Marianne J Hjermstad

Oslo University Hospital, Kristiania (historical), Oslo, Norway

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Publications (102)362.58 Total impact

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    ABSTRACT: There is no universally accepted definition of cancer cachexia. Two classifications have been proposed; the 3-factor classification requiring ≥2 of 3 factors; weight loss ≥10%, food intake ≤1500 kcal/day, and C-reactive protein ≥10 mg/l, and the consensus classification requiring weight loss >5% the past 6 mo, or body mass index <20 kg/m(2) or sarcopenia, both with ongoing weight loss >2%. Precachexia is the initial stage of the cachexia trajectory, identified by weight loss ≤5%, anorexia and metabolic change. We examined the consistency between the 2 classifications, and their association with survival in a palliative cohort of 45 (25 men, median age of 72 yr, range 35-89) unresected pancreatic cancer patients. Computed tomography images were used to determine sarcopenia. Height/weight/C-reactive protein and survival were extracted from medical records. Food intake was self-reported. The agreement for cachexia and noncachexia was 78% across classifications. Survival was poorer in cachexia compared to noncachexia (3-factor classification, P = 0.0052; consensus classification, P = 0.056; when precachexia was included in the consensus classification, P = 0.027). Both classifications showed a trend toward lower median survival (P < 0.05) with the presence of cachexia. In conclusion, the two classifications showed good overall agreement in defining cachectic pancreatic cancer patients, and cachexia was associated with poorer survival according to both.
    Nutrition and Cancer 02/2015; 67(3):1-9. DOI:10.1080/01635581.2015.1004728 · 2.47 Impact Factor
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    Supportive and Palliative Care 02/2015; DOI:10.1136/bmjspcare-2014-000722.
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    ABSTRACT: Depressive symptoms are common in patients with cancer and tend to increase as death approaches. The study aims were to examine the prevalence of depressive symptoms in patients with cancer in their final 24 h, and their association with other symptoms, sociodemographic and care characteristics. A stratified sample of deaths was drawn by Statistics Netherlands. Questionnaires on patient and care characteristics were sent to the physicians (N=6860) who signed the death certificates (response rate 77.8%). Adult patients with cancer with non-sudden death were included (n=1363). Symptoms during the final 24 h of life were assessed on a 1-5 scale and categorised as 1=no, 2-3=mild/moderate and 4-5=severe/very severe. Depressive symptoms were registered in 37.6% of the patients. Patients aged 80 years or more had a reduced risk of having mild/moderate depressive symptoms compared with those aged 17-65 years (OR 0.70; 95% CI 0.50 to 0.99). Elderly care physicians were more likely to assess patients with severe/very severe depressive symptoms than patients with no depressive symptoms (OR 4.18; 95% CI 1.48 to 11.76). Involvement of pain specialists/palliative care consultants and psychiatrists/psychologists was associated with more ratings of severe/very severe depressive symptoms. Fatigue and confusion were significantly associated with mild/moderate depressive symptoms and anxiety with severe/very severe symptoms. More than one-third of the patients were categorised with depressive symptoms during the last 24 h of life. We recommend greater awareness of depression earlier in the disease trajectory to improve care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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    ABSTRACT: Patients with advanced cancer commonly experience multiple somatic symptoms and declining functioning. Some highly prevalent symptoms also overlap with diagnostic symptom-criteria of depression. Thus, assessing depression in these patients can be challenging. We therefore investigated 1) the effect of different scoring-methods of depressive symptoms on detecting depression, and 2) the relationship between disease load and depression amongst patients with advanced cancer. The sample included 969 patients in the European Palliative Care Research Collaborative-Computer Symptom Assessment Study (EPCRC-CSA). Inclusion criteria were: incurable metastatic/locally advanced cancer and ≥18 years. Biomarkers and length of survival were registered from patient-records. Depression was assessed using the Patient Health Questionnaire (PHQ-9) and applying three scoring-methods: inclusive (algorithm scoring including