared a cohort of 2,893 individuals in south-eastern Sweden, who were diagnosed with actinic keratosis during the period 2000 to 2004, with a matched-control cohort of 14,668 individuals without actinic keratosis during the same inclusion period. The subjects were followed for 10 years to identify skin cancer development in both cohorts. Hazard ratios with 95% confidence intervals (95% CI) were used as risk measures. Individuals in the actinic keratosis cohort had a markedly higher risk for all skin cancer forms compared with the control cohort (hazard ratio (HR) 5.1, 95% CI 4.7-5.6). The relative risk was highest for developing squamous cell carcinoma (SCC) (HR 7.7, 95% CI 6.7-8.8) and somewhat lower for basal cell carcinoma (BCC) (HR 4.4, 95% CI 4.1-5.0) and malignant melanoma (MM) (HR 2.7 (2.1-3.6). Patients with a diagnosis of actinic keratosis were found to be at increased risk of developing SCC, BCC and MM in the 10 years following diagnosis of actinic keratosis. In conclusion, a diagnosis of actinic keratosis, even in the absence of documentation of other features of chronic sun exposure, is a marker of increased risk of skin cancer, which should be addressed with individually directed preventive advice.
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Affiliation(s)
- Ghassan Guorgis
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
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17
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Isaksson K, Mikiver R, Eriksson H, Lapins J, Nielsen K, Ingvar C, Lyth J. Survival in 31 670 patients with thin melanomas: a Swedish population-based study. Br J Dermatol 2020; 184:60-67. [PMID: 32133615 DOI: 10.1111/bjd.19015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma (CMM) continues to increase in most countries worldwide and the majority are diagnosed with thin tumours (≤ 1 mm). OBJECTIVES The aim of the present study was to investigate the melanoma-specific survival (MSS) as well as conditional MSS (CMSS) in patients with thin CMM in Sweden. PATIENTS AND METHODS Clinical and histological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with thin CMM between 1990 and 2017. Patients were followed until the end of 2017. MSS as well as CMSS for different thickness groups were calculated using the Kaplan-Meier method and Cox regression analyses were used to calculate for survival differences between thickness groups. RESULTS There were 31 670 patients included for final analyses. The overall 10- and 20-year MSS for thin CMMs was 97% [95% confidence interval (CI) 97-97] and 95% (95% CI 95-96), respectively. From 0·7 mm and above, MSS decreased significantly with increasing thickness level. All thickness groups had an increased survival over time. The lowest CMSS was confirmed for men with 1·0 mm in thickness but their 10-year CMSS increased steadily over time. Women had overall better MSS as well as CMSS than men. However, the relation between MSS and CMSS was similar for both sexes. CONCLUSIONS MSS was confirmed as excellent for patients with thin CMMs in Sweden. Although we could show a decreased MSS for patients with 0·7 mm thickness and above, the long-term survival and, in addition, a very favourable CMSS for those patients do not support more extended follow-up programmes than the current recommendations in Sweden.
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Affiliation(s)
- K Isaksson
- Surgery, Lund University, Lund, Sweden.,Surgery, Skåne University Hospital, Lund, Sweden.,Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - R Mikiver
- Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Regional Cancer Center South East, Region Östergötland, Linköping, Sweden
| | - H Eriksson
- Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - J Lapins
- Departments of Dermatology, Karolinska Institutet, Stockholm, Sweden.,Departments of Dermatology, Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - K Nielsen
- Dermatology, Lund University, Lund, Sweden.,Departments of Dermatology, Skåne University Hospital, Lund, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - C Ingvar
- Surgery, Lund University, Lund, Sweden.,Surgery, Skåne University Hospital, Lund, Sweden
| | - J Lyth
- Departments of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Research and Development Unit, Region Östergötland, Linköping, Sweden
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Persson HL, Lyth J, Lind L. The Health Diary Telemonitoring and Hospital-Based Home Care Improve Quality of Life Among Elderly Multimorbid COPD and Chronic Heart Failure Subjects. Int J Chron Obstruct Pulmon Dis 2020; 15:527-541. [PMID: 32210547 PMCID: PMC7069558 DOI: 10.2147/copd.s236192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/24/2020] [Indexed: 12/28/2022] Open
Abstract
Background Elderly, multimorbid patients with advanced chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) exhibit poor health-related quality of life (HRQoL). Telemonitoring, based on digital pen technology, supported by hospital-based home care (HBHC) significantly reduces the number of hospitalizations. We hypothesized that the same intervention would prevent the deterioration of HRQoL that follows upon disease progression. Methods Elderly computer-illiterate subjects with ≥2 hospitalizations the previous year were included. HRQoL was assessed at inclusion (baseline) and at 1, 6 and 12 months employing EuroQol-5 Dimensions (EQ-5D) and RAND-36 for general HRQoL, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) and St. Georges Respiratory Questionnaire (SGRQ) for disease-specific HRQoL. Healthcare contacts, hospitalizations, as-needed medications, prescription changes and healthcare costs were registered. Results Ninety-four patients were enrolled of which 53 subjects completed the 12-month study period. Compared to baseline, most domains of RAND-36 were improved significantly at 1 time-point or more. Only among COPD subjects, the disease-specific HRQoL was worsened at the 12 month evaluation. Measures of healthcare dependency were associated with poor HRQoL. Conclusion The Health Diary system and HBHC together improve general HRQoL, and measures of healthcare dependency are associated with HRQoL variables.
