Publications
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Asphaug, Lars; Akslen, Lars Andreas; Blix, Egil Støre; Boge, Beate; Borgen, Elin Faye & Brekke, Marianne B.
[Show all 28 contributors for this article]
(2025).
Cost-Effectiveness of Prosigna for Adjuvant Treatment Decisions in Early Breast Cancer: Healthcare Sector and Societal Perspectives.
Clinical Breast Cancer.
ISSN 1526-8209.
25(6),
p. e721–e730.
doi:
10.1016/j.clbc.2025.04.011.
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Background Gene expression profiling tests such as the Prosigna-assay are used to aid adjuvant treatment decisions in hormone receptor positive (HR+) HER2 negative (HER2-) early breast cancer (EBC). In this economic evaluation, the cost-effectiveness of Prosigna against immunohistochemical (IHC) markers including Ki-67, was evaluated from the Norwegian healthcare- and societal perspective.
Materials and methods The impact of Prosigna on the treatment decision was assessed in the prospective, observational EMIT-1 trial. Using individual data collected during the first 12 months post-surgery, a decision model was built to project the economic consequences of using the Prosigna compared to IHC-markers for adjuvant treatment decisions. A bottom-up costing analysis assessed the two strategies' material- and labour costs. Health benefits were measured by cost per quality-adjusted life-years (QALYs) using the EQ-5D-5L questionnaire and data on income and welfare benefits was obtained from Statistics Norway.
Results Of 2,178 HR+/HER2- pN0 EBC patients in the EMIT-1 trial, 1,985 had available health economic data and 1,850 had complete income and welfare benefit records. Including all pN0 patients in the Prosigna-test strategy, the test was above the cost-effective threshold (€26,000; incremental cost-per QALY gained (ICER) €255,622) in a healthcare sector perspective. Applying a societal perspective incorporating productivity costs, Prosigna was cost saving (ICER €-435,677). Restricting Prosigna-testing to patients assessed as chemotherapy candidates/uncertain chemotherapy candidates, the strategy was cost-effective from both the healthcare and societal perspective (ICER €8,884 and €-620,170, respectively). For other subgroups (pT>1cm, ≤/>50 years), cost-effectiveness was only achievable from a societal perspective (ICER €-574,911, €-602,955 and €-336,832, respectively).
Conclusions Using the Prosigna-assay for all HR+/HER2- pN0 EBC patients was not cost-effective from a healthcare perspective, but from the societal perspective it was cost-saving compared to the IHC-classification. Selecting patients who are clear/uncertain candidates for chemotherapy based on IHC-classification, Prosigna is cost-effective from both perspectives.
Micro-abstract
This economic evaluation assessed the cost-effectiveness of the Prosigna gene expression profiling test versus immunohistochemical (IHC) markers for adjuvant treatment decisions in hormone receptor positive (HR+) HER2 negative (HER2-) early breast cancer (EBC) from Norwegian healthcare and societal perspectives. The Prosigna test was not cost-effective from a healthcare perspective but was cost-saving from a societal perspective. When use was restricted to patients who were clear chemotherapy candidates or uncertain candidates, Prosigna was cost-effective from both perspectives.
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Ohnstad, Hege Oma; Blix, Egil Støre; Akslen, Lars Andreas; Gilje, Bjørnar; Raj, Sunil Xavier & Skjerven, Helle
[Show all 45 contributors for this article]
(2024).
Impact of Prosigna test on adjuvant treatment decision in lymph node-negative early breast cancer—a prospective national multicentre study (EMIT-1).
ESMO Open.
9(6),
p. 1–12.
doi:
10.1016/j.esmoop.2024.103475.
