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Nilsson J, Bergström S, Hållberg H, Berglund A, Bergqvist M, Holgersson G. Prospective Study of Preferred Versus Actual Place of Death Among Swedish Palliative Cancer Patients. Am J Hosp Palliat Care 2023:10499091231213640. [PMID: 37933153 DOI: 10.1177/10499091231213640] [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] [Indexed: 11/08/2023] Open
Abstract
Background: The place of death of cancer patients is an important aspect of end-of-life care. However, little research has been conducted regarding factors that may influence the preferred and actual place of death in cancer patients and whether the patients die at their preferred place of death. In this study, we aimed to investigate the preferred and actual place of death for palliative cancer patients, and factors influencing these variables. Methods: Patients diagnosed with cancer and admitted to a palliative care team across three Swedish cities between 2019 and 2022 were asked for participation. Participants completed a questionnaire capturing sociodemographic data and preferred place of death. Further data regarding age, sex, and cancer type were collated at inclusion, and the actual place of death recorded for those deceased by 5-May-2023. Results: The study included 242 patients. A majority (79%) wanted to die at home which was the actual death location for 76% of the patients. When the place-of-death decision was made by the patient alone, 75% chose home, compared to 96% when decided jointly with relatives-a statistically significant variation (p = 0.0037). For the patients who wanted to die at home, 80% actually died at home, with insignificant disparities among subgroups. Conclusions: Most palliative cancer patients in this Swedish cohort preferred and achieved death at home. Involving relatives in decision-making may influence the preferred place of death, however larger studies are needed to comprehensively assess factors affecting the preferred and actual place of death in different subgroups of patients.
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Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Radiation Sciences & Oncology, Umeå University Hospital, Umeå, Sweden
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - Stefan Bergström
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
| | | | | | - Michael Bergqvist
- Department of Radiation Sciences & Oncology, Umeå University Hospital, Umeå, Sweden
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Georg Holgersson
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University Hospital, Uppsala, Sweden
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Källman M, Bergström S, Carlsson T, Järås J, Holgersson G, Nordberg JH, Nilsson J, Wode K, Bergqvist M. Use of CAM among cancer patients : Results of a regional survey in Sweden. BMC Complement Med Ther 2023; 23:51. [PMID: 36797715 PMCID: PMC9933304 DOI: 10.1186/s12906-023-03876-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg. METHODS A total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis. RESULTS 54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use. CONCLUSIONS The use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care.
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Affiliation(s)
- Mikael Källman
- Department of Radiation Sciences, Umeå University, Umeå, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden. .,Department of Oncology, Gävle Hospital, Gävle, Sweden.
| | - Stefan Bergström
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden ,grid.413607.70000 0004 0624 062XDepartment of Oncology, Gävle Hospital, Gävle, Sweden
| | - Tobias Carlsson
- grid.413607.70000 0004 0624 062XDepartment of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Georg Holgersson
- grid.412354.50000 0001 2351 3333Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Johanna Hök Nordberg
- Regional Cancer Centre Stockholm–Gotland, Stockholm, Sweden ,Department of NVS, Karolinska Institution, Stockholm, Sweden ,Department of Physiology & Pharmacology, Karolinska Institution, Stockholm, Sweden
| | - Jonas Nilsson
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Kathrin Wode
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,Regional Cancer Centre Stockholm–Gotland, Stockholm, Sweden ,grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden
| | - Michael Bergqvist
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden). PLoS One 2022; 17:e0278706. [PMID: 36520832 PMCID: PMC9754210 DOI: 10.1371/journal.pone.0278706] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES While studies have found lower cancer risks and better cancer survival in immigrant populations, it is debated whether cancer care is offered on equal terms to all residents regardless of background. Our aim was to study patterns of care and outcomes in immigrants in a country with a tax-financed universal health care system. MATERIAL AND METHODS We used a population-based database to compare clinical presentation, management and mortality between Swedish-born and immigrant patients with non-small cell lung cancer (NSCLC). Analyses were adjusted for potential confounders. RESULTS We identified 40,075 patients diagnosed with NSCLC of which 84% were born in Sweden, 7% in Nordic and 9% in Non-Nordic countries. Non-Nordic immigrants were to a higher extent male, smokers, younger at diagnosis, had a better performance status and a higher educational level. No differences were seen regarding comorbidity burden or stage at diagnosis. Non-Nordic immigrants more often underwent positron emission tomography (PET) (aHR 1.32; 95% CI 1.19-1.45) and were more often discussed in a multidisciplinary team setting (aHR 1.30; 95% CI 1.17-1.44). There were no differences in treatment modalities following adjustment for age, with the exception of concurrent chemoradiotherapy in stage IIIA disease which was more common in Non-Nordic immigrants (aOR 1.34; 95% CI 1.03-1.74). Both overall and cause specific survival in non-metastatic disease were higher among Non-Nordic immigrants. Overall mortality in stage I-II: HR 0.81; 95% CI 0.73-0.90 and stage IIIA: HR 0.75; 95% CI 0.65-0.86. Following full adjustments, cause-specific mortality in stage I-II was aHR 0.86, 95% CI 0.75-0.98. CONCLUSION Taken together, only minor differences in management and outcomes were observed between Swedish-born and immigrant patients. We conclude that lung cancer care is offered on equal terms. If anything, outcomes were better in Non-Nordic immigrants with early stage NSCLC.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Section of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Central Sweden, Uppsala, Sweden
- * E-mail:
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Are older patients with non-small cell lung cancer receiving optimal care? A population-based study. Acta Oncol 2022; 61:309-317. [PMID: 34779354 DOI: 10.1080/0284186x.2021.2000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Results from studies addressing age-related patterns of cancer care have found evidence of unjustified differences in management between younger and older patients. METHODS We examined associations between age and clinical presentation, management and mortality in patients diagnosed with non-small cell lung cancer (NSCLC) between 2002 and 2016. Analyses were adjusted for comorbidity and other factors that may have affected management decisions and outcomes. RESULTS The study population encompassed 40,026 patients with NSCLC. Stage at diagnosis did not differ between age groups ≤ 84. The diagnostic intensity was similar in age groups <80 years. In patients with stage IA-IIB disease and PS 0-2, surgery was more common in the youngest age groups and decreased with increasing age, and was rarely performed in those ≥ 85 years. The use of stereotactic body radiotherapy (SBRT) increased with age (≤69 years 5.4%; ≥85 years 35.8%). In patients with stage IIIA disease and PS 0-2, concurrent chemoradiotherapy was more common in younger patients (≤69 years 55.3%; ≥85 years 2.2%). In stage IA-IIIA disease, no major differences in treatment-related mortality was observed. In stage IIIB-IV and PS 0-2, chemotherapy was more common in patients <80 years. However, 58.1% of patients 80-84 years and 30.3% ≥ 85 years received treatment. In stage IA-IIIA, overall and cause-specific survival decreased with increasing age. No age-differences in survival were observed in patients with stage IIIB-IV NSCLC. CONCLUSION Treatments were readily given to older patients with metastatic disease, but to a lesser degree to those with early stage disease. Significant differences in cause specific survival were observed in early, but not late stage disease. Our findings underscore the importance of individualized assessment of health status and life expectancy. Our results indicate that older patients with early stage lung cancer to a higher extent should be considered for curative treatment.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Central Sweden, Uppsala, Sweden
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Reply to Assoc. Prof. Kocak. Acta Oncol 2022; 61:320. [PMID: 35012418 DOI: 10.1080/0284186x.2021.2023216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Regional Cancer Center Central Sweden, Uppsala, Sweden
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Nilsson J, Holgersson G, Ullenhag G, Holmgren M, Axelsson B, Carlsson T, Bergqvist M, Bergström S. Socioeconomy as a prognostic factor for location of death in Swedish palliative cancer patients. BMC Palliat Care 2021; 20:43. [PMID: 33715623 PMCID: PMC7958382 DOI: 10.1186/s12904-021-00736-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/22/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background An important aspect of end-of-life care is the place of death. A majority of cancer patients prefer home death to hospital death. At the same time, the actual location of death is often against patient’s last-known wish. The aim of this study was to analyze whether socioeconomic factors influence if Swedish palliative cancer patients die at home or at a hospital. There is no previous study on location of death encompassing several years in Swedish cancer patients. Methods Data was collected from the Swedish Register of Palliative Care for patients diagnosed with brain tumor, lung, colorectal, prostate or breast cancer recorded between 2011 and 2014. The data was linked to the Swedish Cancer Register, the Cause of Death Register and the Longitudinal Integration Database for health-insurance and labor-market studies. A total of 8990 patients were included. Results We found that marital status was the factor that seemed to affect the place of death. Lack of a partner, compared to being married, was associated with a higher likelihood of dying at a hospital. Conclusion Our findings are in line with similar earlier studies encompassing only 1 year and based on patients in other countries. Whether inequalities at least partly explain the differences remains to be investigated. Patients dying of cancer in Sweden, who do not have a life partner, may not have the option of dying at home due to lack of informal support. Perhaps the need of extensive community support services to enable home death have to improve, and further studies are warranted to answer this question.
