Stein Kaasa

St. Olavs Hospital, Nidaros, Sør-Trøndelag, Norway

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Publications (402)1494.43 Total impact

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    ABSTRACT: Background. Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefit is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo- and radiotherapy during EOL, knowledge that might be used to improve practice. Methods. Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis. Results. In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3-4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied significantly between the different types of cancer. Multivariate analyses revealed that those at age < 70 years, GPS 2, no contact with our Palliative Care Unit and synchronous metastases received most chemotherapy the last 30 days. PS 3-4, GPS 2 and synchronous metastases were strongest associated with radiotherapy the last 30 days. Conclusion. Ten percent received chemotherapy and 8% radiotherapy the last 30 days of life. GPS 2 and synchronous metastases were most significantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo- and radiotherapy during EOL than other patients.
    Acta oncologica (Stockholm, Sweden) 08/2014; · 2.27 Impact Factor
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    ABSTRACT: Background Despite a high incidence of life-limiting disease, there is a deficit of palliative care outcome evidence in sub-Saharan Africa. Providers of end of life care call for appropriate measurement tools. The objective is to compare four approaches to self-report pain and symptom measurement among African palliative care patients completing the African Palliative Care Association African Palliative Outcome Scale (APCA African POS).Methods Patients were recruited from five services (4 in South Africa and 1 in Uganda). Research nurses cross-sectionally administered POS pain and symptom items in local languages. Both questions were scored from 0 to 5 using 4 methods: verbal rating, demonstrating the score using the hand (H), selecting a face on a visual scale (F), and indicating a point on the Jerrycan visual scale (J). H, F and J scores were correlated with verbal scores as reference using Spearman¿s rank and weighted Kappa. A Receiver Operating Characteristic (ROC) analysis was performed.Results315 patients participated (mean age 43.5 years, 69.8% female), 71.1% were HIV positive and 35.6% had cancer, 49.2% lived in rural areas. Spearman¿s rank correlations for pain scores were: H: 0.879, F: 0.823, J: 0.728 (all p¿<¿0.001); for symptoms H: 0.876, F: 0.808, J: 0.721 (all p¿<¿0.001). Weighted Kappa for pain was H: 0.798, F: 0.719 J: 0.548 and for symptoms: H: 0.818, F: 0.718, J: 0.571. There was lower agreement between verbal and both hand and face scoring methods in the Ugandan sample. Compared to the verbal scale the accuracy of predicting high pain/symptoms was H¿>¿F¿>¿J (0.96¿0.89) in ROC analysis.Conclusions Hands and faces scoring methods correlate highly with verbal scoring. The Jerrycan method had only moderate weighted Kappa. POS scores can be reliably measured using hand or face score.
    Health and Quality of Life Outcomes 08/2014; 12(1):118. · 2.27 Impact Factor
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    ABSTRACT: Corticosteroids are frequently used in cancer pain management despite limited evidence. This study compares the analgesic efficacy of corticosteroid therapy with placebo.
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 07/2014;
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    ABSTRACT: Patients with advanced cancer need multiple drugs to control symptoms and to treat cancer and concomitant diseases. At the same time, the goal of treatment changes as life expectancy becomes limited. This results in a risk for polypharmacy, maintained use of unneeded drugs, and drug-drug interactions (DDIs). The aim of the study was to analyze the use of medications, and to identify unneeded drugs as well as drugs and drug combinations with a risk for DDIs in a cohort of advanced cancer pain patients, defined by a need for a World Health Organization (WHO) analgesic ladder step III opioid. All drugs taken within a study day by cancer patients receiving opioids for moderate or severe pain (step III opioids) were analyzed. Non-opioids and adjuvants were analyzed for their use across countries. Unneeded medications as well as drugs and drug combinations with a risk for pharmacodynamic and pharmacokinetic DDIs were identified on the basis of published literature and electronic resources. In total, 2282 patients from 17 centers in 11 European countries were included. They received a mean of 7.8 drugs (range 1-20). Over one-quarter used 10 or more medications. The drugs and drug classes most frequently co-administered with opioids were: proton pump inhibitors, laxatives, corticosteroids, paracetamol (acetaminophen), nonsteroidal anti-inflammatory drugs, metoclopramide, benzodiazepines, anticoagulants, antibiotics, anticonvulsants, diuretics and antidepressants. The use of non-opioids and essential adjuvants varied across countries. Forty-five percent of patients received unnecessary or potentially unnecessary drugs and about 7% were given duplicate or antagonizing agents. Exposures to DDIs were frequent and increased the risk of sedation, gastric ulcerations, bleedings, and neuropsychiatric and cardiac complications. Many patients were exposed to pharmacokinetic DDIs involving CYP450, including 58% who used a step III opioid CYP3A4 substrate, and more than 10% who were given major CYP3A4 inhibitors or inducers. Patients with cancer treated with a WHO step III opioid use a high number of drugs. Non-opioid analgesics and corticosteroids are frequently used, but different patterns of use between countries were found. Many patients receive unneeded drugs and are at risk of serious DDIs. These findings demonstrate that drug therapy in these patients need to be evaluated continuously.