the somatic symptom-criteria), exclusive (algorithm scoring excluding the somatic symptom-criteria) and sum-score (sum of all symptoms with a cut-off ≥8). Depression prevalence rates varied according to scoring-method: inclusive 13.7%, exclusive 14.9% and sum-score 45.3%. Agreement between the algorithm scoring-methods was excellent (Kappa=0.81), but low between the inclusive and sum scoring-methods (Kappa=0.32). Depression was significantly associated with more pain (OR-range: 1.09-1.19, p<0.001-0.04) and lower performance status (KPS-score, OR-range=0.68-0.72, p<0.001) irrespective of scoring-method. Depression was assessed using self-report, not clinical interviews. The scoring-method, not excluding somatic symptoms, had the greatest effect on assessment outcomes. Increasing pain and poorer than expected physical condition should alert clinicians to possible co-morbid depression. The large discrepancy in prevalence rates between scoring-methods reinforces the need for consensus and validation of depression definitions and assessment in populations with high disease load. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 173C:176-184. DOI:10.1016/j.jad.2014.11.006 · 3.71 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 10/2014; 23(10). DOI:10.1002/pon.3541 · 4.04 Impact Factor
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    ABSTRACT: Background The objective of this study was to pilot test an updated version of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N60). Methods Head and neck (H&N) cancer patients were asked to complete a list of 60 head and neck cancer specific items comprising the updated EORTC head and neck module and the core questionnaire EORTC QLQ-C30. Debriefing interviews were conducted to identify any irrelevant items and confusing or upsetting wording. Results Interviews were performed with 330 patients from 17 countries, representing different H&N cancer sites and treatments. 41 out of the 60 items were retained according to the pre-defined EORTC criteria for module development, for another 2 items the wording was refined, and 17 items were removed. Conclusions The preliminary EORTC QLQ-H&N43 can now be used in academic research. Psychometrics will be tested in a larger field study. Head Neck, 2014.
    Head & Neck 07/2014; DOI:10.1002/hed.23762 · 3.01 Impact Factor
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    ABSTRACT: Context: Chemotherapy induces a wide array of acute and late oral adverse effects which makes symptom alleviation and information an important part of patient care. Aims: To assess the prevalence and intensity of oral problems in outpatients receiving chemotherapy for cancers outside the head and neck region, and to investigate if information about possible oral adverse effects was received by the patients. Methods: Outpatients coming for scheduled chemotherapy at the Cancer Centre, aged 18 years or above were invited to participate and included if they fulfilled the inclusion criteria. All patients completed the Edmonton Symptom Assessment System (ESAS), underwent a semi-structured interview and an oral examination conducted by a dentist. Results: Of 226 eligible patients 155 (69%) participated. Mean age was 57 yrs (SD 11.8), 34% were males. Breast (45%) and gastro-intestinal cancers (37%) were the most prevalent diagnoses. Xerostomia was reported by 59%, taste changes by 62%, oral discomfort by 41%, and 27% had problems eating. Fatigue (48%) and xerostomia (37%) were the most prevalent bothersome symptoms on the ESAS (score >3). Oral discomfort was not related to the number cycles received prior to the assessment, but with the total number medications (p=0.01). Twenty-seven percent confirmed that they had received information on oral adverse effects of cancer treatment. Patients reporting oral discomfort were significantly less satisfied with the information received (p=0.01) Conclusions: Oral problems were frequently reported by patients. Less than one-third of the patients remembered receiving information about oral problems associated with chemotherapy. Re-information on oral adverse effects during cancer treatment is needed. Patients should be instructed on how to optimize their oral health during and after chemotherapy.
    8th World Research Congress of the EAPC, Lleida, Spain; 06/2014
