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  • 1. Benyi, Emelie
    et al.
    Linder, Marie
    Adami, Johanna
    Sophiahemmet University.
    Kieler, Helle
    Palme, Mårten
    Sävendahl, Lars
    Adult height is associated with risk of cancer and mortality in 5.5 million Swedish women and men2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 8, p. 730-736, article id jech-2018-211040Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have indicated that taller individuals are at greater risk of developing cancer. Death from cancer and other specific causes have also been linked to height, but the results have been inconclusive. We aimed to shed further light on the associations between height, cancer incidence and mortality.

    METHODS: We conducted a nationwide, population-based prospective cohort study, including 5.5 million Swedish women and men (aged 20-74). They were followed over a period of up to 54 years. Heights were retrieved from national registers (mainly the Passport Register where heights are most often self-reported). The risks of overall and specific cancers, as well as overall and cause-specific mortality, were presented as HR with 95% CIs per 10 cm increase in height.

    RESULTS: A total of 278 299 cases of cancer and 139 393 cases of death were identified. For overall cancer, HR was 1.19 (1.18-1.20) in women and 1.11 (1.10-1.12) in men for every 10 cm increase in height. All 15 specific cancer types were positively associated with height-most strongly for malignant melanoma in both genders, with HRs of 1.39 (1.35-1.43) in women and 1.34 (1.30-1.38) in men. For overall mortality, HR was 0.98 (0.97-0.99) in women and 0.91 (0.90-0.92) in men for every 10 cm increase in height. Cancer mortality was increased in taller individuals, with HR 1.15 (1.13-1.17) in women and 1.05 (1.03-1.07) in men for every 10 cm increase in height, whereas shorter individuals had increased overall mortality due to a number of other causes, such as cardiovascular disease.

    CONCLUSION: Overall and specific cancer risks, particularly malignant melanoma, were positively associated with height. Cancer mortality also increased with height. In contrast, overall mortality was decreased with height, particularly in men due to inverse associations with height for other causes of death.

  • 2. Bjöhle, Judith
    et al.
    Onjukka, Eva
    Rintelä, Niina
    Eloranta, Sandra
    Wickman, Marie
    Sophiahemmet University.
    Sandelin, Kerstin
    Gagliardi, Giovanna
    Liljegren, Annelie
    Post-mastectomy radiation therapy with or without implant-based reconstruction is safe in terms of clinical target volume coverage and survival: A matched cohort study2019In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 131, p. 229-236, article id S0167-8140(18)33384-XArticle in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Patients with breast cancer receiving mastectomy in our institution are offered immediate breast reconstruction (IBR). IBR may have an impact on the optimisation of radiation therapy (RT). Therefore, we aimed to evaluate the clinical target volume (CTV) dose coverage when disregarding the dose received by the breast implant in women treated for breast cancer. Furthermore, to investigate the safety of immediate breast reconstruction (IBR) with an implant (IBR+) in terms of recurrence and survival compared to patients without an implant (IBR-).

    PATIENTS AND METHODS: This matched-cohort included 128 patients with IBR+ and 252 IBR- patients (controls). The potential confounding effects of tumour stage and treatment were controlled for. For IBR+ patients, the implant volume was excluded from the CTV in the RT planning images, and the RT target coverage (V95%: CTV covered by ≥the 95% isodose) was compared between the IBR+ and IBR- groups.

    RESULTS: A limited under dosage was observed in patients without lymph-node irradiation; the V95% mean values for the CTV subtracting the implant were 84% and 92%, for IBR+ and IBR- groups, respectively. Median follow-up duration was 5.8 years (0.1-7.5 years). In comparing IBR+ and IBR- groups, no statistically significant differences were found in the incidence of recurrence rate ratios or recurrence free survival (log-rank p = 0.142), overall survival (log-rank p = 0.096), or breast cancer specific survival (log-rank p = 0.147).

    CONCLUSIONS: Post-mastectomy radiation therapy and implant-based reconstruction lead to minor under dosage of the target, due to the projection of the subcutaneous tissue in the presence of the implant. However, recurrence and survival rates were equally distributed among IBR+ and IBR- patients indicating that the overall treatment protocol used in our institution is safe.