    Journal of pain and symptom management 04/2014; · 2.42 Impact Factor
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    ABSTRACT: Depression is common in patients with advanced cancer; however, it is not often recognized and therefore not treated. The aims of this study were to examine the prevalence of the use of antidepressants (ADs) in an international cross-sectional study sample and to identify sociodemographic and medical variables associated with their use. The study was conducted in patients with advanced cancer from 17 centres across eight countries. Healthcare professionals registered patient and disease-related characteristics. A dichotomous score (no/yes) was used to assess the use of ADs other than as adjuvant for pain. Self-report questionnaires from patients were used for the assessment of functioning and symptom intensity. Of 1051 patient records with complete data on ADs, 1048 were included (M:540/F:508, mean age 62 years, standard deviation [SD] 12). The majority were inpatients, and 85% had metastatic disease. The prevalence of AD use was 14%. Multivariate logistic regression analyses showed that younger age (odds ratio [OR] 2.46; confidence interval [CI] 1.32-4.55), female gender (OR 1.59; CI 1.09-2.33), current medication for pain (OR 2.68; CI 1.65-4.33) and presence of three or more co-morbidities (OR 4.74; CI 2.27-9.91) were associated with AD use for reasons other than pain. Disease-related variables (diagnoses, stage, Karnofsky Performance Status and survival) were not associated with the use of ADs. Female gender, younger age, analgesic use and multiple co-morbidities were associated with the use of ADs. However, information is still limited on which variables guide physicians in prescribing AD medication. Further longitudinal studies including details on psychiatric and medication history are needed to improve the identification of patients in need of ADs. Copyright © 2014 John Wiley & Sons, Ltd.
    Psycho-Oncology 04/2014; · 3.51 Impact Factor
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    ABSTRACT: We investigated the feasibility and acceptance of electronic monitoring of symptoms and syndromes in oncological outpatient clinics using a PALM (handheld computer). The assessment of a combination of symptoms and clinical benefit parameters grouped in four pairs was tested in a pilot phase in advanced cancer patients. Based on these experiences, the software E-MOSAIC was developed, consisting of patient-reported symptoms and nutritional intake and objective assessments (weight, weight loss, performance status and medication for pain, fatigue, and cachexia). E-MOSAIC was then tested in four Swiss oncology centers. In order to compare the methods, patients completed the E-MOSAIC as a paper and a PALM version. Preferences of version and completion times were collected. Assessments were compared using Wilcoxon signed-rank tests , and the test-retest reliability was evaluated. The pilot phase was completed by 22 patients. Most patients and physicians perceived the assessment as useful. Sixty-two patients participated in the feasibility study. Twelve patients reported problems (understanding, optical, tactile), and five patients could not complete the assessment. The median time to complete the PALM-based assessment was 3 min. Forty-nine percent of patients preferred the PALM, 23 % preferred a paper version, and 28 % of patients had no preference. Paper vs. PALM revealed no significant differences in symptoms, but in nutritional intake (p = 0.013). Test-retest (1 h, n = 20) reliability was satisfactory (r = 073-98). Electronic symptom and clinical benefit monitoring is feasible in oncology outpatient clinics and perceived as useful by patients, oncology nurses, and oncologists. E-MOSAIC is tested in a prospective randomized trial.