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Affiliation(s)
- Hans Lennart Persson
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping SE-581 85, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, Linköping University, Linköping SE-581 85, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Linköping SE-581 85, Sweden.,Digital Systems Division, Department of Industrial Systems, RISE Research Institutes of Sweden, Linköping University, Linköping, S-581 83, Sweden
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19
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Abstract
Background The healthcare for older adults is insufficient in many countries, not designed to meet their needs and is often described as disorganized and reactive. Prediction of older persons at risk of admission to hospital may be one important way for the future healthcare system to act proactively when meeting increasing needs for care. Therefore, we wanted to develop and test a clinically useful model for predicting hospital admissions of older persons based on routine healthcare data. Methods We used the healthcare data on 40,728 persons, 75–109 years of age to predict hospital in-ward care in a prospective cohort. Multivariable logistic regression was used to identify significant factors predictive of unplanned hospital admission. Model fitting was accomplished using forward selection. The accuracy of the prediction model was expressed as area under the receiver operating characteristic (ROC) curve, AUC. Results The prediction model consisting of 38 variables exhibited a good discriminative accuracy for unplanned hospital admissions over the following 12 months (AUC 0.69 [95% confidence interval, CI 0.68–0.70]) and was validated on external datasets. Clinically relevant proportions of predicted cases of 40 or 45% resulted in sensitivities of 62 and 66%, respectively. The corresponding positive predicted values (PPV) was 31 and 29%, respectively. Conclusion A prediction model based on routine administrative healthcare data from older persons can be used to find patients at risk of admission to hospital. Identifying the risk population can enable proactive intervention for older patients with as-yet unknown needs for healthcare.
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Affiliation(s)
- Jan Marcusson
- Acute Internal Medicine and Geriatrics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Magnus Nord
- Family Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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20
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Tillander B, Gauffin H, Lyth J, Knutsson A, Timpka T. Symptomatic Achilles Tendons are Thicker than Asymptomatic Tendons on Ultrasound Examination in Recreational Long-Distance Runners. Sports (Basel) 2019; 7:sports7120245. [PMID: 31817429 PMCID: PMC6955697 DOI: 10.3390/sports7120245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 12/03/2022] Open
Abstract
There is a need for clinical indicators that can be used to guide the treatment of Achilles tendon complaints in recreational runners. Diagnostic ultrasound has recently been introduced for clinical decision support in tendon pain management. The aim of this study was to determine whether tendon thickness and morphological changes in the Achilles tendon detected in ultrasound examinations are associated with local symptoms in middle-age recreational long-distance runners. Forty-two Achilles tendons (21 middle-aged runners) were investigated by ultrasound examination measuring tendon thickness and a morphology score indicating tendinosis. The Generalized Estimating Equations method was applied in multiple models of factors associated with reporting a symptomatic tendon. Eleven symptomatic and 31 asymptomatic Achilles tendons were recorded. In the multiple model that used tendon thickness measured 30 mm proximal to the distal insertion, an association was found between thickness and reporting a symptomatic tendon (p < 0.001; OR 12.9; 95% CI 3.1 to 53.2). A qualitative morphology score was not found to be significantly associated with reporting a symptomatic tendon (p = 0.10). We conclude that symptomatic Achilles tendons were thicker than asymptomatic tendons on ultrasound examination among recreational long-distance runners and that the importance of parallel morphological findings need to be further investigated in prospective studies.
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Affiliation(s)
- Bo Tillander
- Athletics Research Center, Linköping University, SE-581 83 Linköping, Sweden; (H.G.); (T.T.)
- Department of Orthopaedics, Linköping University, SE-581 83 Linköping, Sweden
- Correspondence:
| | - Håkan Gauffin
- Athletics Research Center, Linköping University, SE-581 83 Linköping, Sweden; (H.G.); (T.T.)
- Department of Orthopaedics, Linköping University, SE-581 83 Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, SE-581 85 Linköping, Sweden;
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anders Knutsson
- Department of Radiology, Linköping University, SE-581 83 Linköping, Sweden;
| | - Toomas Timpka
- Athletics Research Center, Linköping University, SE-581 83 Linköping, Sweden; (H.G.); (T.T.)