  • 3.
    Doveson, Sandra
    Sophiahemmet University.
    Erfarenheter, förväntningar och beslutsfattande hos män med metastatisk prostatacancer2023Conference paper (Other academic)
  • 4.
    Doveson, Sandra
    et al.
    Sophiahemmet University.
    Fransson, Per
    Axelsson, Lena
    Sophiahemmet University.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Associations between experiences of treatment decision-making and treatment experiences during the first year of life-prolonging treatment among men with metastatic castration-resistant prostate cancerManuscript (preprint) (Other academic)
  • 5.
    Doveson, Sandra
    et al.
    Sophiahemmet University.
    Holm, Maja
    Sophiahemmet University.
    Fransson, Per
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Identification of early symptoms and changes in QoL and functioning among men with primary localized prostate cancer who later develop metastases: A matched, prospective study2022In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify early symptoms and changes in QoL among men with primary localized prostate cancer (PC) who later develop metastases.

    METHODS: From an ongoing prospective study of 3.885 men with localized PC, primarily treated with radiotherapy (RT), a subsample of men developing metastatic PC (mPC) following the first year after the start of RT and that had died during the follow-up (mPC group, n = 107) were matched against men who did not develop metastases (non-mPC group, n = 214). Data were collected using the EORTC QLQ-C30 and PCSS instruments. Non-parametric tests were performed for comparisons at baseline, end of RT, 3 months, and 1, 2, 3, and 5 years after RT.

    RESULTS: The final sample consists of 317 men (mPC n = 106; non-mPC n = 211) who had completed at least one questionnaire. Initially, symptom levels were generally low and QoL and functioning high in both groups. An increasing difference between the groups was found, where the mPC group gradually deteriorated from the 2-year follow-up. Significant differences were found for several outcomes at 3 and 5 years. In a sensitivity analysis, where metastatic patients were removed from the time-point of verified metastases, most differences did not remain significant. Significant deterioration over time was seen within both groups for some outcomes.

    SIGNIFICANCE OF RESULTS: The results indicate that unmet supportive needs occur over time among these men. Worsening QoL or functioning and symptoms may be difficult to recognize when the development is gradual over several years, and with various access to systematic follow-up in late phases. This highlights the need for continuous monitoring of PC patients to detect needs for supportive interventions early and throughout the disease course, also among those with non-metastatic disease who have undergone curatively intended treatment.

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  • 6.
    Doveson, Sandra
    et al.
    Sophiahemmet University.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Fransson, Per
    Axelsson, Lena
    Sophiahemmet University.
    Men's experiences related to decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer: A wish for a process adapted to personal preferences: A prospective interview studyManuscript (preprint) (Other academic)
  • 7. Eriksson, Linda
    et al.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Bergkvist, Karin
    Sophiahemmet University.
    Ljungman, Per
    Winterling, Jeanette
    Important factors associated with sick leave after allogeneic haematopoietic stem cell transplantation: A 1-year prospective study2021In: Journal of cancer survivorship, ISSN 1932-2259, E-ISSN 1932-2267, Vol. 15, no 6, p. 933-941Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study examines sick leave (SL) and factors associated with full-time SL 1 year after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in patients of working age from 2009 to 2016 (n = 122).

    METHODS: Questionnaire data were collected on admission to the allo-HSCT unit, at 7 months and 1 year after allo-HSCT. Associations between factors and SL were analysed using logistic regression analyses.

    RESULTS: One year after allo-HSCT, 76% of participants were on SL, with 36% on full-time SL. In univariable analyses, chronic graft-versus-host-disease (cGvHD) (OR 3.07; 95% CI 1.34-7.07; p = 0.01), having symptoms of depression at 7 months (OR 4.81; 95% CI 1.69-13.69; p = 0.00) and low levels of vocational satisfaction at 7 months after treatment (OR 3.27; 95% CI 1.27-8.41; p = 0.01) were associated with full-time SL 1 year after allo-HSCT. cGvHD (OR 3.43; 95% CI 1.35-8.73; p = 0.01) and having symptoms of depression at 7 months after allo-HSCT (OR 3.37; 95% CI 1.2-11.58; p = 0.02) remained significant in multivariable analysis.

    CONCLUSION: The majority of allo-HSCT survivors were on SL 1 year after treatment, and cGvHD, low vocational satisfaction and depressive symptoms were associated with full-time SL 1 year after allo-HSCT.

    IMPLICATIONS FOR CANCER SURVIVORS: Healthcare professionals need to be observant of and manage the consequences of cGvHD and patients' symptoms of depression in order to support them appropriately in their return-to-work process.

