Ingvild Vistad

• Tarabar, Zaklina; Børøsund, Elin; Fosstveit, Sindre Herskedal; Berntsen, Sveinung; Hagen, Milada & Vistad, Ingvild (2026). Factors Associated With the Use of the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) mHealth App in Routine Follow-Up After Gynecologic Cancer Treatment: Observational Study. JMIR Cancer. 12, p. 1–14. doi: 10.2196/89918. Full text in Research Archive Show summary

  Background Mobile health (mHealth) apps offer new opportunities to support cancer survivors in managing their health, adopting healthier lifestyles, and increasing awareness of recurrence symptoms. However, despite their potential, little is known about survivors’ use of such tools in routine follow-up care, or which factors are associated with their engagement. Objective The aim of the present study was to identify survivor characteristics associated with the use of the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) app. In addition, we aimed to describe engagement patterns among gynecologic cancer survivors during the first year of follow-up after treatment. Methods App data from 378 participants in the intervention group of the LETSGO multicenter clinical trial were included in the analysis. Using multiple logistic regression, we analyzed app data from the first year of LETSGO app use to identify participant characteristics associated with use. In addition, we described the frequency of user interactions with app features and identified the most frequently used features during the first year of the intervention in a subset of 49 participants with complete app log data. Results Of the 378 participants in the intervention group, 267 (70.6%) used the LETSGO app at least twice and were defined as app users. The median age of app users was 63 (53-70) years vs 70 (60-78) years among app nonusers ( P <.001). App use was associated with younger age (odds ratio [OR] 0.96 per year, 95% CI 0.93‐0.99; P =.003), higher education (OR 2.2, 95% CI 1.1‐4.6; P =.03), and having ovarian cancer (OR 2.9; 95% CI 1.1‐7.5; P =.03). The LETSGO app included a monthly reminder for symptom self-registration, and monthly peaks in the symptom monitoring feature corresponded with the timing of this reminder. App log data from the full first year of the intervention were available for 49 participants. Among these, user engagement was highest for the physical activity and activity goal-setting features, whereas the disease information feature showed steady but less frequent use. Conclusions Our findings indicate that LETSGO app use was associated with survivor characteristics such as age, education level, and cancer type. Considering user characteristics when tailoring mHealth apps may support user engagement in digital follow-up care and inform the development of mHealth tools that better align with survivors’ needs and preferences. Engagement with the LETSGO app during the first year of follow-up among a subset of participants with complete app log data was highest for the physical activity and activity goal-setting features. The pattern of symptom registration following reminders indicates that scheduled prompts may support regular app engagement, while steady use of the disease information feature suggests an ongoing need for accessible health information during follow-up.

• Fox, Louis; Leeuwen, Marieke van; Jones, Jennifer M.; Al-Omari, Amal; Abaza, Haneen & Al-Khaifi, Muna [Show all 64 contributors for this article] (2026). International phase IV field study to validate the European Organisation for Research and Treatment of Cancer questionnaire for assessing the health-related quality of life of cancer survivors: The EORTC QLQ-SURV100. European Journal of Cancer. ISSN 0959-8049. 245. doi: 10.1016/j.ejca.2026.116959. Full text in Research Archive
• Fosstveit, Sindre Herskedal; Vistad, Ingvild; Skorstad, Mette & Berntsen, Sveinung (2026). Long-Term Engagement With a Physical Activity App Among Gynecologic Cancer Survivors in the LETSGO Trial: 12-Month Prospective, Multicenter, Quasi-Experimental Study. JMIR mhealth and uhealth. 14. doi: 10.2196/84838. Full text in Research Archive Show summary