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Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden. .,Department of Radiation Sciences Umeå University Hospital, Umeå, Sweden. .,Department of Radiology, Gävle Hospital, Gävle, Sweden.
| | - Georg Holgersson
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University Hospital, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Gustav Ullenhag
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University Hospital, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Malin Holmgren
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Bertil Axelsson
- Department of Radiation Sciences Umeå University Hospital, Umeå, Sweden.,Unit of Clinical research center, Östersund, Sweden
| | - Tobias Carlsson
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of Radiation Sciences Umeå University Hospital, Umeå, Sweden.,Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Stefan Bergström
- Center for Research & Development, Uppsala University/ County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of Radiation Sciences Umeå University Hospital, Umeå, Sweden.,Department of Oncology, Gävle Hospital, Gävle, Sweden
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Bergqvist M, Christensen HN, Wiklund F, Bergström S. Real world utilization of EGFR TKIs and prognostic factors for survival in NSCLC during 2010-2016 in Sweden: A nationwide observational study. Int J Cancer 2019; 146:2510-2517. [PMID: 31350754 DOI: 10.1002/ijc.32596] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 11/10/2022]
Abstract
The purpose of our study was to investigate time trends in treatment pattern and prognostic factors for overall survival (OS) in epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKIs) treated nonsmall cell lung cancer (NSCLC) patients. Utilizing Swedish nationwide registers, we identified all Stage IIIB-IV NSCLC patients treated with EGFR TKIs and followed them from diagnosis (2010-2015) until death or end of observation (2016). Multivariable Cox regression analyses were performed to test associations of patient-, tumor-related factors with OS. Of 9,992 Stage IIIB-IV NSCLC patients, the 1,419 (14%) who initiated EGFR TKI treatment during observation were younger (median age 68 vs. 71 years), less ≥1 comorbidities (34% vs. 46%), more often female (59% vs. 47%), Stage IV (89% vs. 85%) and adenocarcinoma (85% vs. 66%) compared to non-TKI treated patients. After TKI initiation, 7% (n = 100) of the patients switched, 4% (n = 62) rechallenged a TKI treatment, 65% (n = 919) discontinued and 24% (n = 338) had died. A more recent diagnosis demonstrated shorter time to EGFR TKI initiation, prolonged treatment length and longer median OS (15.3 months 2010-2011; 14.4 months 2012-2013; 18.6 months 2014-2015). Prognostic factors for longer OS when treated with EGFR TKIs were younger age, adenocarcinoma, less advanced clinical stage and less comorbid disease. In conclusion, during the observation period, survival improved for EGFR TKI treated NSCLC patients, as did the accessibility for targeted therapies for these patients.
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Affiliation(s)
- Michael Bergqvist
- Center for Research & Development, Uppsala University, County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of radiation sciences, Umeå University, Umea, Sweden
| | | | | | - Stefan Bergström
- Center for Research & Development, Uppsala University, County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
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Willén L, Berglund A, Bergström S, Bergqvist M, Öjdahl-Bodén A, Wagenius G, Lambe M. Educational level and management and outcomes in non-small cell lung cancer. A nationwide population-based study. Lung Cancer 2019; 131:40-46. [PMID: 31027696 DOI: 10.1016/j.lungcan.2019.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 08/29/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We examined associations between educational level and clinical presentation, patterns of management and mortality in patients with non-small cell lung cancer (NSCLC) in Sweden, a country with a National Health Care System. MATERIALS AND METHODS We identified 39,671 patients with a NSCLC diagnosis 2002-2016 in Lung Cancer Data Base Sweden (LCBaSe), a population-based research database. In analyses adjusted for comorbidity and other prognostic factors, odds Ratios (OR) and hazard Ratios (HR) were estimated to examine associations between patients' educational level and aspects of management and mortality. RESULTS Stage at diagnosis and waiting times did not differ between educational groups. In multivariable analysis, the likelihood to undergo PET/CT and assessment in a multidisciplinary team setting were higher in patients with high compared to low education (aOR 1.14; CI 1.05-1.23 and aOR 1.22; CI 1.14-1.32, respectively). In patients with early stage IA-IIB disease, the likelihood to undergo stereotactic radiotherapy was elevated in patients with high education (aOR 1.40; CI 1.03-1.91). Both all-cause (aHR 0.86; CI 0.77-0.92) and cause-specific mortality (aHR 0.83; CI 0.74-0.92) was lower in patients with high compared to low education in early stage disease (IA-IIB). In higher stage NSCLC no differences were observed. Patterns were similar in separate assessments stratified by sex and histopathology. CONCLUSIONS While stage at diagnosis and waiting times did not differ between educational groups, we found socioeconomic differences in diagnostic intensity, multidisciplinary team assessment, stereotactic radiotherapy and mortality in patients with NSCLC. These findings may in part reflect social gradients in implementation and use of novel diagnostic and treatment modalities. Our findings underscore the need for improved adherence to national guidelines.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden.
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Michael Bergqvist
- Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Anna Öjdahl-Bodén
- Division of Respiratory Diseases, Department of Medical Sciences, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Regional Cancer Center Uppsala Örebro, Uppsala, Sweden
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Nilsson J, Järås J, Henriksson R, Holgersson G, Bergström S, Estenberg J, Augustsson T, Bergqvist M. No Evidence for Increased Brain Tumour Incidence in the Swedish National Cancer Register Between Years 1980-2012. Anticancer Res 2019; 39:791-796. [PMID: 30711958 DOI: 10.21873/anticanres.13176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/06/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The main objective of this study was to evaluate if there was an increased incidence of brain tumours between years 1980-2012, a time period when mobile phone usage has increased substantially. MATERIALS AND METHODS From the Swedish Cancer Registry, cases of meningiomas, low-grade gliomas (LGG) and high-grade gliomas (HGG) were identified in patients between 1980-2012. Direct age-standardised incidence rates were used to calculate incidence trends over time. RESULTS A total of 13,441 cases of meningiomas, 12,259 cases of high-grade gliomas and 4,555 cases of LGG were reported to the register during the study period. The results suggest that there may be a negative development in the trend for LGG of -0,016 cases per 100,000 and year, corresponding to a mean reduction of approximately 1% per year. CONCLUSION The present study was not able to demonstrate an increased incidence of glioma during the past 30 years in Sweden.
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Affiliation(s)
- Jonas Nilsson
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden.,Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - Jacob Järås
- Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden.,Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
| | - Georg Holgersson
- Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | - Stefan Bergström
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden.,Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | | | - Michael Bergqvist
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden .,Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden.,Department of Oncology, Gävle Hospital, Gävle, Sweden
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Bergqvist M, Nordahl Christensen H, Wiklund F, Bergström S. MA18.05 Characteristics and Long-Term OS of Non-Small Cell Lung Cancer Patients Receiving EGFR Tyrosine Kinase Inhibitor Treatment. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.468] [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: 11/25/2022]
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Bergström S, Nordahl Christensen H, Wiklund F, Bergqvist M. EGFR tyrosine kinase inhibitors in non-small cell lung cancer: Nationwide register-based cohort study in Sweden. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.076] [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: 11/14/2022] Open
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12
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Nyman J, Bergström S, Björkestrand H, Svärd A, Ekman S, Lundin E, Holmberg E, Johansson M, Friesland S, Hallqvist A. MA05.07 Dose Escalated Chemo-RT to 84 Gy in Stage III NSCLC Appears Excessively Toxic: Results from a Randomized Phase II Trial. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.354] [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: 11/24/2022]
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13
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Mäkitie A, Ruuskanen M, Bentzen J, Brun E, Gebre-Medhin M, Friesland S, Marsk E, Hammarstedt-Nordenvall L, Gille E, Reizenstein J, Adell G, Farnebo L, Rzepecki J, Haugen H, Söderström K, Zackrisson B, Bergström S, Lödén B, Cederblad L, Laurell G, Smeland E, Folkvard Evensen J, Lund JÅ, Tøndel H, Karlsdottir Å, Jóhannsson J, Johansen J, Kristensen CA, Jensen K, Andersen LJ, Koivunen P, Korpela M, Voutilainen L, Wigren T, Minn H, Joensuu H, Overgaard J, Saarilahti K. The management and survival outcomes of nasopharyngeal cancer in the Nordic countries<sup/>. Acta Oncol 2018; 57:557-560. [PMID: 29202641 DOI: 10.1080/0284186x.2017.1408961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- A. Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - M. Ruuskanen
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - J. Bentzen
- Department of Oncology, Herlev University Hospital, Copenhagen, Denmark
| | - E. Brun
- Department of Oncology, Skane University Hospital, Lund University, Sweden
| | - M. Gebre-Medhin
- Department of Oncology, Skane University Hospital, Lund University, Sweden
| | - S. Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - E. Marsk
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - L. Hammarstedt-Nordenvall
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - E. Gille
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - J. Reizenstein
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - G. Adell
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
| | - L. Farnebo