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  • 8.
    Holm, Maja
    et al.
    Sophiahemmet University.
    Doveson, Sandra
    Sophiahemmet University.
    Lindqvist, Olav
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Fransson, Per
    Quality of life in men with metastatic prostate cancer in their final years before death: a retrospective analysis of prospective data2018In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 17, no 1, article id 126Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Quality of Life (QoL) is the most important outcome for patients in palliative care along with symptom alleviation. Metastatic prostate cancer (mPC) is a life-threatening illness, and hence, a palliative care approach may be beneficial to this group. Over time, new life-prolonging treatments have been developed for men with mPC, but the possibility to prolong life should also be balanced against the men's QoL, particularly because there are side effects involved with these treatments. The aim of this study was to evaluate QoL, functioning and symptoms in men with mPC during their final years before death.

    METHODS: This is a retrospective analysis of data from a long-term prospective study of men (n = 3885) with prostate cancer from two regions in Sweden. Validated questionnaires asking about participants' QoL, functioning and symptoms were used to collect data. From the overall study, 190 men with mPC were identified. They were stratified into three groups, depending on the amount of time that had passed between the last questionnaire and their death; < 6 months, 6-18 months and > 18 months before death.

    RESULTS: Men with mPC generally rated their QoL poorly compared to established clinically significant threshold values. The group of men that were < 6 months before death rated their QoL, functioning and several symptoms significantly worse than the two other groups. Men that died after the year 2006 reported lower QoL and functioning and more pain and fatigue than those who died before 2006.

    CONCLUSION: The results in this study indicate that men with mPC have unmet needs with regards to QoL and symptoms. A palliative care approach, alongside possible life-prolonging treatments, that focuses on QoL and symptom relief, may serve as an important frame to give the best support to these men in their final years of life.

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  • 9. Kidayi, Paulo L
    et al.
    Manhica, Helio
    Sophiahemmet University.
    Mtuya, Christina C
    Johnson, Mahande Michael
    Furaha, Serventi
    Aune, Ragnhild E
    Björling, Gunilla
    Quality of cancer care in Tanzania as experienced by patients: A qualitative study2023In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 9, article id 23779608231157332Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cancer is a disease of public importance in Tanzania. Considering a limited health care system with few cancer centers and low health literacy in general, people are diagnosed at late stage and face difficulties in accessing care for their cancer. All these challenges affect the caring situation for the nurses who meet the patients at the cancer care centers.

    OBJECTIVE: This study aimed to explore the journey of cancer care experienced by patients with cancer.Research questions:How do patients experience the quality of care at the cancer care centers?How do patients experience the family's and the community's role?

    METHODS: Semi-structured qualitative interviews were carried out with 15 patients treated for colorectal-, breast-, or prostate cancer in three cancer care centers in Tanzania. A purposive sampling was used. Qualitative content analysis according to Graneheim and Lundman was employed.

    RESULTS: Three main themes and six sub-themes emerged. The main themes were e xperiences of cancer care services, the role of the family, community challenges and cancer care. The sub-themes were communication, resource allocation at the cancer care centers, fmily's denial, family challenges, limitations of primary care and misconceptions, and accessibility of cancer service and the health care system. The findings show that patients experienced incapacitated health care facilities for cancer care, misconceptions in the community and challenges for the families.

    CONCLUSIONS: The quality of cancer care in Tanzania needs to be improved, patients face challenges in all levels of health care facilities, including families, and the community at large. The distance to oncology care, economic hardship, and lack of knowledge in the community including families, lead to late diagnosis and suffering for the patients. There is a great need for education regarding cancer within healthcare, as well as in the community, to change the situation for patients with cancer.

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  • 10. Kidayi, Paulo L
    et al.
    Pakpour, Amir H
    Saboonchi, Fredrik
    Bray, Freddie
    Manhica, Hélio
    Sophiahemmet University.
    Mtuya, Christina C
    Serventi, Furaha
    Aune, Ragnhild E
    Mahande, Michael J
    Björling, Gunilla
    Cross-Cultural adaptation and psychometric properties of the Swahili version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 among breast cancer patients in Tanzania2023In: Healthcare (Basel, Switzerland), ISSN 2227-9032, Vol. 11, no 18, article id 2467Article in journal (Refereed)
    Abstract [en]

    Breast cancer is the most frequent cancer in women in Africa and contributes to premature death and poor quality of life. This study aimed to determine the validity, reliability, and psychometric properties of the Swahili version of EORTC QLQ-BR45 among women with breast cancer in Tanzania. A cross-sectional study design with non-probability convenience sampling was employed. Data were collected in two tertiary hospitals and one national cancer institute; 414 participants completed the EORTC-QLQ-C-30 and EORTC-QLQ-BR45. The reliability of QLQ-BR45 was measured using Cronbach's alpha and McDonald's Omega coefficients. The factor structure of EORTC QLQ-BR45 was assessed using confirmatory factor analysis. The internal consistencies for the five dimensions were all above 0.7 indicating satisfaction, except for systemic therapy side effects with a marginal value of 0.594 and significant correlations between the dimensions of QLQ-C30 and BR45. The final model fit well to the data, with the comparative fit index = 0.953, Tucker-Lewis index = 0.947, root mean square error of approximation = 0.041 (90% CI: 0.035, 0.046), and standardized root mean square residual = 0.072. In conclusion, the QLQ BR45 Swahili version displayed good reliability, validity, and psychometric properties and can be used in Swahili-speaking Sub-Saharan countries.