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Background EMIT-1 is a national, observational, single-arm trial designed to assess the value of the Prosigna, Prediction Analysis of Microarray using the 50 gene classifier (PAM50)/Risk of Recurrence (ROR), test as a routine diagnostic tool, examining its impact on adjuvant treatment decisions, clinical outcomes, side-effects and cost-effectiveness. Here we present the impact on treatment decisions. Patients and methods Patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative pT1-pT2 lymph node-negative early breast cancer (EBC) were included. The Prosigna test and standard histopathology assessments were carried out. Clinicians’ treatment decisions were recorded before (pre-Prosigna) and after (post-Prosigna) the Prosigna test results were disclosed. Results Of 2217 patients included, 2178 had conclusive Prosigna results. The pre-Prosigna treatment decisions were: no systemic treatment (NT) in 27% of patients, endocrine treatment alone (ET) in 38% and chemotherapy (CT) followed by ET (CT + ET) in 35%. Post-Prosigna treatment decisions were 25% NT, 51% ET and 24% CT + ET, respectively. Adjuvant treatment changed in 28% of patients, including 21% change in CT use. Among patients assigned to CT + ET pre-Prosigna, 45% were de-escalated to ET post-Prosigna. Of patients assigned to ET, 12% were escalated to CT + ET and 8% were de-escalated to NT; of those assigned to NT, 18% were escalated to ET/CT + ET. CT was more frequently recommended for patients aged ≤50 years. In the subgroup with pT1c-pT2 G2 and intermediate Ki67 (0.5-1.5× local laboratory median Ki67 score), the pre-Prosigna CT treatment decision varied widely across hospitals (3%-51%). Post-Prosigna, the variability of CT use was markedly reduced (8%-24%). The correlation between Ki67 and ROR score within this subgroup was poor (r = 0.25-0.39). The median ROR score increased by increasing histological grade, but the ROR score ranges were wide (for G1 0-79, G2 0-90, G3 16-94). Conclusion The Prosigna test result changed adjuvant treatment decisions in all EBC clinical risk groups, markedly decreased the CT use for patients categorized as higher clinical risk pre-Prosigna and reduced treatment decision discrepancies between hospitals.
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Mecinaj, Albulena; Gulati, Geeta; Ree, Anne Hansen; Gravdehaug, Berit; Røsjø, Helge Rørvik & Steine, Kjetil
[Show all 10 contributors for this article]
(2024).
Impact of the ESC Cardio-Oncology Guidelines Biomarker Criteria on Incidence of Cancer Therapy–Related Cardiac Dysfunction.
JACC: CardioOncology.
6(1),
p. 83–95.
doi:
10.1016/j.jaccao.2023.10.008.
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Background The impact of recent consensus definitions of cancer therapy–related cardiac dysfunction (CTRCD) from the European Society of Cardiology cardio-oncology guidelines on the reported incidence of CTRCD has not yet been assessed. Objectives The aim of this study was to assess the: 1) cumulative incidence; 2) point prevalence during and after adjuvant therapy; and 3) prognostic value of CTRCD as defined by different asymptomatic CTRCD guideline criteria. Methods The cumulative incidence and point prevalence of CTRCD were retrospectively assessed in 118 patients participating in the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial. Asymptomatic CTRCD was assessed using alternative cardiac troponin (cTn) 99th percentile upper reference limits (URLs) to define cTnT and cTnI elevation. Results The cumulative incidence of moderate or severe CTRCD was low (1.7%), whereas the cumulative incidence of mild asymptomatic CTRCD was higher and differed markedly according to the biomarker criteria applied, ranging from 49.2% of patients when cTnT greater than the sex-specific 99th percentile URL was used to define cTn elevation to 9.3% when sex-neutral cTnI was used. The point prevalence of CTRCD was highest at the end of anthracycline therapy (47.8%) and was driven primarily by asymptomatic cTn elevation. CTRCD during adjuvant therapy was not prognostic for CTRCD at extended follow-up of 24 months (Q1-Q3: 21-29 months) after randomization. Conclusions Mild asymptomatic CTRCD during adjuvant breast cancer therapy was frequent and driven mainly by cTn elevation and was not prognostic of subsequent CTRCD. The incidence of mild, asymptomatic CTRCD differed markedly depending on the cTn assay and whether sex-neutral or sex-dependent URLs were applied. (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy [PRADA]; NCT01434134)
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Strømsvik, Nina; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Lurås, Hilde; Schlichting, Ellen & Jørgensen, Kjersti
[Show all 11 contributors for this article]
(2022).