- Department of Otorhinolaryngology – Head and Neck Surgery, Linköping University Hospital, Linköping, Sweden
| | - J. Rzepecki
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
| | - H. Haugen
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K. Söderström
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - B. Zackrisson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - S. Bergström
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - B. Lödén
- Department of Oncology, Karlstad Hospital, Karlstad, Sweden
| | - L. Cederblad
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - G. Laurell
- Department of Otorhinolaryngology – Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - E. Smeland
- Department of Oncology, University Hospital North Norway, Tromsoe, Norway
| | | | - J. Å. Lund
- Department of Oncology, Trondheim University Hospital, Trondheim, Norway
| | - H. Tøndel
- Department of Oncology, Trondheim University Hospital, Trondheim, Norway
| | - Å. Karlsdottir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - J. Jóhannsson
- Department of Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - J. Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - C. A. Kristensen
- Department of Oncology, The Finsen Centre, Rigshospitalet, Copenhagen, Denmark
| | - K. Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - L. J. Andersen
- Department of Oncology, Aalborg Hospital, Aalborg, Denmark
| | - P. Koivunen
- Department of Otorhinolaryngology – Head and Neck Surgery, Oulu University Hospital, Oulu, Finland
| | - M. Korpela
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - L. Voutilainen
- Department of Oncology, Kuopio University Hospital, Kuopio, Finland
| | - T. Wigren
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - H. Minn
- Department of Oncology, Turku University Hospital, Turku, Finland
| | - H. Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J. Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - K. Saarilahti
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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14
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Sooman L, Gullbo J, Bergqvist M, Bergström S, Lennartsson J, Ekman S. Synergistic effects of combining proteasome inhibitors with chemotherapeutic drugs in lung cancer cells. BMC Res Notes 2017; 10:544. [PMID: 29096687 PMCID: PMC5667477 DOI: 10.1186/s13104-017-2842-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/28/2016] [Accepted: 10/23/2017] [Indexed: 12/29/2022] Open
Abstract
Background The prognosis for patients with disseminated lung cancer is poor and current treatments have limited survival benefit as resistance often occurs, and is often associated with significant toxicity. A possible strategy to improve treatment and evade chemoresistance may be to find new combinations of drugs. The aim of this study was to analyze the potential of combining proteasome inhibitors (PIs) with chemotherapeutic drugs used in the routine treatment for lung cancer patients. Results The median-effect method was applied to the Fluorometric Microculture Cytotoxicity Assay (FMCA) to evaluate effects of combining two different PIs (bortezomib and b-AP15) with clinically used chemotherapeutic drugs representing different mechanisms of action (cisplatin, gefitinib, gemcitabine and vinorelbine) in two lung cancer cell lines (one sensitive and one resistant). Proteasome inhibition in combination with cisplatin, gemcitabine or vinorelbine had synergistic effects in at least one of the tested cell lines. Furthermore, the effect of gefitinib appeared strongly potentiated by the PI in the least resistant lung cancer cell line, although the level of synergy could not be determined with the median-effect method. Conclusions Combining PIs with cisplatin, gefitinib, gemcitabine or vinorelbine show potential as new combination chemotherapy for the treatment of lung cancer. Electronic supplementary material The online version of this article (10.1186/s13104-017-2842-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda Sooman
- Department of Immunology, Genetics and Pathology (former Radiation, Oncology and Radiation Science), Section of Oncology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Joachim Gullbo
- Department of Immunology, Genetics and Pathology (former Radiation, Oncology and Radiation Science), Section of Oncology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden.,Department of Medical Sciences, Division of Clinical Pharmacology, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, 801 87, Gävle, Sweden. .,Department of Oncology, Gävle Hospital, 801 87, Gävle, Sweden. .,Department of Radiation Sciences & Oncology, Umeå University Hospital, 901 87, Umeå, Sweden.
| | - Stefan Bergström
- Department of Immunology, Genetics and Pathology (former Radiation, Oncology and Radiation Science), Section of Oncology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Johan Lennartsson
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24, Uppsala, Sweden
| | - Simon Ekman
- Department of Immunology, Genetics and Pathology (former Radiation, Oncology and Radiation Science), Section of Oncology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, 171 76, Stockholm, Sweden
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15
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Nilsson J, Berglund A, Bergström S, Bergqvist M, Lambe M. P1.06-002 The Role of Comorbidity in the Management and Prognosis in Nonsmall Cell Lung Cancer: A Population-Based Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.896] [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: 10/18/2022]
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16
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Nilsson J, Berglund A, Bergström S, Bergqvist M, Lambe M. The role of comorbidity in the management and prognosis in nonsmall cell lung cancer: a population-based study. Acta Oncol 2017; 56:949-956. [PMID: 28486004 DOI: 10.1080/0284186x.2017.1324213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coexisting disease constitutes a challenge for the provision of optimal cancer care. The influence of comorbidity on lung cancer management and prognosis remains incompletely understood. We assessed the influence of comorbidity on treatment intensity and prognosis in a population-based setting in patients with nonsmall cell lung cancer. MATERIAL AND METHODS Our study was based on information available in Lung Cancer Data Base Sweden (LcBaSe), a database generated by record linkage between the National Lung Cancer Register (NLCR) and several other population-based registers in Sweden. The NLCR includes data on clinical characteristics on 95% of all patients with lung cancer in Sweden since 2002. Comorbidity was assessed using the Charlson Comorbidity Index. Logistic regression and time to event analysis was used to address the association between comorbidity and treatment and prognosis. RESULTS In adjusted analyses encompassing 19,587 patients with a NSCLC diagnosis and WHO Performance Status 0-2 between 2002 and 2011, those with stage-IA-IIB disease and severe comorbidity were less likely to be offered surgery (OR: 0.45; 95% CI: 0.36-0.57). In late-stage disease (IIIB-IV), severe comorbidity was also associated with lower chemotherapy treatment intensity (OR: 0.76; 95% CI: 0.65-0.89). In patients with early, but not late-stage disease, severe comorbidity in adjusted analyses was associated with an increased all-cause mortality, while lung cancer-specific mortality was largely unaffected by comorbidity burden. CONCLUSIONS Comorbidity contributes to the poor prognosis in NSCLC patients. Routinely published lung cancer survival statistics not considering coexisting disease conveys a too pessimistic picture of prognosis. Optimized management of comorbid conditions pre- and post-NSCLC-specific treatment is likely to improve outcomes.
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Affiliation(s)
- Jonas Nilsson
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Michael Bergqvist
- Center for Research and Development, Uppsala University/County Council of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Uppsala-Örebro, Uppsala, Sweden
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17
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Nilsson J, Blomberg C, Holgersson G, Carlsson T, Bergqvist M, Bergström S. End-of-life care: Where do cancer patients want to die? A systematic review. Asia Pac J Clin Oncol 2017; 13:356-364. [DOI: 10.1111/ajco.12678] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
- Department of Radiology; Gävle Hospital; Gävle Sweden
| | - Carl Blomberg
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Georg Holgersson
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
| | - Tobias Carlsson
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
- Department of Radiation Sciences & Oncology; Umeå University Hospital; Umeå Sweden
| | - Stefan Bergström
- Center for Research & Development, Uppsala University/County Council of Gävleborg; Gävle Hospital; Gävle Sweden
- Department of Oncology; Gävle Hospital; Gävle Sweden
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18
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Nilsson J, Holgersson G, Carlsson T, Henriksson R, Bergström S, Bergqvist M. Incidence trends in high-grade primary brain tumors in males and females. Oncol Lett 2017; 13:2831-2837. [PMID: 28454474 DOI: 10.3892/ol.2017.5770] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/06/2016] [Indexed: 12/24/2022] Open
Abstract
The focus of the present review is to investigate whether there is a variation in the incidence rates between male and female patients with high-grade primary brain tumors and if there are altered incidence rates associated with the time at which they were diagnosed. Previous studies identified in internationally peer-reviewed journals were identified using a systematic search of the PubMed database. Due to the difficulties in data interpretation, studies that exclusively included patient data classified prior to the 2nd edition of the World Health Organization histological classification system of brain tumors were excluded. The overall incidence rates and incidence trends of male and female patients were analyzed separately. The mean age-adjusted overall incidence rate in the male population was 1.27 per 100,000 compared with 0.89 per 100,000 in the female population. The variance between the two genders differed and a Wilcoxon rank-sum test indicated that there was no significant difference in the incidence rate of high-grade primary brain tumors between males and females (P=0.3658). Furthermore, there was no significant difference in incidence rate trend between 1996-2004 and 2005-2010 for male or female populations (P=0.101 and P=0.472, respectively). The results from the present systematic review did not demonstrate a significant difference in incidence rate between the two genders. Therefore, the results from the current study are considered to be preliminary and further studies are required to elucidate this issue.