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  • 11. Nilsson, Marie I
    et al.
    Saboonchi, Fredrik
    Alexanderson, Kristina
    Olsson, Mariann
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Petersson, Lena-Marie
    Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this2016In: Journal of cancer survivorship, ISSN 1932-2259, E-ISSN 1932-2267, Vol. 10, no 3, p. 564-572Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to investigate how women, during the 2 years following breast cancer surgery, rate importance of work and vocational satisfaction, and baseline factors associated with rating over time.

    METHODS: A prospective cohort study of 692 women aged 20-63 included about 4 weeks after a first breast cancer surgery. Register data on treatment and data from six repeated questionnaires during a 2-year follow-up (at baseline, 4, 8, 12, 18, 24 months) were used in two-way mixed repeated analysis of variance and mixed repeated measures analysis of covariance.

    RESULTS: The women rated importance of work (m = 3.74; sd 0.88) (maximum 5) and vocational satisfaction (m = 4.30; sd 1.38) (maximum 6) high during the 2 years. Women with planned chemotherapy rated lower vocational satisfaction and especially so at 4 months after inclusion (F 1, 498 = 8.20; p = 0.004). Higher age, better physical, and mental/social work ability at baseline influenced rating of vocational satisfaction. Supportive colleagues was an important covariate that significantly affected ratings of importance of work as well as vocational satisfaction, i.e., women with better support rated on average higher on these outcomes. The effect of chemotherapy disappeared after including the abovementioned baseline covariates.

    CONCLUSIONS: Women diagnosed with breast cancer in the following 2 years rate importance of work and vocational satisfaction high, which are associated to lower work ability and social support.

    IMPLICATIONS FOR CANCER SURVIVORS: Work is a very important aspect in life also after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with women with breast cancer. Furthermore, workplace support needs to be assessed as this is an influential factor.

  • 12. Petersson, Lena-Marie
    et al.
    Vaez, Marjan
    Nilsson, Marie I
    Saboonchi, Fredrik
    Alexanderson, Kristina
    Olsson, Mariann
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Sickness absence following breast cancer surgery: a two-year follow-up cohort study2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 715-724Article in journal (Refereed)
    Abstract [en]

    RATIONALE AND AIM: Most women of working ages with limited breast cancer (BC) have returned to work within the first year after diagnosis. However, little is known about what is happening during this year regarding sickness absence and return to work. Also, the knowledge is very limited about the occurrence of part-time sickness absence after BC diagnosis. Therefore, the aim of this study was to describe occurrence, extent and length of SA during a two-year follow-up after BC surgery and to analyse the association between being SA and type of cancer treatment.

    METHODS: In this prospective cohort study, 497 women responded to questionnaires about different aspects of sickness absence at six occasions during two years after primary BC surgery (at baseline and after 4, 8, 12, 18 and 24 months). Treatment information was obtained from the National breast cancer register. Multinomial logistic regression was used to calculate odds ratios (OR) for likelihood of being sickness absent more than once.

    RESULTS: Two-thirds of the women were sickness absent at baseline; this proportion decreased, especially during the first eight months. At 24 months, 13% were sickness absent. Of all women, 27% never reported sickness absence and 14% were sickness absent at most of the six survey times. At eight months, many had shifted from full- to part-time sickness absence. Women with chemotherapy and/or advanced BC surgery had higher ORs for being sickness absent at most of the follow-ups.

    CONCLUSIONS: Most women returned to work within the first eight months after BC surgery and of those sickness absent after that, most had been part-time sickness absent. Thus, it is important to differentiate between part- and full-time sickness absence in future studies. Special attention should be paid to the impact of chemotherapy and type of surgery on the likelihood of being sickness absent.