    Supportive Care in Cancer 04/2014; · 2.09 Impact Factor
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    ABSTRACT: Prevalence rates of depression in patients with advanced cancer vary considerably. This may be due to heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. Our objective was two-fold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer. Second, to examine the methods used for assessing and classifying depression in these studies. PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression", "palliative care", and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text papers were evaluated independently by two authors. Information on thirty-two predefined variables on cancer disease, treatment, socio-demographics, depression-related factors, and assessment methods was extracted from the papers. After removing duplicates, 916 citations were screened of which 59 papers were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, e.g. antidepressant use (10%), and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work towards a common standard for sample descriptions.
    Journal of pain and symptom management 03/2014; · 2.42 Impact Factor
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    ABSTRACT: Systematic knowledge about the prevalence and the treatment effects of cancer pain in patients attending a general oncology outpatient department is limited. The purpose of this study was to investigate the prevalence of pain in a large representative cohort of patients attending a general oncology outpatient department in order to guide further screening, classification, and treatment of pain. A cross-sectional study among patients visiting the outpatient clinic with histologically verified cancer, age ≥18 years, adequate cognitive function, and no surgical procedures last 24 h were included. Pain was assessed by the Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool. Three hundred five patients were included. The mean age was 60 years, 94 % had a WHO performance status of 0-1 and 59 % received oncological treatment with a curative intent. The mean score for average pain last 24 h (numerical rating scale, 0-10) and current pain was 1.84 and 1.08, respectively. Twenty-two percent reported pain score of ≥4 as their average pain in the previous 24 h. Twenty-one percent reported breakthrough pain (BTP). In multivariate analyses, sleep, BTP, age, treatment intent, and comorbidity was significantly associated with mean average pain in the previous 24 h and explained 29 % of the variability of average pain in the previous 24 h. Of the patients at an oncology outpatient clinic, 22 % reported clinically significant pain. These findings indicate that all patients are candidates to be screened for pain and, if present, a more detailed pain diagnosis should be established before any interventions can be recommended.
    Supportive Care in Cancer 03/2014; · 2.09 Impact Factor
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    ABSTRACT: Weight loss and cachexia are common, reduce tolerance of cancer treatment and the likelihood of response, and independently predict poor outcome. A group of experts met under the auspices of the European School of Oncology to review the literature and - on the basis of the limited evidence at present - make recommendations for malnutrition and cachexia management and future research. Our focus should move from end-stage wasting to supporting patients' nutritional and functional state throughout the increasingly complex and prolonged course of anti-cancer treatment. When inadequate nutrient intake predominates (malnutrition), this can be managed by conventional nutritional support. In the presence of systemic inflammation/altered metabolism (cachexia), a multimodal approach including novel therapeutic agents is required. For all patients, oncologists should consider three supportive care issues: ensuring sufficient energy and protein intake, maintaining physical activity to maintain muscle mass, and (if present) reducing systemic inflammation. The results of Phase II/III trials based on novel drug targets (e.g. cytokines, ghrelin receptor, androgen receptor, myostatin) are expected in the next two years. If effective therapies emerge, early detection of malnutrition and cachexia will be increasingly important in the hope that timely intervention can improve both patient-centered and oncology outcomes.
    Annals of Oncology 02/2014; · 7.38 Impact Factor
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    ABSTRACT: Significant progress has been made in the field of defining and describing the pathophysiology of wasting conditions such as cachexia. The number of new promising drugs, nutritional therapy alternatives, and exercise/rehabilitation programs is increasing. The purpose of this review is to give an overview of recent clinical findings from intervention studies investigating multimodal anabolic therapies utilizing drug, nutritional, and/or exercise interventions in order to counteract wasting. Anabolic agents such as ghrelin and selective androgen receptor modulators are under late-phase clinical testing and hold promise as new therapies, and their ability to mitigate weight loss and improve muscle mass and physical function is evaluated. In the past 2 years, eight new studies investigating interventions with anabolic potential in wasting have been published, among which three of these studies were multimodal. Targeted anabolic therapies aiming to prevent or reverse wasting might involve a combination of anabolic pharmacologic drugs, nutrition, and physical exercise working concurrently to enhance muscle protein synthesis and reduce breakdown. Some anabolic pharmacological interventions demonstrate the potential to improve muscle mass, but the multimodal interventions seem in greater extent to also demonstrate improvement in physical function.