  Background: Physical activity (PA) alleviates many treatment-related side effects in gynecologic cancer survivors, yet long-term PA levels remain low. Mobile health interventions can support self-management and increase PA levels; however, evidence from real-world, year-long engagement with smartphone apps in this population is still limited. Objective: The aim of this study is to describe 12-month user engagement with the PA component of a smartphone app implemented within a partially nurse-led routine follow-up in a real-world cohort of gynecologic cancer survivors. Methods: This descriptive study analyzed server-generated log data from the intervention arm of the prospective, multicenter, quasi-experimental LETSGO (Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology) trial (NCT04122235). Between December 2019 and July 2022, 378 cancer survivors (ovarian, endometrial, cervical, vulvar, or vaginal cancer) from 5 Norwegian hospitals were enrolled in the intervention arm and were offered the app plus a Garmin Vivofit 4 activity tracker alongside standard consultations. Primary outcomes for this study were (1) weekly PA registrations (objective step counts from the activity tracker and self-reported PAs) and (2) temporal patterns of step logging during each cancer survivor’s first 52 weeks postenrollment. Secondary analyses compared baseline characteristics of app users (≥2 wk of PA logging) and nonusers. Results: Of 378 eligible participants (mean age 63, SD 13 y; BMI 28.5, SD 6.4 kg/m²), 272 (72%) logged at least 2 weeks of PA, and 225 (60%) synchronized objective step data. Mean daily steps were 5657 (SD 2799; median 5533, IQR 3499‐7498). Step tracking dominated app use (mean 21, SD 16 logged wk), followed by self-reported walking (mean 23, SD 19 wk) and resistance training (mean 15, SD 16 wk). Weekly step-logger counts fell around study weeks 16, 32, and 44, but rebounded by 30 to 50 participants within 3 weeks, indicating episodic rather than permanent disengagement. App users were younger (mean difference –6.7 y, 95% CI –9.6 to –3.9; P<.001), more often employed (χ²1=12.7; P<.001), and more likely to have higher education (χ²2=13.6; P<.001) than nonusers. Tumor type and treatment modality were not associated with engagement. Conclusions: In a routine-care setting, nearly three-quarters of gynecologic cancer survivors engaged repeatedly with an app-supported PA module over 12 months, although mean PA levels were modest and participation was more prevalent among younger, employed, and more highly educated participants. Engagement followed an ebb-and-flow pattern, suggesting that built-in re-engagement prompts and equity-focused onboarding are needed to sustain and broaden participation. These findings support the feasibility of blended mobile health follow-up while highlighting the importance of adaptive strategies to promote long-term PA adherence and bridge the digital divide among cancer survivors.

• Froeding, Ligita Paskeviciute; Greimel, Eva; Nordin, Andy; Vistad, Ingvild; Lanceley, Anne & Bjelic-Radisic, Vesna [Show all 20 contributors for this article] (2026). Phase 1–3 cross-cultural development and pre-testing of the European Organisation of Research and Treatment of Cancer Vulva cancer questionnaire module (EORTC QLQ- VU). Gynecologic Oncology. ISSN 0090-8258. 212, p. 17–23. doi: 10.1016/j.ygyno.2026.07.014. Full text in Research Archive
• Gissum, Karen; Engen, Caroline Benedicte Nitter; Drageset, Sigrunn; Eriksson, Ane Gerda Zahl; Vistad, Ingvild & Strand, Roger [Show all 7 contributors for this article] (2026). Hope and hopelessness in the face of ovarian cancer: perspectives from gynecologists. Frontiers in Oncology. 16. doi: 10.3389/fonc.2026.1931795. Full text in Research Archive Show summary

  Background Effective communication plays a key role in fostering strong relationships between patients and healthcare providers during cancer treatment and care. Women with ovarian cancer live with the illness and disease aspects of the condition, while biomedical knowledge tends to focus on the disease. We aimed to gain an understanding of the patient-provider relationship in ovarian cancer from a gynecologists’ perspective. Materials and methods We collected data using semi-structured interviews and applied a phenomenological approach to data analysis. Results We conducted individual interviews with nine gynecologists between October 2022 and February 2023. Three distinctive features defined the gynecologists’ understanding (1). When interacting with patients, they focused on diagnostic markers and treatment choices, paying more attention to the disease than to holistic well-being (2). The gynecologists’ understanding of ovarian cancer was mainly based on medical knowledge rather than on patients’ experiences (3). The tragic nature of ovarian cancer led the gynecologists to create emotional distance as a means of self-preservation, while harboring a hope that medical advancements would lead to a cure in the future but acknowledging their feelings of helplessness in treating these patients. Conclusion Gynecologists understand ovarian cancer from a disease perspective of health. Their role is to maintain the biomedical dimension of condition, upholding patients’ hope as well as their own for medical advancement throughout the ovarian cancer trajectory. Furthermore, gynecologists understand their role as constrained by a rigid system that limits their ability to best provide holistic care to patients.