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    ABSTRACT: Chemotherapy induces a wide array of acute and late oral adverse effects that makes symptom alleviation and information important parts of patient care. To assess the prevalence and intensity of acute oral problems in outpatients receiving chemotherapy for cancers outside the head and neck region, and to investigate if information about possible oral adverse effects was received by the patients. In this cross-sectional study, outpatients aged 18 years or older were invited to participate and included if they fulfilled the inclusion criteria. All patients completed the Edmonton Symptom Assessment System (ESAS), participated in a semi-structured interview and underwent an oral examination by a dentist. Of 226 eligible patients, 155 (69%) participated. Mean age was 57 years and 34% were males. The most prevalent diagnoses were breast (45%) and gastrointestinal cancers (37%). Xerostomia was reported by 59%, taste changes by 62%, oral discomfort by 41%, and 27% had problems eating. Fatigue (3.4) and xerostomia (3.1) received the highest intensity scores on the ESAS. Oral candidiasis confirmed by positive cultures was seen in 10%. Twenty-seven percent confirmed that they had received information on oral adverse effects of cancer treatment. Oral sequelae were frequently reported, and health care providers should be attentive to the presence and severity of these problems. Less than one-third of the patients remembered having received information about oral sequelae associated with chemotherapy. A continuous focus on how to diagnose, manage and inform about oral cancer-related complications is advisable.
    Journal of pain and symptom management 04/2014; DOI:10.1016/j.jpainsymman.2014.02.009 · 2.74 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; 48(4). DOI:10.1016/j.jpainsymman.2013.11.013 · 2.74 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; DOI:10.1007/s00520-014-2178-3 · 2.50 Impact Factor
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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; 25(8). DOI:10.1093/annonc/mdu086 · 6.58 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. DOI:10.1016/j.jpain.2013.09.011 · 4.22 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. DOI:10.1016/j.jpainsymman.2013.02.025 · 2.74 Impact Factor
  • Journal of Geriatric Oncology 10/2013; 4:S74-S75. DOI:10.1016/j.jgo.2013.09.120 · 1.15 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; DOI:10.1016/j.jpainsymman.2013.06.005 · 2.74 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; 53(4). DOI:10.3109/0284186X.2013.823239 · 3.71 Impact Factor
  • Pål Klepstad, Marianne Jensen Hjermstad
    Supportive and Palliative Care 09/2013; 3(3):292-293. DOI:10.1136/bmjspcare-2013-000461
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    ABSTRACT: In advanced cancer, oncological treatment is influenced by performance status (PS), however this has limitations. Biomarkers of systemic inflammation may have prognostic value in advanced cancer. The study compares key factors in prognosis (PS, patient reported outcomes) against an inflammation-based score (Glasgow Prognostic Score - mGPS). A new method of prognosis in advanced cancer (combining PS and mGPS) is tested and then validated. Two international biobanks of advanced cancer patients were analysed. Key prognostic factors (PS, patient reported outcomes (EORTC QLQ-C30) and mGPS (using C-reactive protein and albumin concentrations)) were examined. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods, in a test sample before independent validation. Data were available on 1825 patients (test) and 631 patients (validation). Median survival ranged from 3.2 months (test) - to 7.03 months (validation). On multivariate analysis, PS (HR 1.62-2.77) and mGPS (HR 1.51-2.27) were independently associated with, and were the strongest predictors of survival (p<0.01). Survival at 3 months varied from 82% (mGPS 0) to 39% (mGPS 2) and from 75% (PS 0-1) to 14% (PS 4). When used together survival ranged from 88% (mGPS 0, PS 0-1) to 10% (mGPS 2, PS 4), p<0.001. A systemic inflammation-based score, mGPS, and PS predict survival in advanced cancer. The mGPS is similar to PS in terms of prognostic power. Used together, PS and mGPS act synergistically improving prognostic accuracy. This new method may be of considerable value in the management of advanced cancer patients.
    Clinical Cancer Research 08/2013; 19(19). DOI:10.1158/1078-0432.CCR-13-1066 · 8.19 Impact Factor