  • 13. Piper, Barbara F
    et al.
    Olson, Karin
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Cancer-related fatigue2011In: The MASCC textbook of cancer supportive care and survivorship / [ed] Olver, Ian N., New York: Springer , 2011, p. 23-32Chapter in book (Other academic)
    Abstract [en]

    This chapter describes what is currently known about cancer-related fatigue (CRF) in cancer survivors. Significance and prevalence rates are reviewed and definitions are discussed within the context of the need to develop case definitions and phenotypes to advance the science and practice of CRF. Two conceptual frameworks/models for CRF are identified based on emerging evidence that unify the seemingly disparate underlying mechanisms proposed in the literature. While further testing of these models and their propositions are needed, these models can be used to guide future studies investigating CRF and its underlying relationships with other symptoms such as pain, depression, and insomnia. The National Comprehensive Cancer Network (NCCN) guidelines for the assessment and management of CRF are reviewed. Particular emphasis is given to the assessment and management of the common contributing and treatable factors associated with CRF (i.e., anemia, comorbidities, deconditioning, emotional distress, nutrition, pain, sleep disturbance/insomnia, symptom clusters, and cognitive impairment). Barriers to guideline adherence and exercise prescription are discussed, and patient and provider education is emphasized.

  • 14. Porserud, Andrea
    et al.
    Aly, Markus
    Nygren-Bonnier, Malin
    Hagströmer, Maria
    Sophiahemmet University.
    Association between early mobilisation after abdominal cancer surgery and postoperative complications2023In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 9, article id 106943Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Postoperative complications and readmission to hospital after major cancer surgery are common. Early mobilisation in hospital is thought to reduce complications, and patients are recommended to mobilise for at least 2 h on the day of surgery, and thereafter at least 6 h per day. Evidence for early mobilisation is limited and therefore also how early mobilisation may influence the development of postoperative complications. The aim of this study was to evaluate the association between early mobilisation after abdominal cancer surgery and readmission to hospital due to postoperative complications.

    MATERIAL AND METHODS: Adult patients who had abdominal cancer surgery due to ovarian, colorectal, or urinary bladder cancer between January 2017 and May 2018 were included in the study. Exposure was set to the mean number of steps taken over the first three postoperative days, measured with an activity monitor. Primary outcome was readmission to hospital within 30 days after discharge, and secondary outcome was severity of complications. Data were obtained from medical records. Logistic regression was used to investigate the association between exposure and outcomes.

    RESULTS: Of 133 patients included in the study, 25 were readmitted to the hospital within 30 days after discharge. The analysis showed no association between early mobilisation and readmission or severity of complications.

    CONCLUSION: Early mobilisation does not seem to increase the odds of readmission, nor the severity of complications. This study contributes to the limited research on the association between early mobilisation and postoperative complications after abdominal cancer surgery.

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  • 15. Rosenblad, Andreas Karlsson
    et al.
    Sundqvist, Pernilla
    Westman, Bodil
    Sophiahemmet University.
    Ljungberg, Börje
    A psychometric evaluation of the Functional assessment of cancer therapy-kidney symptom index (FKSI-19) among renal cell carcinoma patients suggesting an alternative two-factor structure2021In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To psychometrically evaluate the hypothesized four-factor structure of the 19-item Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI-19) health-related quality of life (HRQoL) instrument in a sample of surgically treated renal cell carcinoma (RCC) patients and examine if an alternative factor structure with good psychometric properties may be derived from the available items.

    METHODS: The model fit of the hypothesized four-factor structure was examined using confirmatory factor analysis on cohort data from 1731 individuals included in the National Swedish Kidney Cancer Register who had undergone surgery for RCC during the three years 2016-2018 and answered the FKSI-19 instrument within 6-12 months after surgery. Exploratory factor analysis was applied to the same dataset to derive a possible alternative factor solution.

    RESULTS: The four-factor structure did not reach the thresholds for good model fit using the normed χ2-value or the Comparative Fit Index, although the Standardized Root Mean Square Residual and Root Mean Square Error of Approximation measures indicated good and acceptable model fits, respectively. An alternative 14-item trimmed FKSI version (FKSI-14) with a two-factor structure derived from the available FKSI-19 items was found to measure the same aspects of HRQoL as the full FKSI-19 instrument.

    CONCLUSION: The present study is the first to use psychometric methods for examining the factor structure of the FKSI-19 instrument. The hypothesized four-factor structure of FKSI-19 provided a barely acceptable model fit. The two-factor FKSI-14 structure may be used as an alternative or complement to the four-factor structure when interpreting the FKSI-19 instrument.