“It was an important part of my treatment”: a qualitative study of Norwegian breast Cancer patients’ experiences with mainstreamed genetic testing.
Hereditary Cancer in Clinical Practice.
ISSN 1731-2302.
20(6).
doi:
10.1186/s13053-022-00212-6.
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Background: In South-Eastern Norway, genetic testing for BRCA1 and BRCA2 is offered to breast cancer patients by their treating surgeon or oncologist. Genetic counselling from a geneticist or a genetic counsellor is offered only to those who test positive for a pathogenic variant or have a family history of cancer. This practice is termed "mainstreamed genetic testing". The aim of this study was to learn about patients' experience of this healthcare service.
Methods: Qualitative in-depth interviews were conducted with 22 breast cancer patients who had been diagnosed during the first half of 2016 or 2017 at one regional and one university hospital and who had been offered testing by their treating physician. A six-phase thematic approach was used to analyse the data.
Results: The participants had varied experiences of how and when testing was offered. Three main themes emerged from the analysis: 1. informational and communicational needs and challenges during a chaotic time, 2. the value of genetic testing and 3. the importance of standardised routines for mainstreamed genetic testing.
Conclusions: Despite the shock of their diagnosis and the varying experiences they had in respect of how and when testing was offered, all of the participants emphasised that genetic testing had been an important part of their diagnosis and treatment. Our results indicate that there is a need for continuous collaboration between geneticists, surgeons, oncologists and laboratory specialists in order to establish simple and robust routines so as to ensure that all eligible breast cancer patients are offered testing at a point when the test result can have an impact on treatment.
Keywords: BRCA1, BRCA2; Breast cancer; Genetic testing for breast cancer; Mainstreamed genetic testing; Qualitative study.
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Heck, Siri Lagethon; Mecinaj, Albulena; Ree, Anne Hansen; Hoffmann, Pavel; Schulz-Menger, Jeanette & Fagerland, Morten
[Show all 12 contributors for this article]
(2021).
Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): Extended follow-up of a 2×2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol.
Circulation.
ISSN 0009-7322.
143(25),
p. 2431–2440.
doi:
10.1161/CIRCULATIONAHA.121.054698.
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Background: Adjuvant breast cancer therapy containing anthracyclines with or without anti–human epidermal growth factor receptor–2 antibodies and radiotherapy is associated with cancer treatment–related cardiac dysfunction. In the PRADA trial (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy), concomitant treatment with the angiotensin receptor blocker candesartan attenuated the reduction in left ventricular ejection fraction (LVEF) in women receiving treatment for breast cancer, whereas the β-blocker metoprolol attenuated the increase in cardiac troponins. This study aimed to assess the long-term effects of candesartan and metoprolol or their combination to prevent a reduction in cardiac function and myocardial injury. Methods: In this 2×2 factorial, randomized, placebo-controlled, double-blind, single-center trial, patients with early breast cancer were assigned to concomitant treatment with candesartan cilexetil, metoprolol succinate, or matching placebos. Target doses were 32 and 100 mg, respectively. Study drugs were discontinued after adjuvant therapy. All 120 validly randomized patients were included in the intention-to-treat analysis. The primary outcome measure was change in LVEF assessed by cardiovascular magnetic resonance imaging from baseline to extended follow-up. Secondary outcome measures included changes in left ventricular volumes, echocardiographic peak global longitudinal strain, and circulating cardiac troponin concentrations. Results: A small decline in LVEF but no significant between-group differences were observed from baseline to extended follow-up, at a median of 23 months (interquartile range, 21 to 28 months) after randomization (candesartan, 1.7% [95% CI, 0.5 to 2.8]; no candesartan, 1.8% [95% CI, 0.6 to 3.0]; metoprolol, 1.6% [95% CI, 0.4 to 2.7]; no metoprolol, 1.9% [95% CI, 0.7 to 3.0]). Candesartan treatment during adjuvant therapy was associated with a significant reduction in left ventricular end-diastolic volume compared with the noncandesartan group (P=0.021) and attenuated decline in global longitudinal strain (P=0.046) at 2 years. No between-group differences in change in cardiac troponin I and T concentrations were observed. Conclusions: Anthracycline-containing adjuvant therapy for early breast cancer was associated with a decline in LVEF during extended follow-up. Candesartan during adjuvant therapy did not prevent reduction in LVEF at 2 years, but was associated with modest reduction in left ventricular end-diastolic volume and preserved global longitudinal strain. These results suggest that a broadly administered cardioprotective approach may not be required in most patients with early breast cancer without preexisting cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01434134.