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    ABSTRACT: Abstract Objective. The most important outcome of renal cell carcinoma (RCC) treatment is survival. However, all cancer treatment should evaluate the health-related quality of life (HRQoL) outcome of the treatment. This has not been sufficiently documented in RCC. The aim of this investigation was therefore to document the HRQoL outcome of RCC. Material and methods. All 413 RCC patients treated with radical or partial nephrectomy at Haukeland University Hospital, Norway, during the period 1997--2010 were included. After exclusions, invitations to participate were mailed to 260 patients; 185 patients (71%) returned the questionnaires. In addition, a cohort of general head and neck squamous cell carcinoma (HNSCC) patients, a cohort of laryngectomized HNSCC patients, and a cohort from the general population of Norway, were used to compare the RCC patients' HRQoL scores. Results. Performance status as measured by the American Society of Anesthesiologists (ASA) score and Eastern Cooperative Oncology Group (ECOG) classification at diagnosis showed an inverse relation to HRQoL [maximum coefficient of variation (CVmax) = 5.3%, p < 0.05]. Flank and open transabdominal approaches to RCC tumour resection were followed by reduced HRQoL compared with a general cohort of Norwegian citizens. However, the laparoscopically treated RCC patients had HRQoL scores at the level of the population. The indices "general health/QoL", the functional indices, and the symptom indices "fatigue", "pain", "sleep", "nausea and vomiting", "constipation" and "diarrhoea" were particularly affected. Conclusion. The results show that RCC patients, and in particular those treated by a flank approach but not those treated by minimal invasive surgery, have a multifacetedly reduced HRQoL compared to a general population cohort.
    07/2013; DOI:10.3109/21681805.2013.813963
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    ABSTRACT: Patients with advanced cancer are often admitted to hospital as emergency cases. This may not always be medically indicated. Study objectives were to register the reasons for the emergency admissions, to examine interventions performed during hospitalisation and self-reported symptom intensity at admission and discharge, and to assess patients' opinions about the admission. This was a descriptive before-and-after study. Participating patients completed the Edmonton Symptom Assessment System (ESAS) twice, upon hospital admission and prior to discharge. All patients underwent a structured interview assessing their opinion about the emergency admission. Medical data were obtained from the hospital records. The study was performed in two Norwegian acute care secondary hospitals with urban catchment areas. 44 patients with cancer (men 27 and women 17; mean age 69.2, SD 9.2) representing 50 emergency admissions were included. Median length of stay was 7 days (95% CI 7.4 to 11.4). Median survival was 50 days (95% CI 51 to 115). 90% were admitted from home, and 46% had been hospitalised less than 1 month earlier. Lung and gastrointestinal symptoms and pain were the most frequent reasons for admissions. Mean pain scores on ESAS were reduced by 50% from admission to discharge (p<0.01). Simple interventions such as hydration, bladder catheterisation and oxygen therapy were most frequent. Nearly one-third would have preferred treatment at another site, provided that the quality of care was similar. Home visits by the family doctor and specialised care teams were perceived by patients as important to prevent hospitalisation. In most emergency admissions, relatively simple medical interventions are necessary. Specialised care teams with palliative care physicians, easier access to the family doctor and better lines of cooperation between hospitals and the primary care sector may make it possible to perform more of these procedures at home, thereby reducing the need for emergency admissions.
    BMJ Open 05/2013; 3(5). DOI:10.1136/bmjopen-2012-002515 · 2.06 Impact Factor

Publication Stats

3k Citations
362.58 Total Impact Points

Institutions

  • 2005–2015
    • Oslo University Hospital
      • • Department of Oncology
      • • Center for Clinical Heart Research
      Kristiania (historical), Oslo, Norway
  • 2007–2014
    • Norwegian University of Science and Technology
      • Department of Cancer Research and Molecular Medicine
      Nidaros, Sør-Trøndelag, Norway
  • 2012
    • NTNU Samfunnsforskning
      Nidaros, Sør-Trøndelag, Norway
  • 2009
    • Haukeland University Hospital
      Bergen, Hordaland, Norway
  • 2005–2008
    • University of Aberdeen
      Aberdeen, Scotland, United Kingdom
  • 2004–2008
    • University of Oslo
      • Department of Behavioural Sciences in Medicine
      Kristiania (historical), Oslo, Norway
  • 2006
    • St. Olavs Hospital
      • Department of Physiotherapy
      Nidaros, Sør-Trøndelag, Norway
  • 1999–2003
    • Norwegian Cancer Society
      Kristiania (historical), Oslo County, Norway
  • 1995
    • University Hospital of North Norway
      Tromsø, Troms, Norway