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  • 16. Rönningås, Ulrika
    et al.
    Fransson, Per
    Holm, Maja
    Sophiahemmet University.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Prostate-specific antigen (PSA) and distress: a cross-sectional nationwide survey in men with prostate cancer in Sweden2019In: BMC Urology, E-ISSN 1471-2490, Vol. 19, no 1, article id 66Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The prostate-specific antigen (PSA) -value is often used during the prostate cancer trajectory as a marker of progression or response to treatment. Concerns about PSA-values are often expressed by patients in clinical situations. Today there is a lack of larger studies that have investigated the association between PSA-value and distress. The aim was to investigate the association between PSA-values and distress adjusted for sociodemographic factors, hormonal therapy and quality of life (QoL), among men with prostate cancer.

    METHODS: In this cross-sectional survey of 3165 men with prostate cancer, members of the Swedish Prostate Cancer Federation, answered questions about sociodemographic factors, PSA, distress, QoL and treatments. Descriptive statistics, and bivariate and multivariable analyses were performed. The result was presented based on four PSA-value groups: 0-19, 20-99, 100-999, and ≥ 1000 ng/ml.

    RESULTS: Of the men, 53% experienced distress. An association between distress and PSA-values was found where higher PSA-values were associated with higher OR:s for experiencing distress in the different PSA-groups: 0-19 ng/ml (ref 1), 20-99 ng/ml (OR 1.25, 95% CI 1.01-1.55), 100-999 ng/ml (OR 1.47, 95% CI 1.12-1.94), ≥1000 ng/ml (OR 1.77, 95% CI 1.11-2.85). These associations were adjusted for sociodemographic factors and hormonal therapy. In the multivariable analyses, beside PSA-values, higher levels of distress were associated with being without partner or hormonal therapy. When adding QoL in the multivariable analysis, the association between PSA and distress did not remain significant.

    CONCLUSION: These results indicate that the PSA-values are associated with distress, especially for those with higher values. However, to be able to support these men, continued research is needed to gain more knowledge about the mechanisms behind the association between emotional distress and PSA-values.

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  • 17. Rönningås, Ulrika
    et al.
    Holm, Maja
    Sophiahemmet University.
    Doveson, Sandra
    Sophiahemmet University.
    Fransson, Per
    Beckman, Lars
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Signs and symptoms in relation to progression, experiences of an uncertain illness situation in men with metastatic castration-resistant prostate cancer: A qualitative study2022In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 31, no 4, article id e13592Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Signs and symptoms are important in monitoring prostate cancer, but there is a lack of understanding about the men's interpretation of signs and symptoms in relation to disease progression in advanced phases of the disease. The aim was to illuminate the experience of signs and symptoms in relation to disease progression in men with metastatic castration-resistant prostate cancer (mCRPC).

    METHOD: Thirty longitudinal interviews were conducted with 11 men undergoing life-prolonging treatment for mCRPC. Conventional content analysis was used.

    RESULTS: The results illuminate an uncertainty that the men experience when interpreting signs and symptoms. The overarching theme was The experience of an uncertain illness situation within the framework of progression, with four subthemes: Symptoms triggering thoughts about disease progression; Making sense of signs, also in the absence of symptoms; Making sense of symptoms during treatment; Progression triggering thoughts about the remainder of life.

    CONCLUSION: In the uncertain illness situation, the men strive to make sense of signs and symptoms based on previous experiences and in relation to disease progression. Understanding the men's perspectives on signs and symptoms in this late phase may help health care professionals communicate about disease progression considering the balance between treatment outcome and quality of life.

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  • 18. Saboonchi, Fredrik
    et al.
    Petersson, Lena-Marie
    Alexanderson, Kristina
    Bränström, Richard
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Expecting the best and being prepared for the worst: structure, profiles, and 2-year temporal stability of dispositional optimism in women with breast cancer2016In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no 8, p. 957-963Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Dispositional optimism is viewed as a key personality resource for resiliency and has been linked to adjustment among women with breast cancer. The aim was to examine (a) the psychometric proprieties of Life Orientation Test-Revised (LOT-R), (b) the potential independence and co-occurrence of positive and negative dimensions of future outcome expectancies, (c) the longitudinal invariance of LOT-R and the temporal stability of dispositional optimism over 2 years following surgery, and (d) the predictive impact of optimism and pessimism on emotional distress among women with breast cancer.

    METHODS: Data from a prospective study (n = 750) of women with breast cancer were acquired shortly after surgery, and the women were followed up for 2 years. Assessments of LOT-R, Hospital Anxiety and Depression Scale, treatment-related, and demographic variables were subjected to structural equation modeling analysis.

    RESULTS: A bidimensional and temporarily invariant structure of LOT-R displayed acceptable fit indices. Three profiles of future expectancies consisting of optimists, pessimists, and ambiguous were identified. Temporal stability in optimism and pessimism over 2 years was established. Women with higher education displayed higher degrees of pessimism. Baseline dispositional optimism inversely predicted emotional distress at 2 years.