    Current opinion in clinical nutrition and metabolic care. 02/2014;
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    ABSTRACT: Weight loss limits cancer therapy, quality of life and survival. Common diagnostic criteria and a framework for a classification system for cancer cachexia were recently agreed upon by international consensus. Specific assessment domains (Stores, Intake, Catabolism and Function) were proposed. The aim of this study is to validate this diagnostic criteria (two groups: Model 1) and examine a four group (Model 2) classification system regarding these domains as well as survival. Data from an international patient sample with advanced cancer (n=1070) was analysed. In model 1 the diagnostic criteria for cancer cachexia (weight loss/BMI) were used. Model 2 classified patients into four groups (I-IV) according to weight loss/BMI as a framework for cachexia stages. The cachexia domains, survival and sociodemographic/medical variables were compared across models. 861 patients were included. Model 1 consisted of 399 cachectic and 462 non-cachectic patients. Cachectic patients had significantly higher levels of inflammation, lower nutritional intake and performance status and shorter survival. In model 2, differences were not consistent; appetite loss did not differ between group III&IV, and performance status not between I&II. Survival was shorter in group III and IV compared to other groups. By adding other cachexia domains to the model, survival differences were demonstrated. The diagnostic criteria based on weight loss and BMI distinguish between cachectic and non-cachectic patients concerning all domains (Intake, Catabolism and Function) and is associated with survival. In order to guide cachexia treatment a four-group classification model needs additional domains to discriminate between cachexia stages.
    Annals of Oncology 02/2014; · 7.38 Impact Factor
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    ABSTRACT: This study aimed to investigate whether CYP3A4/5 genetic variants, together with clinical and patient factors, influence serum fentanyl and norfentanyl concentrations and their ratio in cancer pain patients receiving transdermal fentanyl. CYP3A4*22 and CYP3A5*3 polymorphisms were analysed in 620 cancer pain patients receiving transdermal fentanyl (12.5-700 μg/h) from the European Pharmacogenetic Opioid Study. Using stepwise linear regression, CYP3A4/5 genetic variability was examined in combination with patient factors relating to organ drug elimination function and ABCB1 genetics for their association with serum fentanyl and norfentanyl concentrations and metabolic ratio (MR) (norfentanyl : fentanyl). Delivery rate-adjusted serum fentanyl concentrations (0.0012-1.1 nmol/l/μg.h) and MRs (0.08-499) varied widely. Only 43% of variability in serum fentanyl concentrations was accounted for by delivery rate and less than 50% by CYP3A4/5 genotypes and clinical variables (delivery rate, sex, comedications, kidney disease, BMI, serum albumin). CYP3A4*22 and CYP3A5*3 variants, CYP3A inhibitors and variables relating to liver and kidney function (serum albumin, glomerular filtration rate, kidney disease, BMI) were associated with MR, but accounted for only 14% of variability. Serum fentanyl concentrations and MR vary considerably between cancer pain patients on transdermal fentanyl patches. CYP3A4*22 and CYP3A5*3 genotypes, and multiple clinical factors, combine to influence transdermal fentanyl pharmacokinetics, but accounted for only a small proportion of variability in this study. Identification of the remaining factors determining serum fentanyl concentrations, and their relationship to efficacy and adverse effects may aid in improving the safety and effectiveness of transdermal fentanyl.