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
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21
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Persson HL, Lyth J, Wiréhn AB, Lind L. Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting. Int J Chron Obstruct Pulmon Dis 2019; 14:1569-1581. [PMID: 31406459 PMCID: PMC6642647 DOI: 10.2147/copd.s207621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022] Open
Abstract
Background Elderly patients with advanced stages of COPD or chronic heart failure (CHF) often require hospitalization due to exacerbations. We hypothesized that telemonitoring supported by hospital-based home care (HBHC) would detect exacerbations early, thus, reducing the number of hospitalization. We also speculated that patients with advanced COPD or CHF would present differences regarding exacerbation frequency and the need of HBHC. Methods The Health Diary system, based on digital pen technology, was employed. Patients aged ≥65 years with ≥2 hospitalizations the previous year were included. Exacerbations were categorized and treated as either COPD or CHF exacerbation by an experienced physician. All HBHC contacts (home visits or telephone consultations) were registered. Results Ninety-four patients with advanced diseases were enrolled (36 COPD and 58 CHF subjects) of which 53 subjects (19 COPD and 34 CHF subjects) completed the 1-year study period. Death was the major reason for not finalizing the study. Compared to the 1-year prior inclusion, the intervention significantly reduced hospitalization. Although COPD subjects were younger with less comorbidity, exacerbations and HBHC contacts were significantly greater in this group. Conclusions COPD subjects exhibit exacerbations more frequently, mainly due to disease characteristics, thus, demanding much more HBHC.
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Affiliation(s)
- Hans Lennart Persson
- Respiratory Medicine, Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ann-Britt Wiréhn
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Linköping, Sweden.,Rise Research Institutes of Sweden Ab/Division Ict Sics East, Linköping University, Linköping, Sweden
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22
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Abstract
INTRODUCTION Growing populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) require more healthcare. A four-year telehealth intervention - the Health Diary system based on digital pen technology - was implemented. We hypothesized that study patients with advanced COPD or HF would have lower rates of hospitalization when using the Health Diary. The aim was to investigate the effects of the intervention on healthcare costs and the number of hospitalizations, as well as other care required in COPD and HF patients. METHODS Patients were introduced to the telemonitoring system which was supervised by a specialized hospital-based home care (HBHC) unit. Staff associated with this unit were responsible for the healthcare provided. The study included patients with COPD or HF, aged ≥ 65 years who were frequently hospitalized due to exacerbations - at least two inpatient episodes within the last 12 months. Observed number of hospitalizations and total healthcare costs were compared with the expected values, which were calculated using the generalized estimating equations (GEE) method. RESULTS A total of 36 COPD and 58 HF patients with advanced stages of disease were included. The number of hospitalizations was significantly reduced for both HF and COPD patients participating in telemonitoring. Accordingly, hospitalization costs were significantly reduced for both groups, but the total healthcare cost was not significantly different from the expected costs. CONCLUSION A telemonitoring system, the Health Diary, combined with a specialized HBHC unit significantly decreases the need for hospital care in elderly patients with advanced HF or COPD without increasing total healthcare costs.
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Affiliation(s)
- Johan Lyth
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Sweden.,RISE Research Institutes of Sweden AB / Division ICT SICS East, c/o Linköping University, Linköping, Sweden
| | - Hans L Persson
- Department of Respiratory Medicine, Department of Medical and Health Sciences, Linköping University, Sweden
| | - Ann-Britt Wiréhn
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Sweden
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23
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Marcusson J, Nord M, Johansson MM, Alwin J, Levin LÅ, Dannapfel P, Thomas K, Poksinska B, Sverker A, Olaison A, Cedersund E, Kelfve S, Motel-Klingebiel A, Hellström I, Kullberg A, Böttiger Y, Dong HJ, Peolsson A, Wass M, Lyth J, Andersson A. Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden. BMJ Open 2019; 9:e027847. [PMID: 31122995 PMCID: PMC6538001 DOI: 10.1136/bmjopen-2018-027847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER NCT03180606.
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Affiliation(s)
- Jan Marcusson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Nord
- Family Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria M Johansson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Petra Dannapfel
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Susanne Kelfve
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | | | - Ingrid Hellström
- Department of Social and Welfare Studies, Faculty of Health Sciences, Norrköping University, Norrköping, Sweden
| | - Agneta Kullberg
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ylva Böttiger
- Clinical Pharmacology, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Physiotherapy, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Wass
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Agneta Andersson
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
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Malmqvist M, Tropp H, Lyth J, Wiréhn AB, Castelein RM. Patients With Idiopathic Scoliosis Run an Increased Risk of Schizophrenia. Spine Deform 2019; 7:262-266. [PMID: 30660220 DOI: 10.1016/j.jspd.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To investigate a possible linkage between idiopathic scoliosis (IS) and schizophrenia in an adolescent population. SUMMARY OF BACKGROUND DATA There is an interesting link between schizophrenia and idiopathic scoliosis: schizophrenia is a disturbance of mental equilibrium, and scoliosis of physical equilibrium, both are multifactorial, genetically determined, start at a young age, and brain development is thought to play a role. Furthermore, both may be presenting symptoms of the genetic disorder 22q11 deletion syndrome. This study poses the question whether these two poorly understood disorders are related. METHODS A retrospective cohort study was conducted and consisted of 3,702 Swedish adolescents, collected from the National Patient Register, that underwent inpatient care for IS during 1997-2015. These were matched by age, sex, and date of diagnosis to 370,200 controls, collected from Swedish population data, and then followed up in the National Patient Register to identify in- and outpatient care for schizophrenia diagnosis. Follow-up time was calculated from first IS diagnosis date until date of schizophrenia diagnosis or end of follow-up. Cox proportional regression analysis was performed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for being diagnosed with schizophrenia. RESULTS Over a median follow-up time of 9.5 years, 0.7% of patients with IS developed schizophrenia versus 0.5% of controls (p = .04). The risk of schizophrenia was significantly higher in patients with IS (HR, 1.52; 95% CI, 1.03-2.23). Using only hospitalized schizophrenia as event, the prevalence for schizophrenia was 0.5% versus 0.3% (p ≤.01; HR, 1.83; 95% CI, 1.17-2.84). CONCLUSION This study suggests that patients with IS have increased risk of schizophrenia. Dissatisfaction with one's physical appearance might lead to psychological distress and provoke mental illness in predisposed persons. Alternatively, these two disorders may share a common genetic background. LEVEL OF EVIDENCE Level 2B.