• Köpp, Unni Mette Stamnes; Mikkelsen, Hilde E. Timenes & Vistad, Ingvild (2026). Omvendt undervisning – en kvalitativ studie blant medisinstudenter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146(5). doi: 10.4045/tidsskr.25.0438. Full text in Research Archive Show summary

  Bakgrunn og formål Omvendt undervisning, det vil si at studentene forbereder seg før undervisningen, innebærer at undervisningstiden kan brukes til diskusjon, refleksjon og studentaktiviserende arbeid. Formålet med denne kvalitative studien var å undersøke hvordan forberedelsesoppgaver påvirker medisinstudentenes motivasjon, engasjement og opplevde læring. Materiale og metode To fokusgruppeintervjuer med til sammen 14 medisinstudenter ved Universitetet i Oslo, Campus Sør, ble gjennomført i mai 2024. Studentene hadde erfaring med både tradisjonell og omvendt undervisning. Intervjuene ble analysert med refleksiv tematisk analyse med fokus på studentenes erfaringer med forberedelser og undervisning. Resultater Studentene ga uttrykk for at tydelige forventninger og forberedelser tilpasset undervisningens omfang styrket motivasjonen. De foretrakk kortfattede forberedelsesoppgaver tilgjengelig i god tid. Aktiv bruk av forberedelsesoppgavene i undervisningen gjennom quiz, diskusjoner og kasuistikker fremmet engasjement og opplevd faglig mestring. Studentene erfarte at undervisningsmodellen styrket forståelse av stoffet og trygghet i faglige diskusjoner, særlig ved komplekse temaer. Studentene opplevde også at undervisningsformen støttet utvikling av profesjonell identitet og forberedelse til klinisk arbeid. Fortolkning Kombinasjon av avgrensede forberedelsesoppgaver og aktiv integrering av disse i omvendt undervisning fremmer studentenes motivasjon, engasjement, faglige mestringsfølelse og refleksjon.

• Allotey, John; Coomar, Dyuti; Ensor, Joie; Ruiz-Calvo, Gabriel; Boath, Anna & Ogwulu, Chidubem Okeke [Show all 103 contributors for this article] (2026). Effects of lifestyle interventions in pregnancy on gestational diabetes: individual participant data and network meta-analysis. The BMJ. 392. doi: 10.1136/bmj-2025-084159. Full text in Research Archive
• Tarabar, Zaklina; Vistad, Ingvild & Børøsund, Elin (2025). Gynecological Cancer Survivors’ Experiences Using a Supportive Care Application During Posttreatment Follow-up A Qualitative Study. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000001542. Full text in Research Archive
• Paulsen, Anita; Fegran, Liv; Hagen, Milada & Vistad, Ingvild (2025). Self-reported Sexual Health-Related Outcomes in Gynecological Cancer Survivors: Results from a Quasi-experimental Multicenter Intervention Study on Follow-up after Gynecological Cancer Treatment. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000001493. Full text in Research Archive Show summary

  Background: Gynecological cancer survivors often face sexual health challenges posttreatment, making interventions to address these issues essential. Objective: The aim of this study was to investigate changes in sexual health–related outcomes among gynecological cancer survivors comparing 2 different follow-up models. Methods: This preplanned substudy utilized data from the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology study. Participants were assigned to either the intervention or control group based on their treatment hospital. The control group received standard follow-up care, whereas the intervention group received shared follow-up care with sexual health communication. Analyses included 686 participants with sexual activity as the primary outcome. Secondary outcomes included feelings of reduced physical attractiveness for all, sexual enjoyment and vaginal dryness (sexually active participants), and reasons for sexual inactivity (sexually inactive participants). Assessments were conducted at the end of treatment and at 6 and 12 months posttreatment. Results: No statistically significant group differences were found in any of the outcomes at 12 months. The intervention group showed a more favorable trend in sexual activity at 6 months, not sustained at 12 months. Both groups experienced an increase in vaginal dryness. The absence of a partner was the most common reason for sexual inactivity. Conclusions: Findings suggest that nurse-led sexual health communication during routine follow-up consultations may have a limited impact on the sexual health–related outcomes measured in this study. Implications for Practice: More intensive and individualized interventions may be necessary for significant improvements in the outcomes of this study.