    Pharmacogenetics and Genomics 01/2014; · 3.61 Impact Factor
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    ABSTRACT: The aim of the present study is to compare physician clinical assessment with patient-rated evaluations in the classification of cancer pain patients into groups with different pain levels, according to the presence of incident/breakthrough pain, neuropathic pain, and psychological distress. Average pain in the previous 24 hours was used as the dependent variable in multivariate linear regression models, and incident/breakthrough pain, neuropathic pain, and psychological distress were tested as regressors; in the assessment of regressors, physicians used the Edmonton Classification System for Cancer Pain, whereas patients used structured self-assessment questionnaires. The amount of variability in pain intensity scores explained by the 2 sets of regressors, physician and patient rated, was compared using R(2) values. When tested in 2 separate models, patient ratings explained 20.3% of variability (95% confidence interval [CI] = 15.2-25.3%), whereas physician ratings explained 6.1% (95% CI = 2.2-9.8%). The higher discriminative capability of patient ratings was still maintained when both regressor sets were introduced in the same model, with R(2) indices of 17.6% (95% CI = 13.0-22.2%) for patient ratings vs 3.4% (95% CI = .9-5.9%) for physician ratings. Patients' self-assessment of subjective symptoms should be integrated in future cancer pain classification systems. Our results indicate that patient-structured assessment of incident/breakthrough pain, neuropathic pain, and psychological distress significantly contributes to the discrimination of cancer patients with different pain levels. The integration of patient self-assessment tools with more objective clinician assessments can improve the classification of cancer pain.
    The journal of pain: official journal of the American Pain Society 01/2014; 15(1):59-67. · 3.78 Impact Factor
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    ABSTRACT: Purpose A systematical literature review evaluating the effect of dietary counselling in treating weight loss and improving energy intake in patients with advanced cancer with different stages of cachexia. Principal results Five publications were retrieved, of which three were randomized. Two out of five studies showed less weight loss with dietary counselling (+1% weight gain vs. -1.5% weight loss, p = 0.03, 1.4 kg vs. -2 kg, p < 0.05), two presented positive effect on energy intake (92% of total caloric need vs. 73%, p < 0.01, 1865 ± 317 kcal vs. 1556 ± 497 kcal, ns). Conclusion Dietary counseling can effect energy intake and body weight, however, apperent heterogeneity between studies is present. Based on these results there is not enough proof of evidence that dietary counselling given to patients with cancer is beneficial for improving weight or energy balance in the different cachexia stages. Nutrition is an essential part of cachexia treatment as it is not considered possible to increase or stabilize weight if nutritional needs are not met.
    Critical reviews in oncology/hematology 01/2014; · 5.27 Impact Factor
  • Palliative Medicine 01/2014; 28:463-473. · 2.61 Impact Factor
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    ABSTRACT: Context Pain localization is an important part of pain assessment. Development of pain tools for self-report should include expert and patient input, and patient testing in large samples. Objectives To develop a computerized pain body map (CPBM) for use in patients with advanced cancer. Methods Three studies were conducted: 1) an international expert survey and a pilot study guiding the contents and layout of the CPBM, 2) clinical testing in an international symptom assessment study in eight countries and 17 centers (N = 533), and 3) comparing patient pain markings on computer and paper body maps (N = 92). Results Study 1: 22 pain experts and 28 patients participated. A CPBM with anterior and posterior whole body views was developed for marking pain locations, supplemented by pain intensity ratings for each location. Study 2: 533 patients (286 male, 247 female, mean age 62 years) participated; 80% received pain medication and 81% had metastatic disease. Eighty-five percent completed CPBM as intended. Mean ± SD number of marked pain locations was 1.8 ± 1.2. Aberrant markings (15%) were mostly related to software problems. No differences were found regarding age, gender, cognitive/physical performance, or previous computer experience. Study 3: 70% of the patients had identical markings on the computer and paper maps. Only four patients had completely different markings on the two maps. Conclusion This first version of CPBM was well accepted by patients with advanced cancer. However, several areas for improvement were revealed, providing a basis for the development of the next version, which is subject to further international testing.