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Bahrami, Nazli; Jabeen, Shakila; Tahiri, Andliena; Sauer, Torill; Ødegård, Hilde Presterud & Geisler, Stephanie Beate
[Show all 11 contributors for this article]
(2021).
Lack of cross-resistance between non-steroidal and steroidal aromatase inhibitors in breast cancer patients: the potential role of the adipokine leptin.
Breast Cancer Research and Treatment.
ISSN 0167-6806.
190,
p. 435–449.
doi:
10.1007/s10549-021-06399-x.
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Abstract Purpose The aromatase inactivator exemestane may cause clinical disease stabilization following progression on non-steroidal aromatase inhibitors like letrozole in patients with metastatic breast cancer, indicating that additional therapeutic effects, not necessarily related to estrogen-suppression, may be involved in this well-known “lack of cross-resistance”. Methods Postmenopausal women with ER positive, HER-2 negative, locally advanced breast cancer were enrolled in the NEOLETEXE-trial and randomized to sequential treatment starting with either letrozole (2.5 mg o.d.) or exemestane (25 mg o.d.) followed by the alternative aromatase inhibitor. Serum levels of 54 cytokines, including 12 adipokines were assessed using Luminex xMAP technology (multiple ELISA). Results Serum levels of leptin were significantly decreased during treatment with exemestane ( p < 0.001), regardless whether exemestane was given as first or second neoadjuvant therapy. In contrast, letrozole caused a non-significant increase in serum leptin levels in vivo. Conclusions Our findings suggest an additional and direct effect of exemestane on CYP-19 (aromatase) synthesis presumably due to effects on the CYP19 promoter use that is not present during therapy with the non-steroidal aromatase inhibitor letrozole. Our findings provide new insights into the influence of clinically important aromatase inhibitors on cytokine levels in vivo that contribute to the understanding of the clinically observed lack of cross-resistance between non-steroidal and steroidal aromatase inhibitors in breast cancer patients. Trial registration Registered on March 23rd 2015 in the National trial database of Norway (Registration number: REK-SØ-84-2015).
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Grindedal, Eli Marie; Jørgensen, Kjersti; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Lurås, Hilde & Schlichting, Ellen
[Show all 10 contributors for this article]
(2020).
Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway.
Familial Cancer.
ISSN 1389-9600.
19(2),
p. 133–142.
doi:
10.1007/s10689-020-00160-x.
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Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed "mainstreamed genetic testing". The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway.
Keywords: BRCA; Breast cancer; Genetic testing; Mainstreaming cancer genetics.
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Bahrami, Nazli; Chang, Gregory; Kanaya, Noriko; Sauer, Torill; Park, Daehoon & Loeng, Marie
[Show all 9 contributors for this article]
(2020).
Changes in serum estrogenic activity during neoadjuvant therapy with letrozole and exemestane.
Journal of Steroid Biochemistry and Molecular Biology.
ISSN 0960-0760.
200,
p. 1–8.
doi:
10.1016/j.jsbmb.2020.105641.