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Affiliation(s)
- Marcus Malmqvist
- Department of Spinal Surgery, Linköping University, 581 83 Linköping, Sweden.
| | - Hans Tropp
- Department of Spinal Surgery, Linköping University, 581 83 Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Ann-Britt Wiréhn
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Rene Marten Castelein
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Abstract
Conditional survival in patients with localized primary cutaneous malignant melanoma (CMM) is well described. However, conditional recurrence-free survival (RFS) has not been investigated before. The aim of this study was to determine conditional RFS and test for time dependency in prognostic factors in patients with localized stage I-II CMM. This study included 1437 CMM patients registered in one region of Sweden during 1999-2012 followed up through 31 December 2012. To identify first recurrence of CMM disease, data from a care data warehouse, the pathology and radiology department registries were used. Patients were also followed through a Census Register and the National Cause of Death Register. The time-dependent risk of recurrence was analysed in a Cox's proportional hazard regression. The 5-year conditional RFS increased from 86% (95% confidence interval: 84-88) at diagnosis to 96% (95% confidence interval: 94-98) at 5 years after diagnosis. Women showed a 60% lower risk of recurrence than men and this effect was stable over time (P=0.39). Patients aged greater than or equal to 65 years had a 40% higher risk of recurrence than patients aged less than 65 years, and this effect was stable over time (P=0.65). Patients with tumour ulceration showed a 70% higher risk of recurrence than nonulcerated patients, but this effect disappeared after 2 years (P=0.04). For patients with T3-T4 CMM, the hazard ratios decreased over time and were similar to hazard ratio of patients with T2 CMM after 2 years and later. The decreasing impact of tumour thickness and ulceration over time could have important implications for CMM patients in terms of counselling and follow-up.
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Affiliation(s)
- Johan Lyth
- Research and Development Unit in Region Östergötland, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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26
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Utjés D, Lyth J, Lapins J, Eriksson H. Reduced disease-specific survival following a diagnosis of multiple primary cutaneous malignant melanomas-a nationwide, population-based study. Int J Cancer 2017; 141:2243-2252. [PMID: 28799271 DOI: 10.1002/ijc.30925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/04/2017] [Indexed: 11/09/2022]
Abstract
Outcome data comparing patients with multiple primary invasive cutaneous malignant melanomas (MPMs) to single primary invasive cutaneous malignant melanomas (SPMs) show conflicting results. We have analyzed differences in disease-specific survival between these patients in a nationwide population-based setting. From the Swedish Melanoma Register, 27,235 patients were identified with a first invasive cutaneous malignant melanoma (CMM) between 1990 and 2007, followed-up through 2013. Of these, 700 patients developed MPMs. Cox proportional hazard regression was used for adjusted cause-specific hazard ratios (HRs). An interval of ≤5 years between CMM diagnoses was significantly correlated to a decreased CMM-specific survival in Stage I-II MPM- vs. SPM-patients (HR 1.32; 95% CI 1.04-1.67; p = 0.02). MPM-patients with longer time interval between diagnoses experienced similar risk of CMM-death as SPM-patients. The risk of CMM-death increased by almost 50% above the expected outcome according to stage of the index CMM by the diagnosis of a second CMM (HR 1.48; 95% CI 1.19-1.85; p < 0.001). MPM vs. SPM-patients had a worse outcome (HR 1.38; 95% CI 1.05-1.83; p = 0.001). This emphasizes the importance of prevention efforts in SPM-patients to decrease the risk of subsequent CMMs and has implications for more vigilant follow-up in MPM-patients.
