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  • 1. Bjöhle, Judith
    et al.
    Onjukka, Eva
    Rintelä, Niina
    Eloranta, Sandra
    Wickman, Marie
    Sophiahemmet Högskola.
    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 study2018Inngår i: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, artikkel-id S0167-8140(18)33384-XArtikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Holm, Maja
    et al.
    Sophiahemmet Högskola.
    Doveson, Sandra
    Sophiahemmet Högskola.
    Lindqvist, Olav
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Fransson, Per
    Quality of life in men with metastatic prostate cancer in their final years before death: a retrospective analysis of prospective data2018Inngår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, nr 1, artikkel-id 126Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3. Nilsson, Marie I
    et al.
    Saboonchi, Fredrik
    Alexanderson, Kristina
    Olsson, Mariann
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Petersson, Lena-Marie
    Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this2016Inngår i: Journal of cancer survivorship, ISSN 1932-2259, E-ISSN 1932-2267, Vol. 10, nr 3, s. 564-572Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4. Petersson, Lena-Marie
    et al.
    Vaez, Marjan
    Nilsson, Marie I
    Saboonchi, Fredrik
    Alexanderson, Kristina
    Olsson, Mariann
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Sickness absence following breast cancer surgery: a two-year follow-up cohort study2018Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 2, s. 715-724Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5. Piper, Barbara F
    et al.
    Olson, Karin
    Lundh Hagelin, Carina
    Sophiahemmet Högskola.
    Cancer-related fatigue2011Inngår i: The MASCC textbook of cancer supportive care and survivorship / [ed] Olver, Ian N., New York: Springer , 2011, s. 23-32Kapittel i bok, del av antologi (Annet vitenskapelig)
    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.

  • 6. Saboonchi, Fredrik
    et al.
    Petersson, Lena-Marie
    Alexanderson, Kristina
    Bränström, Richard
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Expecting the best and being prepared for the worst: structure, profiles, and 2-year temporal stability of dispositional optimism in women with breast cancer2016Inngår i: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, nr 8, s. 957-963Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7. Söderman, M
    et al.
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Alexanderson, K
    Friberg, E
    Positive encounters with healthcare among women sickness absent with breast cancer or with other diagnoses2017Konferansepaper (Annet vitenskapelig)
  • 8. Söderman, Mirkka
    et al.
    Friberg, E
    Alexanderson, K
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    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 study2018Inngår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9. Vasconcellos-Silva, Paulo Roberto
    et al.
    Sormunen, Taina
    Sophiahemmet Högskola.
    Gransjön Craftman, Åsa
    Sophiahemmet Högskola.
    Evolution of accesses to information on breast cancer and screeing on the Brazilian National Cancer Institute website: An exploratory study2018Inngår i: Ciência & Saúde Coletiva, ISSN 1413-8123, E-ISSN 1678-4561, Vol. 23, nr 4, s. 1303-1312Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10.
    Wennman-Larsen, Agneta
    et al.
    Sophiahemmet Högskola.
    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?2016Inngår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 22, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
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