• Meltzer-Gunnes, Christin Julia; Hagen, Milada; Wang, Yun; Jensen, Pernille T. & Vistad, Ingvild (2025). Long-term quality of life, vulvar symptoms, and sexual functioning: A cross-sectional study of Norwegian vulvar cancer survivors. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 104, p. 1505–1516. doi: 10.1111/aogs.15155. Full text in Research Archive
• Vistad, Ingvild; Skorstad, Mette; Berntsen, Sveinung; Demmelmaier, Ingrid; Bjørge, Line & Poll-Franse, Lonneke V. Van De [Show all 17 contributors for this article] (2025). Empowerment and quality of life in gynecological cancer survivors: Outcomes from a multicenter quasi-experimental cohort study from Norway (the LETSGO trial). Cancer. ISSN 0008-543X. 131(16). doi: 10.1002/cncr.70040. Full text in Research Archive Show summary

  Background: Increasing outpatient demands and unmet patient needs necessitate personalized follow-up care for cancer survivors. This study investigated whether a self-management–focused follow-up model improves empowerment and quality of life (QoL) in gynecological cancer survivors compared to standard follow-up. Methods: Twelve Norwegian hospitals participated in this cohort study. Patients initiating routine follow-up after primary treatment were eligible and allocated to either intervention or standard care follow-up groups based on their treatment hospital. The intervention included nurse-led consultations using coaching techniques for education on symptom monitoring and healthy lifestyle, alternated with physician-led consultations and access to a mobile app. Standard follow-up consisted of physician-led consultations only. The primary outcome was change in patient empowerment over 12 months, measured with the self-monitoring and insight domain of the Health Education Impact Questionnaire (heiQ). Secondary outcomes included changes in remaining heiQ domains and QoL. Data were analyzed according to intention-to-treat principles using linear mixed effects models. Results: Among 741 participants (intervention: 378, standard: 363), baseline characteristics were comparable. At 12 months, no significant differences were observed in self-monitoring and insight (Δ = 0.02 [95% confidence interval (CI), –0.04 to 0.08]; effect sizes [ES] = 0.29). However, health-directed activity (Δ = 0.15 [95% CI, 0.04–0.25]; ES = 0.15), emotional well-being (Δ = 0.12 [95% CI, 0.02–0.20]; ES = 0.15), social functioning (Δ = 5.2 [95% CI, 1.1–9.3]; ES = 0.41), and physical functioning (Δ = 2.5 [95% CI, 0.0–5.0]; ES = 0.20) were significantly more improved in the intervention group. Conclusion: Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology follow-up did not significantly impact self-monitoring and insight, but positively influenced other survivorship domains, indicating its potential for enhancing self-management and QoL in gynecological cancer survivors.

• Robstad, Anja Nastasja; Paulsen, Anita; Vistad, Ingvild; Hott, Alexandra Christine; Berg, Kari Hansen & Øgård-Repål, Anita [Show all 9 contributors for this article] (2024). Experiences of pain communication in endometriosis: A meta-synthesis. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. p. 1–16. doi: 10.1111/aogs.14995. Full text in Research Archive Show summary