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Affiliation(s)
- Deborah Utjés
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Lapins
- Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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Lyth J, Falk M, Maroti M, Eriksson H, Ingvar C. Prognostic risk factors of first recurrence in patients with primary stages I-II cutaneous malignant melanoma - from the population-based Swedish melanoma register. J Eur Acad Dermatol Venereol 2017; 31:1468-1474. [DOI: 10.1111/jdv.14280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/27/2017] [Indexed: 02/06/2023]
Affiliation(s)
- J. Lyth
- Local Health Care Research and Development Unit; County of Östergötland Linköping Sweden
| | - M. Falk
- Department of Medical and Health Sciences; Division of Community Medicine; Primary Care; Linköping University; Linköping Sweden
| | - M. Maroti
- Department of Oncology; County Hospital Ryhov; Jönköping Sweden
| | - H. Eriksson
- Department of Oncology and Pathology; Karolinska Institutet; Stockholm Sweden
- Department of Oncology; Karolinska University Hospital; Stockholm Sweden
| | - C. Ingvar
- Department of Surgery; Skåne University Hospital, Clinical Sciences; Lund University; Lund Sweden
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28
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Simberg-Danell C, Lyth J, Månsson-Brahme E, Frohm-Nilsson M, Carstensen J, Hansson J, Eriksson H. Prognostic factors and disease-specific survival among immigrants diagnosed with cutaneous malignant melanoma in Sweden. Int J Cancer 2016; 139:543-53. [PMID: 27004457 DOI: 10.1002/ijc.30103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/30/2016] [Accepted: 02/19/2016] [Indexed: 02/03/2023]
Abstract
Little is known about cutaneous malignant melanoma (CMM) among immigrants in Europe. We aimed to investigate clinical characteristics and disease-specific survival among first- and second-generation immigrants in Sweden. This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with primary invasive CMM, 1990-2007. Data were linked to nationwide, population-based registers followed up through 2013. Logistic regression and Cox regression models were used to determine the association between immigrant status, stage and CMM prognosis, respectively. After adjustments for confounders, first generation immigrants from Southern Europe were associated with significantly more advanced stages of disease compared to Swedish-born patients [Stage II vs. I: Odds ratio (OR) = 2.37, 95% CI = 1.61-3.50. Stage III-IV vs I: OR = 2.40, 95% CI = 1.08-5.37]. The ORs of stage II-IV versus stage I disease were increased among men (OR = 1.9; 95% CI = 1.1-3.3; p = 0.020), and women (OR = 4.8; 95% CI = 2.6-9.1; p < 0.001) in a subgroup of immigrants from former Yugoslavia compared to Swedish-born patients. The CMM-specific survival was significantly decreased among women from former Yugoslavia versus Swedish-born women [hazard ratio (HR)=2.2; 95% CI = 1.1-4.2; p = 0.043]. After additional adjustments including stage, the survival difference was no longer significant. No survival difference between the second generation immigrant group and Swedish-born patients were observed. In conclusion, a worse CMM-specific survival in women from former Yugoslavia was associated with more advanced stages of CMM at diagnosis. Secondary prevention efforts focusing on specific groups may be needed to further improve the CMM prognosis.
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Affiliation(s)
- Caroline Simberg-Danell
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Dermatology and Venereology, Södersjukhuset, Stockholm, SE, 118 83, Sweden
| | - Johan Lyth
- Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden
| | - Eva Månsson-Brahme
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - Margareta Frohm-Nilsson
- Department of Medicine, Unit of Dermatology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - John Carstensen
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Johan Hansson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - Hanna Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
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Lyth J, Mikiver R, Nielsen K, Isaksson K, Ingvar C. Prognostic instrument for survival outcome in melanoma patients: based on data from the population-based Swedish Melanoma Register. Eur J Cancer 2016; 59:171-178. [PMID: 27046697 DOI: 10.1016/j.ejca.2016.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several major analyses have identified a consistent set of independent risk factors for cutaneous malignant melanoma (CMM). A few prognostic models have been presented but some are based on a limited number of patients and others are based on selected groups of patients referred to major institutions. No nationwide population-based prognostic instrument for survival of CMM has been presented. The Swedish Melanoma Register (SMR) database covers 99% of CMM diagnosed in Sweden and includes today >50,000 cases. OBJECTIVES To create a prognostic instrument based on SMR data to give highly reliable risk profiles for patients diagnosed with localised CMM. METHODS Clinicopathological data were linked to the cause of death registry for calculation of CMM-specific survival. A generalised gamma method was used to derive 1, 5 and 10year probabilities of death for each combination of patient and tumour data: age, sex, tumour site, tumour thickness, tumour ulceration, Clark's level of invasion and when applicable also outcome of sentinel node biopsy (SNB). RESULTS Tumour thickness had the highest prognostic impact, explaining 77% of the model. Women had 30% lower risk of death because of CMM than men. Presence of ulceration nearly doubled the risk. If the patient had a positive SNB status the risk of death due to CMM increased three times versus a negative SNB status. CONCLUSION This unique population-based prognostic model for primary CMM shows better survival than the American Joint Commission on Cancer prognostic model widely used. The reason is probably that the referral bias is eliminated in a population-based cohort.