    Journal of pain and symptom management 01/2014; 47(1):45–56. · 2.42 Impact Factor
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    ABSTRACT: An objective measure of pain relief may add important information to patients' self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. Patients were assessed before (baseline) and 6-8weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann-Whitney and Pearson statistical analyses were done. Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p<0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r=0.469, p=0.002) and gait (cadence r=0.341, p=0.03). The activPAL and GAITRite parameters did not change following XRT (p>0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p>0.05). Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT.
    Radiotherapy and Oncology 11/2013; · 4.52 Impact Factor
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    ABSTRACT: The difficulties in defining a palliative care patient accentuate the need to provide stringent descriptions of the patient population in palliative care research. To conduct a systematic literature review with the aim of identifying which key variables have been used to describe adult palliative care cancer populations in randomized controlled trials (RCTs). The data sources used were MEDLINE (1950 to January 25, 2010) and Embase (1980 to January 25, 2010), limited to RCTs in adult cancer patients with incurable disease. Forty-three variables were systematically extracted from the eligible articles. The review includes 336 articles reporting RCTs in palliative care cancer patients. Age (98%), gender (90%), cancer diagnosis (89%), performance status (45%), and survival (45%) were the most frequently reported variables. A large number of other variables were much less frequently reported. A substantial variation exists in how palliative care cancer populations are described in RCTs. Few variables are consistently registered and reported. There is a clear need to standardize the reporting. The results from this work will serve as the basis for an international Delphi process with the aim of reaching consensus on a minimum set of descriptors to characterize a palliative care cancer population.
    Journal of pain and symptom management 09/2013; · 2.42 Impact Factor
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    ABSTRACT: Background. How to assess cachexia is a barrier both in research and in clinical practice. This study examines the need for assessing both reduced food intake and loss of appetite, to see if these variables can be used interchangeably. A secondary aim is to assess the variance explained by food intake, appetite and weight loss by using tumor-related factors, symptoms and biological markers as explanatory variables. Material and methods. One thousand and seventy patients with incurable cancer were registered in an observational, cross sectional multicenter study. A total of 885 patients that had complete data on food intake (PG-SGA), appetite (EORTC QLQ-C30) and weight loss were included in the present analysis. The association between reduced food intake and appetite loss was assessed using Spearman's correlation. To find the explained variance of the three symptoms a multivariate analysis was performed. Results. The mean age was 62 years with a mean survival of 247 days and a mean Karnofsky performance status of 72. Thirteen percent of the patients who reported eating less than normal had good appetite and 25% who had unchanged or increased food intake had reduced appetite. Correlation between appetite loss and food intake was 0.50. Explained variance for the regression models was 44% for appetite loss, 27% for food intake and only 13% for weight loss. Conclusion. Both appetite loss and food intake should be assessed in cachectic patients since conscious control of eating may sometimes overcome appetite loss. The low explained variance for weight loss is probably caused by the need for more knowledge about metabolism and inflammation, and is consistent with the cancer cachexia definition that claims that in cachexia weight loss is not caused by reduced food intake alone. The questions concerning appetite loss from EORTC-QLQ C30 and food intake from PG-SGA seem practical and informative when dealing with advanced cancer patients.
    Acta oncologica (Stockholm, Sweden) 09/2013; · 2.27 Impact Factor
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    ABSTRACT: Inflammation has been identified as a hallmark of cancer and may be necessary for tumorgenesis and maintenance of the cancer state. Inflammation-related symptoms are common in those with cancer; however, little is known about the relationship between symptoms and systemic inflammation in cancer. The aim of the present study was to examine the relationship between symptoms and systemic inflammation in a large cohort of patients with advanced cancer. Data from an international cohort of patients with advanced cancer were analyzed. Symptoms and patient-related outcomes were recorded using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire. Systemic inflammation was assessed using C-reactive protein levels. The relationship between these symptoms and systemic inflammation was examined using Spearman rank correlation (ρ) and the Mann-Whitney U test. Data were available for 1,466 patients across eight European countries; 1,215 patients (83%) had metastatic disease at study entry. The median survival was 3.8 months (interquartile range [IQR] 1.3-12.2 months). The following were associated with increased levels of inflammation: performance status (ρ = .179), survival (ρ = .347), pain (ρ = .154), anorexia (ρ = .206), cognitive dysfunction (ρ = .137), dyspnea (p= .150), fatigue (ρ = .197), physical dysfunction (ρ = .207), role dysfunction (ρ = .176), social dysfunction (ρ = .132), and poor quality of life (ρ = .178). All were statistically significant at p < .001. The results show that the majority of cancer symptoms are associated with inflammation. The strength of the potential relationship between systemic inflammation and common cancer symptoms should be examined further within the context of an anti-inflammatory intervention trial.