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Affiliation(s)
- Jonas Nilsson
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87 Gävle, Sweden.,Department of Radiation Sciences and Oncology, Umeå University Hospital, SE-901 87 Umeå, Sweden.,Department of Radiology, Gävle Hospital, SE-801 88 Gävle, Sweden
| | - Georg Holgersson
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87 Gävle, Sweden.,Department of Oncology, Gävle Hospital, SE-801 88 Gävle, Sweden
| | - Tobias Carlsson
- Department of Oncology, Gävle Hospital, SE-801 88 Gävle, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University Hospital, SE-901 87 Umeå, Sweden.,Regional Cancer Center Stockholm-Gotland, Västgötagatan 2, SE-102 39 Stockholm, Sweden
| | - Stefan Bergström
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87 Gävle, Sweden.,Department of Oncology, Gävle Hospital, SE-801 88 Gävle, Sweden
| | - Michael Bergqvist
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87 Gävle, Sweden.,Department of Radiation Sciences and Oncology, Umeå University Hospital, SE-901 87 Umeå, Sweden.,Department of Oncology, Gävle Hospital, SE-801 88 Gävle, Sweden
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Ansari D, Bauden M, Bergström S, Rylance R, Marko-Varga G, Andersson R. Relationship between tumour size and outcome in pancreatic ductal adenocarcinoma. Br J Surg 2017; 104:600-607. [PMID: 28177521 DOI: 10.1002/bjs.10471] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/10/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The size of pancreatic ductal adenocarcinoma (PDAC) at diagnosis is an indicator of outcome. Previous studies have focused mostly on patients with resectable disease. The aim of this study was to investigate the relationship between tumour size and risk of metastasis and death in a large PDAC cohort, including all stages. METHODS Patients diagnosed with PDAC between 1988 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Tumour size was defined as the maximum dimension of the tumour as provided by the registry. Metastatic spread was assessed, and survival was calculated according to size of the primary tumour using the Kaplan-Meier method. Cox proportional regression modelling was used to adjust for known confounders. RESULTS Some 58 728 patients were included. There were 187 patients (0·3 per cent) with a tumour size of 0·5 cm or less, in whom the rate of distant metastasis was 30·6 per cent. The probability of tumour dissemination was associated with tumour size at the time of diagnosis. The association between survival and tumour size was linear for patients with localized tumours, but stochastic in patients with regional and distant stages. In patients with resected tumours, increasing tumour size was associated with worse tumour-specific survival, whereas size was not associated with survival in patients with unresected tumours. In the adjusted Cox regression analysis, the death rate increased by 4·1 per cent for each additional 1-cm increase in tumour size. CONCLUSION Pancreatic cancer has a high metastatic capacity even in small tumours. The prognostic impact of tumour size is restricted to patients with localized disease.
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Affiliation(s)
- D Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden
| | - M Bauden
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden
| | - S Bergström
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden
| | - R Rylance
- National Registry Centre, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Marko-Varga
- Department of Biomedical Engineering, Clinical Protein Science and Imaging, Lund University, Lund, Sweden
| | - R Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund University, Lund, Sweden
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Granja AC, Machungo F, Gomes A, Bergström S, Brabin B. Malaria-related maternal mortality in urban Mozambique. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1998.11813288] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Nilsson J, Källman M, Östlund U, Holgersson G, Bergqvist M, Bergström S. The Use of Complementary and Alternative Medicine in Scandinavia. Anticancer Res 2016; 36:3243-3251. [PMID: 27354580] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Complementary alternative medicine (CAM) is widely used among patients with cancer. This usage may have potentially harmful effects, especially when combined with anticancer drugs. However, some complementary methods may benefit patients. This review investigated the prevalence of CAM use among patients with cancer in Scandinavia and secondly studied the educational levels of CAM users compared to non-users. MATERIALS AND METHODS A systematic search of the PubMed library was carried out to locate articles published between January 2000 and October 2015 that investigated prevalence of CAM use among Scandinavian patients with cancer. RESULTS Twenty-two articles were found, of which nine were included in the review. The prevalence of CAM use was 7.9% to 53%, with an average of 36.0% across all studies. CONCLUSION Use of CAM is widespread among patients with cancer. Knowledge about CAM should be disseminated to both patients and staff in order to optimise discussions about CAM in clinical practice.
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Affiliation(s)
- Jonas Nilsson
- Centre for Research and Development, Gavle University Hospital, Gavle, Sweden Department of Radiation Sciences and Oncology, Umea University Hospital, Umea, Sweden Department of Radiology, Gavle University Hospital, Gavle, Sweden
| | - Mikael Källman
- Department of Oncology, Gavle University Hospital, Gavle, Sweden
| | - Ulrika Östlund
- Centre for Research and Development, Gavle University Hospital, Gavle, Sweden
| | - Georg Holgersson
- Centre for Research and Development, Gavle University Hospital, Gavle, Sweden Department of Oncology, Gavle University Hospital, Gavle, Sweden
| | - Michael Bergqvist
- Centre for Research and Development, Gavle University Hospital, Gavle, Sweden Department of Oncology, Gavle University Hospital, Gavle, Sweden Department of Radiation Sciences and Oncology, Umea University Hospital, Umea, Sweden
| | - Stefan Bergström
- Centre for Research and Development, Gavle University Hospital, Gavle, Sweden Department of Oncology, Gavle University Hospital, Gavle, Sweden
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Strand RT, Fernandes Dias L, Bergström S, Andersson S. Unexpected low prevalence of HIV among fertile women in Luanda, Angola. Does war prevent the spread of HIV? Int J STD AIDS 2016; 18:467-71. [PMID: 17623504 DOI: 10.1258/095646207781147300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We studied HIV prevalence and risk factors for HIV infection among fertile women in Luanda for the purposes of obtaining background data for planning of interventions as well as to look into the association of armed conflicts and HIV prevalence in sub-Saharan Africa. The HIV-1 prevalence was 1.7% in an antenatal care group ( n = 517) and 1.9% in a family planning group ( n = 518). Socioeconomic and sexual background factors did not significantly differ HIV-positive from HIV-negative women. Data on armed conflict factors were matched with HIV prevalence figures among pregnant women in sub-Saharan Africa. The level of armed conflicts was found to be inversely related to HIV prevalence. The low HIV seroprevalence in Luanda is in sharp contrast to the capitals of neighbouring countries. While the spread of HIV may have been hampered by the long armed conflict in the country, it is feared to increase rapidly with the return of soldiers and refugees in a post-war situation. The challenge for preventive actions is urgent. This example may be relevant to other areas with a recent end-of-war situation.
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Affiliation(s)
- R T Strand
- Division of International Health, Karolinska Institutet, Stockholm, Sweden.
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23
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Holgersson G, Bergström S, Liv P, Nilsson J, Edlund P, Blomberg C, Nyman J, Friesland S, Ekman S, Asklund T, Henriksson R, Bergqvist M. Effect of Increased Radiotoxicity on Survival of Patients with Non-small Cell Lung Cancer Treated with Curatively Intended Radiotherapy. Anticancer Res 2015; 35:5491-5497. [PMID: 26408714] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To elucidate the impact of different forms of radiation toxicities (esophagitis, radiation pneumonitis, mucositis and hoarseness), on the survival of patients treated with curatively intended radiotherapy for non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Data were individually collected retrospectively for all patients diagnosed with NSCLC subjected to curatively intended radiotherapy (≥50 Gy) in Sweden during the time period 1990 to 2000. RESULTS Esophagitis was the only radiation-induced toxicity with an impact on survival (hazard ratio=0.83, p=0.016). However, in a multivariate model, with clinical- and treatment-related factors taken into consideration, the impact of esophagitis on survival was no longer statistically significant (hazard ratio=0.88, p=0.17). CONCLUSION The effect on survival seen in univariate analysis may be related to higher radiation dose and to the higher prevalence of chemotherapy in this group. The results do not suggest that the toxicities examined have any detrimental effect on overall survival.
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Affiliation(s)
- Georg Holgersson
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Stefan Bergström
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Per Liv
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden
| | - Jonas Nilsson
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Per Edlund
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Carl Blomberg
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Ekman
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Thomas Asklund
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Michael Bergqvist
- Center for Research and Development, Uppsala University, Gävle Hospital, Gävle, Sweden Department of Oncology, Gävle Hospital, Gävle, Sweden Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
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Walters S, Benitez-Majano S, Muller P, Coleman MP, Allemani C, Butler J, Peake M, Guren MG, Glimelius B, Bergström S, Påhlman L, Rachet B. Is England closing the international gap in cancer survival? Br J Cancer 2015; 113:848-60. [PMID: 26241817 PMCID: PMC4559829 DOI: 10.1038/bjc.2015.265] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/19/2015] [Accepted: 06/24/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We provide an up-to-date international comparison of cancer survival, assessing whether England is 'closing the gap' compared with other high-income countries. METHODS Net survival was estimated using national, population-based, cancer registrations for 1.9 million patients diagnosed with a cancer of the stomach, colon, rectum, lung, breast (women) or ovary in England during 1995-2012. Trends during 1995-2009 were compared with estimates for Australia, Canada, Denmark, Norway and Sweden. Clinicians were interviewed to help interpret trends. RESULTS Survival from all cancers remained lower in England than in Australia, Canada, Norway and Sweden by 2005-2009. For some cancers, survival improved more in England than in other countries between 1995-1999 and 2005-2009; for example, 1-year survival from stomach, rectal, lung, breast and ovarian cancers improved more than in Australia and Canada. There has been acceleration in lung cancer survival improvement in England recently, with average annual improvement in 1-year survival rising to 2% during 2010-2012. Survival improved more in Denmark than in England for rectal and lung cancers between 1995-1999 and 2005-2009. CONCLUSIONS Survival has increased in England since the mid-1990s in the context of strategic reform in cancer control, however, survival remains lower than in comparable developed countries and continued investment is needed to close the international survival gap.