  Introduction: Endometriosis is the leading cause of chronic pelvic pain among women. The pain associated with endometriosis significantly impacts various aspects of patients' quality of life. A notable void in the literature is the absence of a systematic review exploring pain communication between patients with endometriosis and healthcare professionals. Hence, the aim of this qualitative systematic review was to synthesize findings on how patients with endometriosis experience communicating with healthcare professionals about pain and how healthcare professionals experience these interactions. Material and Methods: A systematic literature search was conducted related to patients with endometriosis and pain communication in CINAHL PLUS with full text and MEDLINE (via EBSCO host) on May 12, 2023, and updated January 26, 2024. Searches were supplemented by backward searching reference lists and forward searching citations of included reports in Scopus and Google Scholar. The review was guided by the four-step meta-synthesis methodology by Sandelowski and Barosso. Critical appraisal of included studies was conducted using Critical Appraisal Skill Program (CASP). Findings were analyzed thematically, using the approach described by Thomas and Harden. The meta-synthesis was based on a registered protocol in PROSPERO (CRD 42023425430), and the study is reported adhering to the PRISMA 2020 checklist. Results: Overall, 37 reports published from 2003 until 2023 contributed to the review, including 4842 participants. Through thematic analysis, we developed the following themes: “Navigating the double burden,” “Lack of mutual understanding,” and “The complexities of conveying pain.” Conclusions: The communication of pain between patients with endometriosis and healthcare professionals is complex, encompassing patterns of disbelief, normalization, and psychological attribution. Engaging in discussions about pain presents diverse challenges stemming from insufficient communication skills and assessment tools. Further research is warranted to comprehensively explore the perspectives of both patients and healthcare professionals, aiming to devise strategies that enhance communication and patient care.

• Gissum, Karen; Drageset, Sigrunn; Thomsen, Liv Cecilie Vestrheim; Vistad, Ingvild; Strand, Roger & Bjørge, Line (2024). Navigating the Complexities of Ovarian Cancer Care: Perspectives from Nurses. Iris Journal of Nursing & Care (IJNC). ISSN 2643-6892. doi: 10.33552/IJNC.2024.05.000605. Full text in Research Archive
• Osestad, Toril Margrethe; Lilleholt, Kristin; Skadberg, Øyvind; Sagedal, Linda Reme; Vistad, Ingvild & Hundhausen, Thomas Eckhard (2024). Glycated albumin in pregnancy correlates negatively with body mass index and contributes to the risk of gestational diabetes mellitus. Practical Laboratory Medicine. 42. doi: 10.1016/j.plabm.2024.e00439. Full text in Research Archive
• Schmalz, Claudia; Oberguggenberger, Anne S.; Nagele, Eva; Bliem, Brigitte; Lanceley, Anne & Nordin, Andy [Show all 24 contributors for this article] (2024). Sexual health—a topic for cancer patients receiving oncological treatment with palliative intent. BMC Palliative Care. 23(1). doi: 10.1186/s12904-024-01513-4. Full text in Research Archive
• Western, Benedikte; Ivarsson, Andreas; Vistad, Ingvild; Demmelmaier, Ingrid; Aaronson, Neil K. & Radcliffe, Gillian [Show all 47 contributors for this article] (2024). Dropout from exercise trials among cancer survivors—An individual patient data meta-analysis from the POLARIS study. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 34(2). doi: 10.1111/sms.14575. Full text in Research Archive Show summary

  Introduction: The number of randomized controlled trials (RCTs) investigating the effects of exercise among cancer survivors has increased in recent years; however, participants dropping out of the trials are rarely described. The objective of the present study was to assess which combinations of participant and exercise program characteristics were associated with dropout from the exercise arms of RCTs among cancer survivors. Methods: This study used data collected in the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) study, an international database of RCTs investigating the effects of exercise among cancer survivors. Thirty-four exercise trials, with a total of 2467 patients without metastatic disease randomized to an exercise arm were included. Harmonized studies included a pre and a posttest, and participants were classified as dropouts when missing all assessments at the post-intervention test. Subgroups were identified with a conditional inference tree. Results: Overall, 9.6% of the participants dropped out. Five subgroups were identified in the conditional inference tree based on four significant associations with dropout. Most dropout was observed for participants with BMI >28.4 kg/m2, performing supervised resistance or unsupervised mixed exercise (19.8% dropout) or had low-medium education and performed aerobic or supervised mixed exercise (13.5%). The lowest dropout was found for participants with BMI >28.4 kg/m2 and high education performing aerobic or supervised mixed exercise (5.1%), and participants with BMI ≤28.4 kg/m2 exercising during (5.2%) or post (9.5%) treatment. Conclusions: There are several systematic differences between cancer survivors completing and dropping out from exercise trials, possibly affecting the external validity of exercise effects.

• Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Nurse–patient sexual health communication in gynaecological cancer follow-up: A qualitative study from nurses' perspectives. Journal of Advanced Nursing. ISSN 0309-2402. 79(12). doi: 10.1111/jan.15755. Full text in Research Archive Show summary

  Aim To explore nurse–patient sexual health communication from the perspectives of nurses trained to address sexual health in gynaecological cancer follow-up. Design A qualitative hermeneutic approach. Methods Individual semi-structured interviews with 10 nurses at five different hospitals in Norway were conducted in March and April 2021. A Gadamerian-inspired research method was used in the analysis. Results Three main themes with six sub-themes were identified. The three main themes were: (1) building relationships through communication, (2) practice makes perfect—the importance of experience and knowledge, and (3) personal attitudes as promoters or inhibiters of sexual health communication. Conclusion This study provides valuable insights into nurse–patient sexual health communication from the perspectives of nurses. The nurses in this study experienced the importance of having a good, respectful nurse–patient relationship as the foundation for sexual health communication. The professional confidence gained through experience and knowledge was emphasized, including the significance of how attitudes and taboos can influence sexual health communication. Impact The main findings of this study indicate that training in sexual health communication and the possibility of addressing sexual health repeatedly give nurses skills and professional confidence to address sexual health in cancer follow-up. Our study indicates that sexual health communication can be achieved in a clinical setting without being overly resource demanding. Our results may also motivate nurses to enhance their knowledge about sexual health in cancer follow-ups.

• Leeuwen, Marieke van; Kieffer, Jacobien M.; Young, Teresa E.; Annunziata, Maria Antonietta; Arndt, Volker & Arraras, Juan Ignacio [Show all 49 contributors for this article] (2023). Phase III study of the European Organisation for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire. Journal of cancer survivorship. ISSN 1932-2259. 17(4), p. 1111–1130. doi: 10.1007/s11764-021-01160-1. Full text in Research Archive
• Western, Benedikte; Demmelmaier, Ingrid; Vistad, Ingvild; Hansen, Bjørge Hermann; Stenling, Andreas & Henriksen, Hege [Show all 9 contributors for this article] (2023). How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors. PLOS ONE. 18(4). doi: 10.1371/journal.pone.0284881. Full text in Research Archive Show summary

  Background Physical activity (PA) monitoring is applied in a growing number of studies within cancer research. However, no consensus exists on how many days PA should be monitored to obtain reliable estimates in the cancer population. The objective of the present study was to determine the minimum number of monitoring days required for reliable estimates of different PA intensities in cancer survivors when using a six-days protocol. Furthermore, reliability of monitoring days was assessed stratified on sex, age, cancer type, weight status, and educational level. Methods Data was obtained from two studies where PA was monitored for seven days using the SenseWear Armband Mini in a total of 984 cancer survivors diagnosed with breast, colorectal or prostate cancer. Participants with ≥22 hours monitor wear-time for six days were included in the reliability analysis (n = 736). The intra-class correlation coefficient (ICC) and the Spearman Brown prophecy formula were used to assess the reliability of different number of monitoring days. Results For time in light PA, two monitoring days resulted in reliable estimates (ICC >0.80). Participants with BMI ≥25, low-medium education, colorectal cancer, or age ≥60 years required one additional monitoring day. For moderate and moderate-to-vigorous PA, three monitoring days yielded reliable estimates. Participants with BMI ≥25 or breast cancer required one additional monitoring day. Vigorous PA showed the largest within subject variations and reliable estimates were not obtained for the sample as a whole. However, reliable estimates were obtained for breast cancer survivors (4 days), females, BMI ≥30, and age <60 years (6 days). Conclusion Shorter monitoring periods may provide reliable estimates of PA levels in cancer survivors when monitored continuously with a wearable device. This could potentially lower the participant burden and allow for less exclusion of participants not adhering to longer protocols.