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The aromatase inhibitors (AIs), letrozole (Femar®/Femara®) and exemestane (Aromasin®), are widely used to treat estrogen receptor (ER) positive breast cancer in postmenopausal patients. In the setting of metastatic breast cancer, these drugs may be used after another causing new responses in selected patients after progressing on the first choice. The precise explanation for this “lack of cross resistance” is still missing. NEOLETEXE is a neoadjuvant, randomized, open-label, cross-over trial. Postmenopausal patients with ER-positive, HER-2 negative, locally advanced breast cancer were enrolled. All patients were randomized to treatment starting with either letrozole or exemestane for at least 2 months followed by another 2 months on the alternative AI. The total estrogenic activities in blood samples were determined using the AroER tri-screen assay developed in the Chen laboratory. Using this highly sensitive assay, estrogenic activity was detected at three time points for all patients. Importantly, a significantly higher total estrogenic activity was found during therapy with exemestane compared to letrozole in 21 out of 26 patients. When letrozole was included in the AroER tri-screen assay, the estrogenic activities in most samples collected during exemestane treatment were further reduced, suggesting that low levels of androgens remained in specimens obtained after exemestane treatment. Our results suggest the AroER tri-screen to be a very sensitive method to estimate the overall estrogen-mediated activity in human samples even during therapy with highly potent aromatase inhibitors. In the present study, serum estrogen activity was significantly higher during exemestane therapy when compared to letrozole therapy.
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Bahrami, Nazli; Sauer, Torill; Engebretsen, Siri Strøm; Aljabri, Mohammad Belal; Bemanian, Vahid & Lindstrøm, Jonas Christoffer
[Show all 17 contributors for this article]
(2019).
The NEOLETEXE trial: a neoadjuvant cross-over study exploring the lack of cross resistance between aromatase inhibitors.
Future Oncology.
ISSN 1479-6694.
15(32),
p. 3675–3682.
doi:
10.2217/fon-2019-0258.
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The aromatase inhibitor letrozole (Femar®) and the aromatase inactivator exemestane (Aromasin®) differ in their biochemical effect on the aromatase enzyme. Letrozole is a competitive aromatase inhibitor while exemestane binds irreversibly to the aromatase enzyme. This pharmacological difference is of clinical interest since a lack of cross-resistance has been documented. It has been demonstrated in several clinical trials that exemestane may cause a disease regression following resistance to nonsteroidal aromatase inhibitors. The exact mechanism(s) behind this phenomenon is yet unknown. Here, we present the NEOLETEXE trial with the aim of exploring the individual mechanisms involved behind the observed lack of cross resistance. Clinical trial registration: The trial has been approved by the Regional Ethics Committee of South-East Norway (project number 2015/84).
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Sauer, Torill; Doughty, Richard William; Orszagh, Vivian C & Gravdehaug, Berit
(2018).
The Cytopathologist in the Hospital - Based Fnac Clinic: US Image Guidance is Our
New Tool to an Even Better Fnac Practice.
Mathews Journal of Cytology and Histology.
2(1).
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Cytopathologists performing fine-needle aspirations (FNAC) on palpable lesions has a long history. Palpation guided FNAC still has its place, but an increasing number of lesions are being investigated by ultrasound and ultrasound guided FNAC. Naturally this applies to all non-palpable lesions, however the use of ultrasound in the investigation of non-palpable lesions may provide more representative samples and generally improved diagnostic quality. In a hospital based setting, ultrasound imaging and often also FNAC or CNB (core needle biopsy) have traditionally been the domain of radiologists. Today, ultrasound is increasingly being used in a number of specialities for specific investigations, and may now be regarded as a general investigative tool. Currently few cytopathologists (outside the US) have adopted this practice in a hospital- based setting. In this review we describe the model used at a large university hospital in Norway.
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Gulati, Geeta; Heck, Siri Lagethon; Røsjø, Helge; Ree, Anne Hansen; HOFFMANN, PAVEL & Hagve, Tor-Arne
[Show all 11 contributors for this article]
(2017).
Neurohormonal blockade and circulating cardiovascular biomarkers during anthracycline therapy in breast cancer patients: Results from the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) study.
Journal of the American Heart Association (JAHA).
6(11).
doi:
10.1161/JAHA.117.006513.