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Affiliation(s)
- Sarah Walters
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sara Benitez-Majano
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Patrick Muller
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John Butler
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Gynaecological Oncology, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Mick Peake
- Glenfield Hospital, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, UK
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, Ullevaal, PO Box 4956, Nydalen, NO-0424 Oslo, Norway
- K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, PO Box 4953, Nydalen, NO-0424 Oslo, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | | | - Lars Påhlman
- Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Ekman S, Harmenberg J, Frödin JE, Bergström S, Wassberg C, Eksborg S, Larsson O, Axelson M, Jerling M, Abrahmsen L, Hedlund Å, Alvfors C, Ståhl B, Bergqvist M. A novel oral insulin-like growth factor-1 receptor pathway modulator and its implications for patients with non-small cell lung carcinoma: A phase I clinical trial. Acta Oncol 2015; 55:140-8. [PMID: 26161618 DOI: 10.3109/0284186x.2015.1049290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A phase Ia/b dose-escalation study was performed to characterize the safety, efficacy and pharmacokinetic properties of the oral small molecule insulin-like growth factor-1-receptor pathway modulator AXL1717 in patients with advanced solid tumors. MATERIAL AND METHODS This was a prospective, single-armed, open label, dose-finding phase Ia/b study with the aim of single day dosing (phase Ia) to define the starting dose for multi-day dosing (phase Ib), and phase Ib to define and confirm recommended phase II dose (RP2D) and if possible maximum tolerated dose (MTD) for repeated dosing. RESULTS AND CONCLUSION Phase Ia enrolled 16 patients and dose escalations up to 2900 mg BID were successfully performed without any dose limiting toxicity (DLT). A total of 39 patients were treated in phase Ib. AXL1717 was well tolerated with neutropenia as the only dose-related, reversible, DLT. RP2D dose was found to be 390 mg BID for four weeks. Some patients, mainly with NSCLC, demonstrated signs of clinical benefit, including four partial tumor responses (one according to RECIST and three according to PET). The 15 patients with NSCLC with treatment duration longer than two weeks with single agent AXL1717 in third or fourth line of therapy showed a median progression-free survival of 31 weeks and overall survival of 60 weeks. Down-regulation of IGF-1R on granulocytes and increases of free serum levels of IGF-1 were seen in patients treated with AXL1717. AXL1717 had an acceptable safety profile and demonstrated promising efficacy in this heavily pretreated patient cohort, especially in patients with NSCLC. RP2D was concluded to be 390 mg BID for four weeks. Trial number is NCT01062620.
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Affiliation(s)
- Simon Ekman
- a Department of Immunology , Genetics and Pathology, Uppsala University , Uppsala , Sweden
| | | | - Jan-Erik Frödin
- c Department of Oncology , Karolinska University Hospital , Stockholm , Sweden
| | | | - Cecilia Wassberg
- e Section of Radiology, Department of Radiology , Oncology and Radiation Sciences, Uppsala University , Uppsala , Sweden
| | - Staffan Eksborg
- f Childhood Cancer Research Unit, Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Olle Larsson
- g Cellular and Molecular Tumor Pathology, Department of Oncology and Pathology , Cancer Centre Karolinska, Karolinska University Hospital , Stockholm , Sweden
| | - Magnus Axelson
- h Department of Clinical Chemistry , Karolinska University Hospital , Stockholm , Sweden
| | - Markus Jerling
- b Axelar AB, Karolinska Institute Science Park , Solna , Sweden
| | - Lars Abrahmsen
- b Axelar AB, Karolinska Institute Science Park , Solna , Sweden
| | - Åsa Hedlund
- a Department of Immunology , Genetics and Pathology, Uppsala University , Uppsala , Sweden
| | | | - Birgitta Ståhl
- b Axelar AB, Karolinska Institute Science Park , Solna , Sweden
| | - Michael Bergqvist
- a Department of Immunology , Genetics and Pathology, Uppsala University , Uppsala , Sweden
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Sandelin M, Berglund A, Sundström M, Micke P, Ekman S, Bergqvist M, Bergström S, Koyi H, Brandén E, Janson C, Botling J. Patients with Non-small Cell Lung Cancer Analyzed for EGFR: Adherence to Guidelines, Prevalence and Outcome. Anticancer Res 2015; 35:3979-3985. [PMID: 26124345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) analysis is the first molecular test introduced in the routine care of patients with non-small cell lung cancer (NSCLC). In the present study, we describe the prevalence of EGFR mutations and the adherence to testing and treatment guidelines in a population-based Swedish NSCLC cohort. MATERIALS AND METHODS Patients with NSCLC analyzed for EGFR mutations were identified and their characteristics and survival data were retrieved. We compared the study cohort to a matched lung cancer population. RESULTS The EGFR mutation frequency was 10%. Mutations were enriched in women and in adenocarcinoma cases. Out of patients with advanced-stage NSCLC with non-squamous histology, only 49% were referred for EGFR analysis. Out of the patients with EGFR mutation and advanced disease, only 38% received EGFR-tyrosine kinase inhibitor (TKI) in first-line therapy. CONCLUSION The EGFR-mutated NSCLC population studied is similar to other Western populations. Surprisingly, a large proportion of patients were not referred for EGFR analysis. Out of the patients with EGFR mutation, fewer than 40% received EGFR-TKI as first-line treatment. Our results highlight the need for follow-up of treatment and diagnostic algorithms in routine healthcare.
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Affiliation(s)
- Martin Sandelin
- Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | | | - Magnus Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Simon Ekman
- Section of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden Unit of Molecular Pathology, Uppsala University Hospital, Uppsala, Sweden
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Holgersson G, Bergqvist M, Koyi H, Berglund A, Lambe M, Bergström S. [Waiting time in lung cancer care. Patient guides provided faster flow]. Lakartidningen 2015; 112:DEYE. [PMID: 26035533] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting time from suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
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Affiliation(s)
- Georg Holgersson
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Onkologikliniken - Gävle sjukhus Gävle, Sweden
| | - Michael Bergqvist
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Gävle sjukhus - Gävle, Sweden
| | - Hirsh Koyi
- Gävle sjukhus - Gävle, Sweden Gävle sjukhus - Gävle, Sweden
| | - Anders Berglund
- Regionalt cancercentrum - Uppsala, Sweden Regionalt cancercentrum - Uppsala, Sweden
| | - Mats Lambe
- Regionalt cancercentrum - Uppsala, Sweden -
| | - Stefan Bergström
- Gävle sjukhus - Onkologikliniken Gävle, Sweden Gävle sjukhus - Onkologikliniken Gävle, Sweden
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28
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Blomberg C, Nilsson J, Holgersson G, Edlund P, Bergqvist M, Adwall L, Ekman S, Brattström D, Bergström S. Randomized Trials of Systemic Medically-treated Malignant Mesothelioma: A Systematic Review. Anticancer Res 2015; 35:2493-2501. [PMID: 25964522] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a rare but aggressive malignancy mainly localized to the pleura. Malignant mesothelioma grows highly invasive into surrounding tissue and has a low tendency to metastasize. The median overall survival (OS) of locally advanced or metastatic disease without treatment is 4-13 months but, during recent years, improvement in survival has been achieved since treatment for patients with mesothelioma has improved with better palliative care, systemic medical treatment, surgery and improved diagnostics methods. The present review aims at describing available data from randomized trials considering systemic medical treatment for this patient category.
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Affiliation(s)
- Carl Blomberg
- Department of Oncology, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Uppsala, Sweden Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Jonas Nilsson
- Department of Oncology, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Uppsala, Sweden Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Georg Holgersson
- Department of Oncology, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Uppsala, Sweden Department of Radiology, Oncology and Radiation Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Per Edlund
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Michael Bergqvist
- Department of Oncology, Gävle Hospital, Gävle, Sweden Centre for Research and Development Uppsala University/County Council of Gävleborg, Uppsala, Sweden Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Linda Adwall
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Simon Ekman
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Brattström
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan Bergström
- Department of Oncology, Gävle Hospital, Gävle, Sweden Department of Oncology, Uppsala University Hospital, Uppsala, Sweden Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
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Holgersson G, Bergström S, Harmenberg J, Ringbom M, Klockare M, Jerling M, Ekman S, Lundström KL, Koyi H, Brandén E, Larsson O, Bergqvist M. A phase I pilot study of the insulin-like growth factor 1 receptor pathway modulator AXL1717 in combination with gemcitabine HCl and carboplatin in previously untreated, locally advanced, or metastatic non-small cell lung cancer. Med Oncol 2015; 32:129. [PMID: 25794491 DOI: 10.1007/s12032-015-0578-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/14/2015] [Indexed: 11/24/2022]
Abstract
AXL1717 is an orally bioavailable IGF-1R pathway modulator that has been shown to have anti-tumoral effects. The objectives of the present study were to define maximum tolerated dose and the recommended phase II dose (RPTD) of AXL1717 in combination with gemcitabine HCl and carboplatin in non-small cell lung cancer (NSCLC). Patients with previously untreated, locally advanced, or metastatic NSCLC (squamous cell cancer or adenocarcinoma) in good performance status and with preserved major organ functions were enrolled in the study. The study was an open-label phase I study with planned cohorts of three patients per dose level of AXL1717 (215, 290, and 390 mg BID). In total, 12 patients were enrolled in the study, and of these, two were prematurely excluded. AXL1717 was administered at one dose level, 215 mg BID. A total number of 81 unique adverse events were reported. Bone marrow toxicity was reported in 10 out of 12 patients, and this organ class showed the largest number of related events. AXL1717 in combination with gemcitabine HCl and carboplatin is a possible treatment approach in previously untreated, locally advanced, or metastatic non-small cell lung cancer. However, due to the bone marrow toxicity profile shown in the present study, further dose increases of AXL1717 above 215 mg BID will probably not be feasible. Therefore, 215 mg BID constitutes maximum tolerated dose and RPTD.