    CONCLUSIONS: The LOT-R should be approached as a bidimensional measure. Co-occurrence of optimism and pessimism may indicate a cautious defensive coping effort in women with breast cancer. The importance of systematic efforts to enhance optimism as well as the capacity to acknowledge both positive and negative future expectancies is emphasized. Copyright © 2015 John Wiley & Sons, Ltd.

  • 19. Sawatzky, Richard
    et al.
    Larsdotter, Cecilia
    Sophiahemmet University.
    Carlsson, Eva
    Pettersson, Monica
    Kenne Sarenmalm, Elisabeth
    Smith, Frida
    Nygren, Jonas
    Russell, Lara
    Öhlén, Joakim
    Predictors of preparedness for recovery following colorectal cancer surgery: A latent class trajectory analysis2023In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 62, no 12, p. 1625-1634Article in journal (Refereed)
    Abstract [en]

    AIM: With an interest in providing knowledge for person-centred care, our overall goal is to contribute a greater understanding of diversity among patients in terms of their preparedness before and up to six months after colorectal cancer surgery. Our aim was to describe and provide a tentative explanation for differences in preparedness trajectory profiles.

    MATERIAL AND METHODS: The study was explorative and used prospective longitudinal data from a previously published intervention study evaluating person-centred information and communication. The project was conducted at three hospitals in Sweden. Patient-reported outcomes measures, including the Longitudinal Preparedness for Colorectal Cancer Surgery Questionnaire, were collected before surgery, at discharge, and four to six weeks, three months, and six months after surgery. Clinical data were retrospectively obtained from patients' medical records. We used latent class growth models (LCGMs) to identify latent classes that distinguish subgroups of patients who represent different preparedness trajectory profiles. To determine the most plausible number of latent classes, we considered statistical information about model fit and clinical practice relevance. We used multivariable regression models to identify variables that explain the latent classes.

    RESULTS: The sample (N = 488) comprised people with a mean age of 68 years (SD = 11) of which 44% were women. Regarding diagnoses, 60% had colon cancer and 40% rectal cancer. The LCGMs identified six latent classes with different preparedness for surgery and recovery trajectories. The latent classes were predominantly explained by differences in age, sex, physical classification based on comorbidities, treatment hospital, global health status, distress, and sense of coherence (comprehensibility and meaningfulness).

    CONCLUSION: Contrary to the received view that emphasizes standardized care practices, our results point to the need for adding person-centred and tailored approaches that consider individual differences in how patients are prepared before and during the recovery period related to colorectal cancer surgery.

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  • 20. Söderman, M
    et al.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Alexanderson, K
    Friberg, E
    Positive encounters with healthcare among women sickness absent with breast cancer or with other diagnoses2017Conference paper (Other academic)
  • 21. Söderman, Mirkka
    et al.
    Friberg, E
    Alexanderson, K
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year follow-up cohort study2019In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 27, no 4, p. 1197-1206Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Breast cancer (BC) is the most common cancer among women, and half of those diagnosed are of working age. Positive encounters regarding work from healthcare professionals have been shown to promote return to work among sickness absentees in general. However, the knowledge about encounters possible associations with sickness absence (SA) in women with BC is scarce.

    AIM: To explore if women had experienced encounters regarding work from healthcare professionals during the first year after BC surgery and if this was associated with SA during the second year after surgery, controlled for treatment and sociodemographic effects.

    METHODS: A prospective cohort study of 690 Swedish women with primary BC, aged 24-63 years included after surgery. Descriptive statistics and adjusted logistic regression (age, birth country, education, self-rated health, treatment) with 95% confidence intervals (CI) were used.

    RESULTS: Eighty percent of the women had experienced encounters regarding work. Women who got advice and support regarding work (adjusted odds ratio (OR) 0.5; 0.3-0.9) or were encouraged to work (adjusted OR 0.6; 0.3-0.9) had less SA. A larger proportion of those encouraged to work had less advanced cancer, surgery, hormone, or radiotherapy. Consistently, women encouraged to be on SA had more SA, but this was partly explained by disease or treatment factors (crude OR 1.6; 1.1-2.4, adjusted OR 1.2 (0.8-1.9) since a larger proportion of those with more advanced cancer, surgery, or chemotherapy had more SA.

    CONCLUSION: Most women experienced encounters regarding work, and the nature of these encounters were associated with SA 2 years after BC surgery.