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Background Anthracyclines are associated with cardiotoxic effects. Cardiovascular biomarkers may reflect myocardial injury, dysfunction, inflammation, and fibrosis and may precede and predict the development of left ventricular impairment. The aim of this study was to assess: (1) longitudinal change in circulating cardiovascular biomarkers, (2) the effect of metoprolol succinate and candesartan cilexetil on the biomarker response, and (3) the associations between on‐treatment changes in biomarker concentrations and subsequent left ventricular dysfunction in patients with early breast cancer receiving anthracyclines. Methods and Results This report encompasses 121 women included in the 2×2 factorial, placebo‐controlled, double‐blind PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial with metoprolol and candesartan given concomitantly with anticancer therapy containing the anthracycline, epirubicin (total cumulative dose, 240–400 mg/m2). Cardiovascular magnetic resonance, echocardiography images, and circulating levels of biomarkers were obtained before and after anthracycline treatment. Cardiac troponins I and T, B‐type natriuretic peptide, N‐terminal pro‐B‐type natriuretic peptide, C‐reactive protein, and galectin‐3 increased during anthracycline therapy (all P<0.05). The troponin response was attenuated by metoprolol (P<0.05), but not candesartan. There was no association between change in biomarker concentrations and change in cardiac function during anthracycline therapy. Conclusions Treatment with contemporary anthracycline doses for early breast cancer is associated with increase in circulating cardiovascular biomarkers. This increase is, however, not associated with early decline in ventricular function. Beta‐blockade may attenuate early myocardial injury, but whether this attenuation translates into reduced risk of developing ventricular dysfunction in the long term remains unclear. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01434134.
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Heck, Siri Lagethon; Gulati, Geeta; HOFFMANN, PAVEL; Knobelsdorff-Brenkenhoff, Florian von; Storås, Tryggve & Ree, Anne Hansen
[Show all 12 contributors for this article]
(2017).
Effect of candesartan and metoprolol on myocardial tissue composition during anthracycline treatment: The PRADA trial.
European Heart Journal-Cardiovascular Imaging.
ISSN 2047-2404.
19(5),
p. 544–552.
doi:
10.1093/ehjci/jex159.
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Aims:
Anthracycline treatment may cause myocyte loss and expansion of the myocardial extracellular volume (ECV) fraction by oedema and fibrosis. We tested the hypotheses that adjuvant treatment for early breast cancer with the anthracycline epirubicin is dose dependently associated with increased ECV fraction and total ECV, as well as reduced total myocardial cellular volume, and that these changes could be prevented by concomitant angiotensin or beta-adrenergic blockade.
Methods and results:
PRevention of cArdiac Dysfunction during Adjuvant breast cancer therapy (PRADA) was a 2 × 2 factorial, placebo-controlled, double-blinded trial of candesartan and metoprolol. Sixty-nine women had valid ECV measurements. ECV fraction, total ECV, and total cellular volume were measured by cardiovascular magnetic resonance before and at the completion of anthracycline therapy. ECV fraction increased from 27.5 ± 2.7% to 28.6 ± 2.9% (P = 0.002). A cumulative doxorubicin equivalent dose of 268 mg/m2 was associated with greater increase in ECV fraction than doses <268 mg/m2 (mean change 3.4% [95% confidence interval (CI) 1.2, 5.5] vs. 0.7% [95% CI 0.0, 1.5], P = 0.006), as well as greater increase in total ECV (1.9 mL [95% CI 0.4, 3.5] vs. 0.1 mL [95% CI -0.6, 0.8], P = 0.04). In patients receiving candesartan, total cellular volume decreased (-3.5 mL [95% CI - 4.7, -2.2], P < 0.001) while in patients not receiving candesartan, it remained unchanged (P = 0.45; between group difference P = 0.003).
Conclusions:
Anthracycline therapy is associated with dose-dependent increase in ECV fraction and total ECV. Concomitant treatment with candesartan reduces left ventricular total cellular volume.