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Affiliation(s)
- Georg Holgersson
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden,
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Abstract
OBJECTIVE Very little is known about car driving in palliative patients. We have asked patients in at home palliative care environments about their driving habits during palliative care. METHODS At admittance to the palliative care program and at regular visits the patients were asked a few questions about age, diagnosis, sex, driving license, driving, medication and functional status. RESULTS 23% (40) of our studied patients (173) were still driving, and if we included patients who responded that they would still consider driving, the corresponding figure was 39%. CONCLUSIONS Our study indicates that the prescribing doctor should be well informed about national driving legislation and be prepared to discuss driving in combination with heavy opioid medication and tranquilizers even with patients in palliative care.
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Affiliation(s)
- Anders Widman
- Palliative Care Team, Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Stefan Bergström
- Palliative Care Team, Department of Oncology, Gävle Hospital, Gävle, Sweden
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31
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Sooman L, Ekman S, Tsakonas G, Jaiswal A, Navani S, Edqvist PH, Pontén F, Bergström S, Johansson M, Wu X, Blomquist E, Bergqvist M, Gullbo J, Lennartsson J. PTPN6 expression is epigenetically regulated and influences survival and response to chemotherapy in high-grade gliomas. Tumour Biol 2014; 35:4479-88. [DOI: 10.1007/s13277-013-1590-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/19/2013] [Indexed: 01/05/2023] Open
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Holgersson G, Bergström S, Ekman S, Brattström D, Henriksson R, Edlund P, Bergqvist M. Radiosensitizing biological modifiers enhancing efficacy in non-small-cell lung cancer treated with radiotherapy. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Georg Holgersson
- Department of Oncology, Entrance 78, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
- Section of Oncology, Department of Radiology, Oncology & Radiation Sciences, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
- Department of Oncology, Gävle Hospital, SE-801 87 Gävle, Sweden
| | | | - Simon Ekman
- Section of Oncology, Department of Radiology, Oncology & Radiation Sciences, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
| | - Daniel Brattström
- Section of Oncology, Department of Radiology, Oncology & Radiation Sciences, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences & Oncology, Umeå University Hospital, SE-901 87 Umeå, Sweden
| | - Per Edlund
- Section of Oncology, Department of Radiology, Oncology & Radiation Sciences, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
| | - Michael Bergqvist
- Section of Oncology, Department of Radiology, Oncology & Radiation Sciences, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
- Department of Oncology, Gävle Hospital, SE-801 87 Gävle, Sweden
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Walters S, Maringe C, Coleman MP, Peake MD, Butler J, Young N, Bergström S, Hanna L, Jakobsen E, Kölbeck K, Sundstrøm S, Engholm G, Gavin A, Gjerstorff ML, Hatcher J, Johannesen TB, Linklater KM, McGahan CE, Steward J, Tracey E, Turner D, Richards MA, Rachet B. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007. Thorax 2013; 68:551-64. [PMID: 23399908 DOI: 10.1136/thoraxjnl-2012-202297] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND The authors consider whether differences in stage at diagnosis could explain the variation in lung cancer survival between six developed countries in 2004-2007. METHODS Routinely collected population-based data were obtained on all adults (15-99 years) diagnosed with lung cancer in 2004-2007 and registered in regional and national cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Stage data for 57 352 patients were consolidated from various classification systems. Flexible parametric hazard models on the log cumulative scale were used to estimate net survival at 1 year and the excess hazard up to 18 months after diagnosis. RESULTS Age-standardised 1-year net survival from non-small cell lung cancer ranged from 30% (UK) to 46% (Sweden). Patients in the UK and Denmark had lower survival than elsewhere, partly because of a more adverse stage distribution. However, there were also wide international differences in stage-specific survival. Net survival from TNM stage I non-small cell lung cancer was 16% lower in the UK than in Sweden, and for TNM stage IV disease survival was 10% lower. Similar patterns were found for small cell lung cancer. CONCLUSIONS There are comparability issues when using population-based data but, even given these constraints, this study shows that, while differences in stage at diagnosis explain some of the international variation in overall lung cancer survival, wide disparities in stage-specific survival exist, suggesting that other factors are also important such as differences in treatment. Stage should be included in international cancer survival studies and the comparability of population-based data should be improved.
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Affiliation(s)
- Sarah Walters
- Department of Non Communicable Disease Epidemiology , London School of Hygiene and Tropical Medicine, London, UK.
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Holgersson G, Bergqvist M, Nyman J, Hoye E, Helsing M, Friesland S, Holgersson M, Ekberg L, Mörth C, Ekman S, Blystad T, Ewers SB, Löden B, Henriksson R, Bergström S. The impact of hyperfractionated radiotherapy regimen in patients with non-small cell lung cancer. Med Oncol 2012; 30:320. [PMID: 23254960 DOI: 10.1007/s12032-012-0320-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 12/25/2022]
Abstract
The prognosis for patients with lung cancer is poor with an average of 5-year overall survival rate of only 10-15 % taking all clinical stages together. The aim of this study was to elucidate the impact of the radiotherapy regimen on survival. Clinical data were collected from all the Swedish Oncology Departments for 1,287 patients with a diagnosed non-small cell lung cancer (NSCLC) subjected to curatively intended irradiation (≥50 Gy) during the years 1990 to 2000. The included patients were identified based on a manual search of all medical and radiation charts at the oncology departments from which the individual patient data were collected. Patients who did not have a histopathological diagnosis date and/or death date/last follow-up date as well as patients being surgically treated were excluded from the study (n = 592). Thus, 695 patients were included in the present study. Patients who received hyperfractionated radiotherapy (HR) had a higher local control rate compared with patients receiving conventional fractionation (CF) (38 vs. 49 % local relapse). The difference in survival between the two radiotherapy regimens was statistically significant in a univariate Cox analysis (p = 0.023) in favor of HR. This significance was, however, not retained in a multivariate Cox analysis (p = 0.56). Thus, the possible beneficial effects of hyperfractionation are still unclear and need to be further investigated in well-controlled prospective clinical trials, preferably including systemic treatment with novel drugs.
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Affiliation(s)
- Georg Holgersson
- Section of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden.
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Wu X, Sooman L, Lennartsson J, Bergström S, Bergqvist M, Gullbo J, Ekman S. Microtubule inhibition causes epidermal growth factor receptor inactivation in oesophageal cancer cells. Int J Oncol 2012; 42:297-304. [PMID: 23174948 DOI: 10.3892/ijo.2012.1710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/02/2012] [Indexed: 11/06/2022] Open
Abstract
Drugs that interfere with microtubule function can prevent cells from mitosis and may cause cell cycle arrest or apoptosis. Various microtubule targeting agents, both stabilizers and inhibitors, are used in a clinical setting to treat cancer. In the current study, we investigated the sensitivity of oesophageal cancer cells to different microtubule targeting agents. The current study demonstrated that different microtubule targeting agents disrupted the microtubule network and inhibited survival of oesophageal cancer cells in a dose-dependent manner. Interestingly, an additional cellular effect with inhibition of tyrosine phosphorylation of the EGFR and subsequent downregulation of EGFR-induced signalling was also observed, suggesting an additional mechanism of action for microtubule destabilising agents. A tyrosine phosphatase inhibitor, sodium orthovanadate, could reverse the EGFR dephosphorylation effects induced by microtubule targeting agents. The EGFR dephosphorylation could be reversed by a tyrosine phosphatase inhibitor, indicating that disruption of the microtubule network may lead to activation of a protein tyrosine phosphatase (PTP) that can regulate EGFR phosphorylation and activation, an effect of potential clinical relevance for combination therapies in patients.
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Affiliation(s)
- Xuping Wu
- The Second Hospital of Nanjing affiliated to Southeast University, Nanjing, People's Republic of China.
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Aronsson A, Bergström S. W404 COMPRESSION OF THE AORTA IMMEDIATELY ARRESTS LIFE-THREATENING OBSTETRIC BLEEDING. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62126-2] [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: 11/29/2022]
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37
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Johansson F, Ekman S, Blomquist E, Henriksson R, Bergström S, Bergqvist M. A review of dose-dense temozolomide alone and in combination with bevacizumab in patients with first relapse of glioblastoma. Anticancer Res 2012; 32:4001-4006. [PMID: 22993350] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Treatment of patients with glioblastoma improved dramatically when concomitant and adjuvant temozolomide was added to external radiation therapy. The addition of this new treatment schedule as well as the improvements in individually-tailored radiation treatment, has resulted in a larger proportion of patients being fit for further treatment after first relapse. One of the most interesting combinations that have started to become part of the therapeutic arsenal in the daily clinic is dose-dense temozolomide in combination with bevacizumab. We reviewed and compiled the literature concerning the present topic based on a search of the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) for the years between 1995 and 2011. The clinical studies that have been performed are small and divergent, making it difficult to grade the scientific evidence for the combinatorial treatment of dose-dense temozolomide and bevacizumab. However, the available studies and the experience we have at our departments suggest that this combination is of interest for glioblastoma patients experiencing first relapse. More randomized clinical trials are needed in order to establish the standard of treatment at first relapse in patients with glioblastoma.