  • 22. Söderman, Mirkka
    et al.
    Wennman-Larsen, Agneta
    Sophiahemmet University.
    Alexanderson, Kristina
    Svärd, Veronica
    Friberg, Emilie
    Oncologists' experiences of and prerequisites for sickness certification tasks: A nationwide questionnaire study2021In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 30, no 4, article id e13414Article in journal (Refereed)
    Abstract [en]

    Oncologists frequently have sickness certification (SC) consultations, however, little is known about their experiences of such tasks.

    OBJECTIVE: To investigate oncologists' experiences of organisational prerequisites for SC tasks, and if lack of resources was related to experiencing SC as problematic.

    METHOD: Questionnaire data from 342 oncologists in Sweden were used for descriptive statistics and to calculate odds ratios (OR) with 95% confidence intervals (CI).

    RESULTS: The majority (92.2%) had SC consultations weekly; 17.8% of the oncologists experienced such consultations as problematic weekly. About a third appreciated the national guidelines for SC (34.5%) and had joint routines/policies regarding SC at their clinic (29.7%). Experiencing SC consultations as problematic was associated with stating not having enough resources for such work (OR 3.47; 95% CI 1.92-6.25). Lack of resources was associated with: experiencing lack of competence in insurance medicine (3.34; 1.92-5.82), conflicts with patients regarding SC (4.22; 1.96-9.07), finding it problematic to manage the two roles as medical expert and as the patient's treating physician (3.31; 2.04-5.34), or to assess work capacity (2.28; 1.46-3.56).

    CONCLUSION: Although oncologists often had SC tasks, most did not experience them as problematic weekly. However, lack of resources for SC tasks was associated with experiencing SC as problematic.

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  • 23. Vasconcellos-Silva, Paulo Roberto
    et al.
    Sormunen, Taina
    Sophiahemmet University.
    Gransjön Craftman, Åsa
    Sophiahemmet University.
    Evolution of accesses to information on breast cancer and screeing on the Brazilian National Cancer Institute website: An exploratory study2018In: Ciência & Saúde Coletiva, ISSN 1413-8123, E-ISSN 1678-4561, Vol. 23, no 4, p. 1303-1312Article in journal (Refereed)
    Abstract [en]

    Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA’s website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

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  • 24.
    Wennman-Larsen, Agneta
    et al.
    Sophiahemmet University.
    Nilsson, Marie
    Saboonchi, Fredrik
    Olsson, Mariann
    Alexanderson, Kristina
    Fornander, Tommy
    Sandelin, Kerstin
    Petersson, Lena-Marie
    Can breast cancer register data on recommended adjuvant treatment be used as a proxy for actually given treatment?2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 22, p. 1-7Article in journal (Refereed)
  • 25.
    Wennman-Larsen, Agneta
    et al.
    Sophiahemmet University.
    Svärd, Veronica
    Alexanderson, Kristina
    Friberg, Emilie
    Factors of decisive importance for being in work or not during two years after breast cancer surgery: Content analysis of 462 women's open answers2021In: BMC Women's Health, E-ISSN 1472-6874, Vol. 21, no 1, article id 332Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Paid work is one of the most important aspects in life among working-aged women diagnosed with breast cancer. Despite several attempts, no previous study provides a comprehensive overview from the women's perspective about factors of importance for being able to work or not. Therefore, the aim of this study was to gain knowledge about factors that women themselves state are of decisive importance for being able to work or not during the first two years after breast cancer surgery.

    METHODS: Data was collected in a two-year follow-up questionnaire within the frame of a prospective cohort study of working-aged women who had undergone breast cancer surgery. 749 were included in the questionnaire study and of the 616 (82%) responding women, 462 (75%) wrote statements on an open-ended question about factors of decisive importance for being able to work or not work during the past two years. The statements were analyzed with content analysis.

    RESULTS: Five categories of factors of importance for being able to  work or not were identified, each covering several sub-categories: Health and wellbeing, Contacts and encounters, Flexibility and adjustment possibilities, Socioeconomic consequences from working/not working, and Own motivation and characteristics. A wide variety of factors were mentioned by the women and the findings give a multifaceted picture of many single but interrelated factors of decisive importance for being able to work/not work. The importance of flexibility in the return-to-work process was stressed, as well as the importance of supportive encounters from, e.g., colleagues, managers, as well as relatives.

    CONCLUSIONS: The results give a comprehensive overview over a variety of different types of factors for being able to return to/remain in work or to not work after breast cancer surgery, adding new knowledge about e.g. the importance of colleagues, and the women's own preferences or characteristics. These are factors that different stakeholders, both from healthcare but also from the work place and the insurance office, need to be aware of and collaborate around to support women with breast cancer during the period of treatment, rehabilitation and return to work.

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