    The Oncologist 08/2013; · 4.10 Impact Factor

Publication Stats

12k Citations
1,494.43 Total Impact Points


  • 2002–2014
    • St. Olavs Hospital
      • Department of Medicine
      Nidaros, Sør-Trøndelag, Norway
    • La Maddalena Cancer Center
      Palermo, Sicily, Italy
  • 1998–2014
    • Norwegian University of Science and Technology
      • • Department of Cancer Research and Molecular Medicine
      • • Faculty of Medicine
      Nidaros, Sør-Trøndelag, Norway
    • IEO - Istituto Europeo di Oncologia
      Milano, Lombardy, Italy
    • New England Baptist Hospital
      Boston, Massachusetts, United States
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2013
    • The University of Edinburgh
      • Edinburgh Cancer Research UK Centre
      Edinburgh, SCT, United Kingdom
  • 2012
    • Sykehuset Telemark
      Skien, Telemark county, Norway
    • Turku University Hospital
      Turku, Province of Western Finland, Finland
  • 2010–2012
    • Cantonal Hospital of Schwyz
      Schwyz, Schwyz, Switzerland
  • 2001–2012
    • NTNU Samfunnsforskning
      Nidaros, Sør-Trøndelag, Norway
    • The Norwegian Medical Association
      Kristiania (historical), Oslo County, Norway
  • 2011
    • University of Bonn
      Bonn, North Rhine-Westphalia, Germany
    • University of Leeds
      • School of Medicine
      Leeds, ENG, United Kingdom
  • 2009–2011
    • Oslo University Hospital
      • Department of Oncology
      Oslo, Oslo, Norway
    • Norwegian Institute of Public Health
      • Department of Pharmacoepidemiology
      Kristiania (historical), Oslo County, Norway
    • Sør-Trøndelag University College
      • Faculty of Technology
      Trondheim, Sor-Trondelag Fylke, Norway
  • 2002–2011
    • University of Aberdeen
      • • Division of Applied Health Sciences
      • • Institute of Applied Health Sciences
      Aberdeen, SCT, United Kingdom
  • 1997–2010
    • University of Oslo
      • • Department of Oncology
      • • Department of Behavioural Sciences in Medicine
      Kristiania (historical), Oslo County, Norway
  • 1995–2010
    • University Hospital of North Norway
      Tromsø, Troms, Norway
  • 2002–2009
    • Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
      Milano, Lombardy, Italy
  • 2008
    • Lund University
      • Department of Clinical Sciences
      Lund, Skane, Sweden
  • 2007
    • University of Texas MD Anderson Cancer Center
      • Department of Epidemiology
      Houston, TX, United States
  • 2003–2006
    • Norwegian University of Technology and Science
      Nidaros, Sør-Trøndelag, Norway
    • Nordlandssykehuset Bodoe
      Bodø, Nordland, Norway
  • 2005
    • Azienda Unità Sanitaria Locale Forlì
      Forlì, Emilia-Romagna, Italy
  • 2004
    • Malmö University
      Malmö, Skåne, Sweden
  • 1988–2004
    • Norwegian Cancer Society
      Kristiania (historical), Oslo County, Norway
    • Institutt for samfunnsforskning, Oslo
      Kristiania (historical), Oslo County, Norway
  • 1997–2001
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 1999
    • IT University of Copenhagen
      København, Capital Region, Denmark
  • 1992
    • University of Helsinki
      • Department of Radiotherapy and Oncology
      Helsinki, Southern Finland Province, Finland
  • 1991
    • Det Norske Veritas
      Kristiania (historical), Oslo County, Norway