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Affiliation(s)
- Fredrik Johansson
- Section of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
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Holgersson G, Hoye E, Bergqvist M, Ekman S, Nyman J, Helsing M, Friesland S, Holgersson M, Ekberg L, Blystad T, Ewers SB, Mörth C, Löden B, Henriksson R, Bergström S. Swedish Lung Cancer Radiation Study Group: predictive value of age at diagnosis for radiotherapy response in patients with non-small cell lung cancer. Acta Oncol 2012; 51:759-67. [PMID: 22793039 DOI: 10.3109/0284186x.2012.681064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of the present study was to investigate the impact of age at diagnosis on prognosis in patients treated with curatively intended radiotherapy for NSCLC. MATERIAL AND METHODS This is a joint effort among all the Swedish Oncology Departments that includes all identified patients with a diagnosed non-small cell lung cancer that have been subjected to curatively intended irradiation (≥50 Gy) treated during 1990 to 2000. Included patients had a histopathological/cytological diagnosis date as well as a death date or a last follow-up date. The following variables were studied in relation to overall and disease-specific survival: age, gender, histopathology, time period, smoking status, stage and treatment. RESULTS The median overall survival of all 1146 included patients was 14.7 months, while the five-year overall survival rate was 9.5%. Younger patients (<55 years), presented with a more advanced clinical stage but had yet a significantly better overall survival compared with patients in the age groups 55-64 years (p = 0.035) and 65-74 years (p = 0.0097) in a multivariate Cox regression analysis. The overall survival of patients aged ≥75 years was comparable to those aged <55 years. CONCLUSION In this large retrospective study we describe that patients younger than 55 years treated with curatively intended radiotherapy for NSCLC have a better overall survival than patients aged 55-64 and 65-74 years and that younger patients seem to benefit more from the addition of surgery and/or chemotherapy to radiotherapy. Due to the exploratory nature of the study, these results should be confirmed in future prospective trials.
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Ekman S, Harmenberg J, Frödin JE, Bergström S, Wassberg C, Eksborg S, Larsson O, Axelson M, Hedlund Å, Alvfors C, Ståhl B, Bergqvist M. A novel targeted oral insulin-like growth factor-1 receptor (IGF-1R) inhibitor and its implications for patients with non-small cell lung cancer (NSCLC): A phase I clinical trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7539] [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] [Indexed: 11/20/2022] Open
Abstract
7539 Background: The small-molecule IGF-1R inhibitor picropodophyllin (PPP) is the active compound in the oral suspension AXL1717. PPP has shown extensive preclinical antitumor effects against a wide range of cancers supporting its use as a single agent treatment. Methods: The clinical phase Ia/b study on advanced progressive cancer patients with various solid tumors and without remaining treatment options aimed at establishing the recommended phase II dose (RPTD) and the maximum tolerated dose (MTD) of AXL1717. Phase Ia consisted of single day dosing and phase Ib multiday dosing (to an accumulated total of 28 days of treatment; 2*28 days following amendment) with 3 weeks intermission between treatments. Non-progressing patients could continue treatment in the extension study without time limitation (treated 119 weeks). PK samples were obtained at 10 different time-points after the morning dose when appropriate. Results: Phase Ia included 16 patients treated with 78 BID doses ranging from 5-2900 mg AXL1717 BID without any dose-limiting toxicity. Phase Ib included 39 patients treated with doses between 290-930 mg BID in periods between 7-28 days, totally for 147 weeks. Phase Ib showed that AXL1717 was well tolerated and neutropenia was the only detected dose-related, reversible, dose-limiting toxicity (DLT). RPTD dose was set at 390 mg BID to minimize neutropenia. Although the study was not designed for efficacy assessment, some patients, mainly with NSCLC, showed signs of clinical benefit, including 3 partial responses and 12 patients with stable disease. The 15 patients with NSCLC and treatment duration of more than 2 weeks with single agent AXL1717 in 3rd or 4th line showed a median time to progression of 31 weeks and a survival time of 60 weeks with 4 patients being alive at cut-off. Down-regulation of IGF-1R on granulocytes and increases of serum IGF-1 were seen. The systemic exposure of AXL1717 was dose-dependent and sufficient for antitumor effects. Conclusions: AXL1717 has a good safety profile and demonstrated promising clinical benefits in this severely ill and heavily pretreated patient cohort, especially in patients with NSCLC.
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Affiliation(s)
- Simon Ekman
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Jan-Erik Frödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Cecilia Wassberg
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
| | - Staffan Eksborg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Olle Larsson
- Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Axelson
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Hedlund
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Carina Alvfors
- Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Birgitta Ståhl
- Karolinska Institutet Science Park/Axelar, Stockholm, Sweden
| | - Michael Bergqvist
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
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Holgersson G, Sandelin M, Hoye E, Bergström S, Henriksson R, Ekman S, Nyman J, Helsing M, Friesland S, Holgersson M, Lundström KL, Janson C, Birath E, Mörth C, Blystad T, Ewers SB, Löden B, Bergqvist M. Swedish lung cancer radiation study group: the prognostic value of anaemia, thrombocytosis and leukocytosis at time of diagnosis in patients with non-small cell lung cancer. Med Oncol 2012; 29:3176-82. [PMID: 22565809 DOI: 10.1007/s12032-012-0247-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/24/2012] [Indexed: 01/18/2023]
Abstract
There is a need to improve the prognostic and predictive indicators in non-small cell lung cancer (NSCLC). At present, the main focus is on genetic predictive markers while the prognostic value of the standard blood variables related to haematopoiesis has been subjected to relatively limited attention. To study the prognostic potential of haemoglobin (Hgb), platelet (Plt) and white blood cell (WBC) levels at time of diagnosis in NSCLC patients, 835 NSCLC patients, stage I-IV, who received radiotherapy with curative intention (>50 Gy), were included in the study. WBC, Plt, Hgb, gender, age at diagnosis, stage, surgery and first-line chemotherapy were studied in relation to overall survival. For patients with Hgb < 110 g/L and Hgb ≥ 110 g/L), the median survival was 11.2 and 14.5 months, respectively (p = 0.0032). For WBC > 9.0 × 10(9)/L and < 9.0 × 10(9)/L, the median survival was 11.6 and 15.4 months, respectively (p < 0.0001). For Plt > 350 × 10(9)/L and <350 × 10(9)/L, the median survival was 11.2 and 14.9 months, respectively (p < 0.0001). The median survival in patients with pathological results in all three markers was half of that in patients with normal levels of all three markers (8.0 and 16.0 months, respectively (p < 0.0001). The level of the three studied haematological biomarkers corresponds significantly to outcome in NSCLC. These results indicate that standard haematological variables may be used as guidance for the clinician in the decision-making regarding treatment intensity and patient information.
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Affiliation(s)
- Georg Holgersson
- Section of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, 751 85, Uppsala, Sweden
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Holgersson G, Sandelin M, Hoye E, Bergström S, Henriksson R, Ekman S, Nyman J, Helsing M, Friesland S, Brodin O, Holgersson M, Lundström KL, Janson C, Ekberg L, Mörth C, Blystad T, Ewers SB, Löden B, Bergqvist M. The value of induction chemotherapy for survival in patients with non-small cell lung cancer treated with radiotherapy. Anticancer Res 2012; 32:1339-1346. [PMID: 22493368] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of the present study was to retrospectively investigate the impact of induction chemotherapy on treatment outcome in patients treated with curatively intended radiotherapy for non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with a diagnosed NSCLC that have been subjected to curatively intended irradiation (≥50 Gy) and treated in an oncology department in Sweden during the years 1990-2000 were included in the study. Operated patients and patients having received concomitant chemotherapy were excluded. The included patients were localised by a manual search of all the oncology departments' medical records and radiation charts. RESULTS Patients treated with induction chemotherapy (n=79) had a significantly better overall survival compared with patients treated with radiotherapy alone (p=0.0097) in a univariate Cox regression analysis. A platinum/taxane combination produced the greatest survival benefit; hazard ratio=0.49 (95% confidence interval=0.31 to 0.75). CONCLUSION We found that patients treated with induction chemotherapy in addition to radiotherapy for NSCLC have a better overall survival than patients treated with radiotherapy alone and that the best results are achieved using a platinum/taxane combination.