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Gulati, Geeta; Heck, Siri Lagethon; Ree, Anne Hansen; HOFFMANN, PAVEL; Schulz-Menger, Jeanette & Fagerland, Morten
[Show all 15 contributors for this article]
(2016).
Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol.
European Heart Journal.
ISSN 0195-668X.
37(21),
p. 1671–1680.
doi:
10.1093/eurheartj/ehw022.
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Tahri, Naima Borg; Gravdehaug, Berit; Bahrami, Nazli & Reitsma, Laurens Cornelus
(2024).
En kvinne i 50-årene med postoperativ infeksjon, generalisert utslett og organsvikt.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
144(5).
doi:
10.4045/tidsskr.23.0623.
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Strømsvik, Nina; Olsson, Pernilla Marie A.; Gravdehaug, Berit; Mæhle, Lovise Olaug; Lurås, Hilde & Schlichting, Ellen
[Show all 11 contributors for this article]
(2021).
Breast Cancer Patients' Experiences with Mainstreamed Genetic Testing in Two Hospitals in South Eastern Norway - Preliminary results.
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Background: In South Eastern Norway, genetic testing of BRCA1 and BRCA2 is mainstreamed into regular oncological care. Testing is offered directly to breast cancer (BC) patients by surgeons and oncologists. Only patients who test positive for a pathogenic BRCA variant or have a family history of cancer, are referred to genetic counseling. The aim of this study was to gain knowledge on how BC patients experience this health care service.
Methods: Thirty women, diagnosed with BC during the first half of 2016 or 2017 at one regional and one university hospital, and who had been tested by their treating physician were invited.. Twenty two (73%) consented to inclusion, and qualitative individual interviews were undertaken with all of them. The data were analysed using a thematic approach.
Results: Being diagnosed with BC was a shock that created a need for and an obstacle to absorbing and remembering information. A feeling of trust in the health care providers facilitated communication in this chaotic period. The women regarded genetic testing as important for themselves, their cancer treatment and their relatives. The participants’ experience of how genetic testing was offered, the amount of information they received and how they had received the test result varied. Not all patients had been offered testing, and some had asked for the test themselves. The participants emphasized the importance of having routines to secure that all eligible patients were given the opportunity of being tested.
Conclusions: Based on the findings in this qualitative study of BC patients’ experience with mainstreamed genetic testing, we conclude that access to testing during diagnosis and treatment had been important to these women. Their varied experiences regarding when and how they had been offered testing indicate that there may be a need to strengthen and unify routines for this health care service.
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Heck, Siri Lagethon; Gulati, Geeta; HOFFMANN, PAVEL; Knobelsdorff-Brenkenhoff, Florian von; Storås, Tryggve & Ree, Anne Hansen
[Show all 11 contributors for this article]
(2016).
Effects of Candesartan and Metoprolol on Myocardial Mass, Edema, and Fibrosis During Anthracycline Treatment in Early Breast Cancer: APRADA-CMR substudy.
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Gulati, Geeta; Heck, Siri Lagethon; HOFFMANN, PAVEL; Ree, Anne Hansen; Schulz-Menger, Jeanette & Knobelsdorff-Brenkenhoff, Florian von
[Show all 12 contributors for this article]
(2016).
Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Primary Results of a Randomized, 2 x 2 Factorial, Placebo-Controlled, Double-Blind Clinical Trial.
Circulation.
ISSN 0009-7322.
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Sauer, Torill; Orszagh, Vivian C; Doughty, Richard W.; Dahl, Sverre; Gravdehaug, Berit & Chen, Ying
(2016).
An audit of a pathologist performed US-guided FNAC out patient clinic; the Ahus institutional experience.
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Gulati, Geeta; Heck, Siri Lagethon; Geisler, Jürgen; Fagerland, Morten; HOFFMANN, PAVEL & Gravdehaug, Berit
[Show all 10 contributors for this article]
(2016).
Effect of candesartan and metoprolol on subclinical myocardial injury during anthracycline therapy: data from the prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA) study.
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Published
Mar. 3, 2022 12:46 PM
- Last modified
May 11, 2023 1:51 PM