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Affiliation(s)
- J Lyth
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping, Sweden.
| | - R Mikiver
- Regional Cancer Centre South East Sweden, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - K Nielsen
- Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - K Isaksson
- Department of Surgery, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - C Ingvar
- Department of Surgery, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Eriksson H, Lyth J, Andersson TML. The proportion cured of patients diagnosed with Stage III-IV cutaneous malignant melanoma in Sweden 1990-2007: A population-based study. Int J Cancer 2016; 138:2829-36. [PMID: 26815934 DOI: 10.1002/ijc.30023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/30/2015] [Accepted: 01/15/2016] [Indexed: 02/03/2023]
Abstract
The survival in cutaneous malignant melanoma (CMM) is highly dependent on the stage of the disease. Stage III-IV CMM patients are at high risk of relapse with a heterogeneous outcome, but not all experience excess mortality due to their disease. This group is referred to as the cure proportion representing the proportion of patients who experience the same mortality rate as the general population. The aim of this study was to estimate the cure proportion of patients diagnosed with Stage III-IV CMM in Sweden. From the population-based Swedish Melanoma Register, we included 856 patients diagnosed with primary Stage III-IV CMM, 1990-2007, followed-up through 2013. We used flexible parametric cure models to estimate cure proportions and median survival times (MSTs) of uncured by sex, age, tumor site, ulceration status (in Stage III patients) and disease stage. The standardized (over sex, age and site) cure proportion was lower in Stage IV CMMs (0.15, 95% CI 0.09-0.22) than non-ulcerated Stage III CMMs (0.48, 95% CI 0.41-0.55) with a statistically significant difference of 0.33 (95% CI = 0.24-0.41). Ulcerated Stage III CMMs had a cure proportion of 0.27 (95% CI 0.21-0.32) with a statistically significant difference compared to non-ulcerated Stage III CMMs (difference 0.21; 95% CI = 0.13-0.30). The standardized MST of uncured was approximately 9-10 months longer for non-ulcerated versus ulcerated Stage III CMMs. We could demonstrate a significantly better outcome in patients diagnosed with non-ulcerated Stage III CMMs compared to ulcerated Stage III CMMs and Stage IV disease after adjusting for age, sex and tumor site.
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Affiliation(s)
- Hanna Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, and Deptartment of Oncology, Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - Johan Lyth
- Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Krynitz B, Rozell BL, Lyth J, Smedby KE, Lindelöf B. Cutaneous malignant melanoma in the Swedish organ transplantation cohort: A study of clinicopathological characteristics and mortality. J Am Acad Dermatol 2015; 73:106-113.e2. [PMID: 25929720 DOI: 10.1016/j.jaad.2015.03.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/02/2015] [Accepted: 03/21/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Risk of cutaneous melanoma is increased among organ transplant recipients (OTRs) but outcome has rarely been evaluated. OBJECTIVE We sought to assess melanoma characteristics and prognosis among OTRs versus the general population. METHODS Using Swedish health care registers, we identified melanomas in OTRs (n = 49) and in the general population (n = 22,496), given a diagnosis between 1984 and 2008 and followed up through December 31, 2012. Tumor slides of posttransplantation melanomas were reviewed. Odds ratios for comparison of histopathological characteristics and hazard ratios of melanoma-specific death were calculated. RESULTS Among OTRs the trunk was the most common anatomic melanoma site (50% among female vs 51% among male) and 73% (n = 36) of all melanomas were histologically associated with a melanocytic nevus, 63% (n = 31) atypical/dysplastic. Compared with population melanomas, posttransplantation melanomas were more advanced at diagnosis (Clark level III-V: odds ratio 2.2 [95% confidence interval 1.01-4.7, P = .03], clinical stages III-IV: odds ratio 4.2 [1.6-10.8, P = .003]). Risk of melanoma-specific death was increased among OTRs: adjusted hazard ratio 3.0 (1.7-5.3, P = .0002). LIMITATIONS Only posttransplantation melanoma slides were reviewed. CONCLUSIONS Melanomas were more advanced at diagnosis and melanoma-specific survival was poorer in OTRs than in the general population. Prophylactic excision of truncal nevi among OTRs may be advised.
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Affiliation(s)
- Britta Krynitz
- Department of Pathology and Cytology, Karolinska University Laboratories, Stockholm, Sweden; Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Barbro Lundh Rozell
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Clinical Pathology and Clinical Genetics, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Regional Cancer Center Southeast, University Hospital, Linköping, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bernt Lindelöf
- Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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Lyth J, Carstensen J, Synnerstad I, Lindholm C. Stage-specific direct health care costs in patients with cutaneous malignant melanoma. J Eur Acad Dermatol Venereol 2015; 30:789-93. [PMID: 25807966 DOI: 10.1111/jdv.13110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical stage at diagnosis is a strong prognostic factor for death in cutaneous malignant melanoma (CMM), with worse prognosis at higher stages. However, few studies have investigated how direct health care cost per patient varies with clinical stage. OBJECTIVE The aim of this study was to determine the stage-specific direct health care costs for CMM patients compared to the health care costs in the general population in the County of Östergötland, Sweden. METHODS Cutaneous malignant melanoma patients in the County of Östergötland diagnosed 2005-2012 were identified from the Swedish cancer registry. Information on clinical stage was collected from the Swedish Melanoma Register (SMR) and cost data from the Cost per Patient database (CPP) for 1075 CMM patients in Östergötland. CPP contains costs associated with all health care contacts per patient including inpatient, outpatient and primary care. The CMM-related costs were defined as the difference in mean health care costs between CMM patients and general population. RESULTS The first year after CMM diagnosis, the average health care costs for CMM patients were 2.8 times higher than in the general population. The health care cost ratio varied from 2.0 (stage I) to 10.1 (stage IV) and the CMM-related costs per patient-year varied from €2 670 (stage I) to €29 291 (stage IV). The mean health care costs decreased over time but remained significantly higher than in the general population for all clinical stages. During the first year after diagnosis, patients in clinical stage III-IV (7% of CMM patients) accounted for 27% of the total CMM-related health care costs. CONCLUSIONS The direct health care costs for CMM patients were significantly higher than in the general population independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs and the health care system may save resources by finding CMM patients in earlier stages.