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Fogliata A, Clivio A, Cozzi L, Nicolini G, Pesce GA, Richetti A, Vanetti E, Bergström S, Hållström P, Cafaro I, Parietti E, Dipasquale G, Weber DC, Mancosu P, Navarria P, Scorsetti M. Reply to the Letter to the editor on Cranio-spinal irradiation with volumetric modulated arc therapy by G. Saini et al. Radiother Oncol 2012. [DOI: 10.1016/j.radonc.2011.08.034] [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: 11/27/2022]
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Wu X, Hedman H, Bergqvist M, Bergström S, Henriksson R, Gullbo J, Lennartsson J, Hesselius P, Ekman S. Expression of EGFR and LRIG proteins in oesophageal carcinoma with emphasis on patient survival and cellular chemosensitivity. Acta Oncol 2012; 51:69-76. [PMID: 21417672 DOI: 10.3109/0284186x.2011.562239] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Leucine-rich and immunoglobulin-like domains 1-3 (LRIG1-3) proteins have been implicated in the regulation of EGFR signalling. In the present study, we investigated the clinical implications of the expression of EGFR and LRIG1-3 in oesophageal carcinoma, as well as the correlation between their expression levels and the chemosensitivity of oesophageal carcinoma cell lines. PATIENTS AND METHODS Tumours from 80 patients with oesophageal carcinoma were investigated for the expression of EGFR and LRIG proteins by immunohistochemistry. Oesophageal carcinoma cell lines were investigated for their expression of EGFR and LRIG1, 2, and 3 by quantitative real time RT-PCR and for their sensitivity to commonly used chemotherapeutics by a cytotoxicity assay. RESULTS AND DISCUSSION Based on a total score of intensity and expression rates, a trend towards survival difference was found for EGFR (p = 0.09) and LRIG2 (p = 0.18) whereas for LRIG1 and -3 there was no trend towards any association with survival. Correlation analysis revealed a correlation with the clinical expression of EGFR and LRIG3 (p = 0.0007). Significant correlations were found between LRIG1 expression levels and sensitivity to cisplatin (r = -0.74), docetaxel (r = -0.69), and vinorelbine (r = -0.82) in oesophageal carcinoma cell lines. EGFR and the LRIG proteins may be functionally involved in oesophageal carcinoma, but larger materials are needed to fully elucidate the clinical implication.
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Affiliation(s)
- Xuping Wu
- Section of Oncology, Department of Oncology, Radiology and Clinical Immunology, Uppsala University, Sweden
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Ekman S, Harmenberg J, Stáhl B, Hedlund A, Bergström S, Frodin J, Bergqvist M. 9013 POSTER DISCUSSION Phase I Dose-escalation Study of AXL1717: a Novel Targeted Oral Insulin-like Growth Factor-1 Receptor (IGF-1R) Inhibitor and Its Implications for Patients With Non-small Cell Lung Carcinoma. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72325-5] [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: 10/17/2022]
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Ekman S, Frödin JE, Harmenberg J, Bergman A, Hedlund A, Dahg P, Alvfors C, Ståhl B, Bergström S, Bergqvist M. Clinical Phase I study with an Insulin-like Growth Factor-1 receptor inhibitor: experiences in patients with squamous non-small cell lung carcinoma. Acta Oncol 2011; 50:441-7. [PMID: 20698809 DOI: 10.3109/0284186x.2010.499370] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Inhibition of the Insulin-like Growth Factor-1 receptor (IGF-1R) has resulted in extensive anti-tumor effects. Picropdophyllin (PPP, AXL1717) is a small-molecule inhibitor of the IGF-1R without inhibition of closely related receptors including the insulin receptor and has shown extensive effects against a wide range of tumors in animals. PPP is currently tested as an orally administrated single agent treatment in an open-label combined Phase I/II clinical study in advanced cancer patients with solid tumors which progress in spite of several lines of treatment. PATIENTS AND METHODS The first part (Phase IA) consisted of single day BID dosing every three weeks with consecutive dose escalations. The second part (Phase IB) consists of seven days or longer BID dosing every three weeks, dosing range being 520-700 mg BID. Non-progressing patients could continue treatment within a compassionate use setting. RESULTS AND DISCUSSION The present report describes our experience with the four patients with progressive squamous non-small cell lung cancer (NSCLC) that have received treatment with PPP. Despite more than seven months of PPP treatment as third or fourth line treatment, the reported patients did not develop any additional metastases. Furthermore, CT scans as well as (18)FDG-Positron Emission Tomography (PET) scans of the patients demonstrated large central necrotic areas, which may suggest tumor response. At the same time, the study drug is so far well tolerated. The phenomenon of necrosis in the tumors suggestive of tumor response has not been reported before in anti-IGF-1R treatment and will be subject to further studies in the present clinical trial.
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Affiliation(s)
- Simon Ekman
- Section of Oncology, Department of Oncology, Radiology and Clinical Immunology, Uppsala University, Sweden.
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Fogliata A, Bergström S, Cafaro I, Clivio A, Cozzi L, Dipasquale G, Hållström P, Mancosu P, Navarria P, Nicolini G, Parietti E, Pesce GA, Richetti A, Scorsetti M, Vanetti E, Weber DC. Cranio-spinal irradiation with volumetric modulated arc therapy: A multi-institutional treatment experience. Radiother Oncol 2011; 99:79-85. [PMID: 21421273 DOI: 10.1016/j.radonc.2011.01.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 11/27/2022]
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Hallqvist A, Wagenius G, Rylander H, Brodin O, Holmberg E, Lödén B, Ewers SB, Bergström S, Wichardt-Johansson G, Nilsson K, Ekberg L, Sederholm C, Nyman J. Concurrent cetuximab and radiotherapy after docetaxel-cisplatin induction chemotherapy in stage III NSCLC: satellite--a phase II study from the Swedish Lung Cancer Study Group. Lung Cancer 2010; 71:166-72. [PMID: 20541833 DOI: 10.1016/j.lungcan.2010.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 04/15/2010] [Accepted: 05/09/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND Several attempts to increase the locoregional control in locally advanced lung cancer including concurrent chemotherapy, accelerated fractionation and dose escalation have been made during the last years. As the EGFR directed antibody cetuximab has shown activity concurrent with radiotherapy in squamous cell carcinoma of the head and neck, as well as in stage IV NSCLC combined with chemotherapy, we wanted to investigate radiotherapy with concurrent cetuximab in locally advanced NSCLC, a tumour type often over expressing the EGF-receptor. METHODS Between February 2006 and August 2007 75 patients in stage III NSCLC with good performance status (PS 0 or 1) and adequate lung function (FEV1>1.0) were enrolled in this phase II study at eight institutions. Treatment consisted of 2 cycles of induction chemotherapy, docetaxel 75 mg/m² and cisplatin 75 mg/m² with 3 weeks interval. An initial dose of cetuximab 400 mg/m² was given before start of 3D-CRT to 68 Gy with 2 Gy per fraction in 7 weeks concurrent with weekly cetuximab 250 mg/m². TOXICITY was scored weekly during radiotherapy (CTC 3.0), and after treatment the patients were followed every third month with CT-scans, toxicity scoring and QLQ. RESULTS Seventy-one patients were eligible for analysis as four were incorrectly enrolled. HISTOLOGY adenocarcinoma 49%, squamous cell carcinoma 39% and other NSCLC 12%. The majority had PS 0 (62.5%), median age 62.2 (42-81), 50% were women and 37% had a pre-treatment weight loss>5%. TOXICITY esophagitis grade 1-2: 72%; grade 3: 1.4%. Hypersensitivity reactions grade 3-4: 5.6%. Febrile neutropenia grade 3-4: 15.4%. Skin reactions grade 1-2: 74%; grade 3: 4.2%. Diarrhoea grade 1-2: 38%; grade 3: 11.3%. Pneumonitis grade 1-2: 26.8%; grade 3: 4.2%; grade 5: 1.4%. The median follow-up was 39 months for patients alive and the median survival was 17 months with a 1-, 2- and 3-year OS of 66%, 37% and 29% respectively. Until now local or regional failure has occurred in 20 patients and 22 patients have developed distant metastases. Weight loss, PS and stage were predictive for survival in univariate as well as in multivariate analysis. CONCLUSION Induction chemotherapy followed by concurrent cetuximab and RT to 68 Gy is clearly feasible with promising survival. TOXICITY, e.g. pneumonitis and esophagitis is low compared to most schedules with concurrent chemotherapy. This treatment strategy should be evaluated in a randomised manner vs. concurrent chemoradiotherapy to find out if it is a valid treatment option.
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Affiliation(s)
- A Hallqvist
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
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Strand RT, Tumba P, Niekowal J, Bergström S. Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola. Afr J Reprod Health 2010; 14:55-62. [PMID: 21243919] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical management reveal weaknesses in obstetric care and may serve as an instrument for future improvement.
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Affiliation(s)
- R T Strand
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Bergström S, Holgersson G, Bergqvist JE, Bergqvist M, Ekman S, Stenström M. Dual-headed coincidence PET vs. dedicated PET/CT in the evaluation of thoracic malignancies. In Vivo 2010; 24:235-238. [PMID: 20364002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The aim of this study was to evaluate the usefulness of coincidence PET imaging as compared with dedicated PET/CT in cancer staging. PATIENTS AND METHODS Sixteen patients with thoracic malignancies referred to a PET/CT examination accepted to repeat the acquisition with a coincidence PET system. One experienced nuclear medicine physician compiled a report from the PET/CT examinations and the coincidence PET images. The reports were compared and evaluated according to the degree of agreement: no agreement, unsatisfactory, acceptable or satisfying agreement. RESULTS Satisfying or acceptable agreement between the PET/CT and the coincidence PET examination was found in 14 out of 16 patients (88%). The main issue for the examining physician was to anatomically locate the FDG uptake in the mediastinum in the coincidence PET images. CONCLUSION The data from this small study imply that the staging results obtained with coincidence PET are in most cases concordant with those obtained with dedicated PET/CT.
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