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Affiliation(s)
- J Lyth
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Regional Cancer Center South East, University Hospital, Linköping, Sweden
| | - J Carstensen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - I Synnerstad
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - C Lindholm
- Regional Cancer Center South East, University Hospital, Linköping, Sweden
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Lyth J, Eriksson H, Hansson J, Ingvar C, Jansson M, Lapins J, Månsson-Brahme E, Naredi P, Stierner U, Ullenhag G, Carstensen J, Lindholm C. Trends in cutaneous malignant melanoma in Sweden 1997-2011: thinner tumours and improved survival among men. Br J Dermatol 2015; 172:700-6. [PMID: 25323770 DOI: 10.1111/bjd.13483] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both patient survival and the proportion of patients diagnosed with thin cutaneous malignant melanoma (CMM) have been steadily rising in Sweden as in most Western countries, although the rate of improvement in survival appears to have declined in Sweden at the end of the last millennium. OBJECTIVES To analyse the most recent trends in the distribution of tumour thickness (T category) as well as CMM-specific survival in Swedish patients diagnosed during 1997-2011. METHODS This nationwide population-based study included 30,590 patients registered in the Swedish Melanoma Register (SMR) and diagnosed with a first primary invasive CMM during 1997-2011. The patients were followed through 2012 in the national Cause of Death Register. RESULTS Logistic and Cox regression analyses adjusting for age at diagnosis, tumour site and healthcare region were carried out. The odds ratio for being diagnosed with thicker tumours was significantly reduced (P < 0·001) and the CMM-specific survival significantly improved in men diagnosed during 2007-2011 compared with men diagnosed during 1997-2001 (hazard ratio = 0·81; 95% confidence interval 0·72-0·91; P < 0·001), while the corresponding differences for women were not significant. Women were diagnosed with significantly thicker tumours during 2002-2006 and a tendency towards decreased survival was observed compared with those diagnosed earlier (during 1997-2001) and later (during 2007-2011). CONCLUSIONS In Sweden, the CMMs of men are detected earlier over time and this seems to be followed by an improved CMM-specific survival for men. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men.
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Affiliation(s)
- J Lyth
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Regional Cancer Center South East, University Hospital, Linköping, Sweden
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Eriksson H, Lyth J, Månsson-Brahme E, Frohm-Nilsson M, Ingvar C, Lindholm C, Naredi P, Stierner U, Carstensen J, Hansson J. Later stage at diagnosis and worse survival in cutaneous malignant melanoma among men living alone: a nationwide population-based study from Sweden. J Clin Oncol 2014; 32:1356-64. [PMID: 24687828 DOI: 10.1200/jco.2013.52.7564] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the association between cohabitation status, clinical stage at diagnosis, and disease-specific survival in cutaneous malignant melanoma (CMM). METHODS This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based registers followed up through 2012. RESULTS After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone versus men living with a partner (stage II v stage I: OR, 1.42; 95% CI, 1.29 to 1.57; stage III or IV v stage I: OR, 1.43; 95% CI, 1.14 to 1.79). The OR for stage II versus stage I disease was also increased among women living alone (OR, 1.15; 95% CI, 1.04 to 1.28). After adjustments for the factors listed earlier, the CMM-specific survival was significantly decreased among men living alone (hazard ratio [HR] for death, 1.48; 95% CI, 1.33 to 1.65; P < .001). After additional adjustments for all potential and established prognostic factors, CMM-specific survival among men living alone versus men living with a partner remained significantly decreased (HR, 1.31; 95% CI, 1.18 to 1.46; P < .001), suggesting a residual adverse effect on survival not accounted for by these parameters. CONCLUSION In all age groups among men, living alone is significantly associated with reduced CMM-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.
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Affiliation(s)
- Hanna Eriksson
- Hanna Eriksson, Eva Månsson-Brahme, Margareta Frohm-Nilsson, and Johan Hansson, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm; Johan Lyth and Christer Lindholm, Regional Cancer Center Southeast, Linköping University Hospital; Johan Lyth and John Carstensen, Linköping University, Linköping; Christian Ingvar, Lund University, Lund; Peter Naredi, Sahlgrenska Academy; and Ulrika Stierner, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lyth J, Hansson J, Ingvar C, Månsson-Brahme E, Naredi P, Stierner U, Wagenius G, Lindholm C. Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register. Br J Dermatol 2013; 168:779-86. [DOI: 10.1111/bjd.12095] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lyth J, Andersson SO, Andrén O, Johansson JE, Carlsson P, Shahsavar N. A decision support model for cost-effectiveness of radical prostatectomy in localized prostate cancer. ACTA ACUST UNITED AC 2011; 46:19-25. [PMID: 21905981 DOI: 10.3109/00365599.2011.615759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to develop a probabilistic decision support model to calculate the lifetime incremental cost-effectiveness ratio (ICER) between radical prostatectomy and watchful waiting for different patient groups. MATERIAL AND METHODS A randomized trial (SPCG-4) provided most data for this study. Data on survival, costs and quality of life were inputs in a decision analysis, and a decision support model was developed. The model can generate cost-effectiveness information on subgroups of patients with different characteristics. RESULTS Age was the most important independent factor explaining cost-effectiveness. The cost-effectiveness value varied from 21,026 Swedish kronor (SEK) to 858,703 SEK for those aged 65 to 75 years, depending on Gleason scores and prostate-specific antigen (PSA) values. Information from the decision support model can support decision makers in judging whether or not radical prostatectomy (RP) should be used to treat a specific patient group. CONCLUSIONS The cost-effectiveness ratio for RP varies with age, Gleason scores, and PSA values. Assuming a threshold value of 200,000 SEK per quality-adjusted life-year (QALY) gained, for patients aged ≤70 years the treatment was always cost-effective, except at age 70, Gleason 0-4 and PSA ≤10. Using the same threshold value at age 75, Gleason 7-9 (regardless of PSA) and Gleason 5-6 (with PSA >20) were cost-effective. Hence, RP was not perceived to be cost-effective in men aged 75 years with low Gleason and low PSA. Higher threshold values for patients with clinically localized prostate cancer could be discussed.
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Affiliation(s)
- Johan Lyth
- Department of Biomedical Engineering, Division of Medical Informatics, Linköping University Hospital, Linköping, Sweden.
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Lundberg JG, Borjeson S, Fomichov V, Lyth J, Petersson C. Chemotherapy-induced nausea and vomiting (CINV) in a naturalistic setting. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Andersson SO, Andrén O, Lyth J, Stark JR, Henriksson M, Adami HO, Carlsson P, Johansson JE. Managing localized prostate cancer by radical prostatectomy or watchful waiting: Cost analysis of a randomized trial (SPCG-4). ACTA ACUST UNITED AC 2011; 45:177-83. [PMID: 21265595 DOI: 10.3109/00365599.2010.545075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The cost of radical prostatectomy (RP) compared to watchful waiting (WW) has never been estimated in a randomized trial. The goal of this study was to estimate long-term total costs per patient associated with RP and WW arising from inpatient and outpatient hospital care. MATERIAL AND METHODS This investigation used the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) trial, comparing RP to WW, and included data from 212 participants living in two counties in Sweden from 1989 to 1999 (105 randomized to WW and 107 to RP). All costs were included from randomization date until death or end of follow-up in July 2007. Resource use arising from inpatient and outpatient hospital costs was measured in physical units and multiplied by a unit cost to come up with a total cost per patient. RESULTS During a median follow-up of 12 years, the overall cost in the RP group was 34% higher (p < 0.01) than in the WW group, corresponding to €6123 in Sweden. The difference was driven almost exclusively by the cost of the surgical procedure. The cost difference between RP and WW was two times higher among men with low (2-6) than among those with high (7-10) Gleason score. CONCLUSION In this economic evaluation of RP versus WW of localized prostate cancer in a randomized study, RP was associated with 34% higher costs. This difference, attributed exclusively to the cost of the RP procedure, was not overcome during extended follow-up.
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Frödin U, Börjeson S, Lyth J, Lotfi K. A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up. Bone Marrow Transplant 2010; 46:1345-52. [PMID: 21113189 DOI: 10.1038/bmt.2010.304] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Few studies have evaluated long-term health-related quality of life (HRQL) in patients during auto-SCT. This prospective study examined HRQL in 96 eligible patients before, during and up to 3 years after auto-SCT. The aim of the study was to make a comprehensive assessment of the frequency and severity of different symptoms in patients undergoing auto-SCT. The European Organization for Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) was administered 13 times. The second week during treatment was the period when patients had the lowest HRQL regarding both total quality of life and function and symptom scales. The patients recovered quickly and just two months after transplantation the baseline values were restored. Three years after transplantation most of the items in the questionnaire had stabilized, except role function and dyspnea, which had improved. There were significant differences between multiple myeloma (MM) and lymphoma patients' physical function, quality of life, fatigue and pain during week 2. At the 3-year follow-up, lymphoma patients indicated a better HRQL than MM patients. The quick recovery of patients after transplantation suggests that treatment is well tolerated; however, the supportive care could be improved at week 2, especially for the lymphoma patients.
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Affiliation(s)
- U Frödin
- Department of Hematology, Linköping University Hospital, Linköping, Sweden.
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