• Vilming, Bente; Dahl, Jørgen Fallås; Bentzen, Anne Gry; Ingebrigtsen, Vibeke Anett; Nilsen, Elisabeth Berge & Vistad, Ingvild [Show all 12 contributors for this article] (2023). Real-world data on niraparib maintenance treatment in patients with non-gBRCA mutated platinum-sensitive recurrent ovarian cancer. International Journal of Gynecological Cancer. ISSN 1048-891X. 33(12), p. 1898–1905. doi: 10.1136/ijgc-2023-004484. Full text in Research Archive Show summary

  Objectives The aim of this study was to provide real-world efficacy and safety data on niraparib maintenance treatment in patients with non-germline (gBRCA)1/2 mutated platinum-sensitive recurrent ovarian cancer. Methods This retrospective multi-center cohort study included 94 platinum-sensitive recurrent ovarian cancer patients without known gBRCA1/2 mutation treated in an individual patient access program in Norway. The primary outcome was time from start of niraparib treatment to first subsequent treatment. Secondary endpoints included progression-free survival, safety, and tolerability. Results After median follow-up of 13.4 months (95% confidence interval (CI) 10.0 to 16.8), 68.1% had progressed and 22.3% had died. Of the entire cohort, 61.7% had commenced a new line of treatment, and 24.5% were still receiving niraparib. The median duration of niraparib treatment was 5.0 months (range 0.4 to 27.3), and the median time to first subsequent treatment was 10.7 months (95% CI 8.4 to 13.0). Patients with elevated CA125 prior to start of niraparib had shorter time to first subsequent treatment (7.3 months, 95% CI 4.2 to 10.3) than patients with normalized CA125 (12.2 months, 95% CI 10.9 to 13.7 (p=0.002). Patients who started on individual dose based on weight and platelet counts had fewer dose reductions (p<0.001) and interruptions (p=0.02). Conclusion In a real-world setting, niraparib maintenance treatment in patients with non-gBRCA1/2 mutated recurrent platinum-sensitive ovarian cancer showed effectiveness comparable with published phase III studies and acceptable safety. Individualized dosing is essential to minimize adverse events. CA125 levels at start of niraparib treatment may help to estimate the individual prognosis.

• Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. p. 1–10. doi: 10.1111/aogs.14749. Full text in Research Archive Show summary

  Introduction Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. Material and methods Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. Results We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. Conclusions Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.

• Jeppesen, M.M.; Bergholdt, S.H.; Bentzen, Anne Gry; Rooij, Rooij de; Skorstad, Mette & Ezendam, N.P.M. [Show all 9 contributors for this article] (2023). Cancer worry is associated with increased use of supportive health care—results from the multinational InCHARGE study. Journal of cancer survivorship. ISSN 1932-2259. doi: 10.1007/s11764-023-01337-w. Full text in Research Archive
• Meltzer-Gunnes, Christin Julia; Lie, Kathrine; Jonassen, Christine M; Rangberg, Anbjørg; Furlund, Camilla Bø & Småstuen, Milada Cvancarova [Show all 7 contributors for this article] (2023). Time trends in human papillomavirus prevalence and genotype distribution in vulvar carcinoma in Norway. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 103(1), p. 153–164. doi: 10.1111/aogs.14702. Full text in Research Archive
• Madland, Karen; Bjørge, Line; Småstuen, Milada Cvancarova; Dørum, Anne & Vistad, Ingvild (2022). Symptomatic or asymptomatic recurrence of ovarian cancer: does it influence survival? International Journal of Gynecological Cancer. ISSN 1048-891X. 32(8), p. 1025–1031. doi: 10.1136/ijgc-2022-003361. Full text in Research Archive
• Skorstad, Mette; Vistad, Ingvild; Fegran, Liv; Berntsen, Sveinung & Johannessen, Berit (2022). Nurse-led consultations reinforced with eHealth technology: a qualitative study of the experiences of patients with gynecological cancer. BMC Nursing. 21. doi: 10.1186/s12912-022-01104-9. Full text in Research Archive Show summary

  Background: During the last decade, the health care profession has moved toward personalized care and has focused on the diversity of survivorship needs after initial cancer treatment. Health care providers encourage empowering patients to participate actively in their own health management and survivorship. Consequently, we developed and piloted a new follow-up model for patients at a Norwegian hospital, referred to as the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) model. Using LETSGO, a dedicated nurse replaces the physician in every second follow-up consultation, providing patients who have undergone cancer treatment with self-management techniques that are reinforced with eHealth technology via a specially designed app. Encouraging behavioral change and evaluating the late effects of treatment and recurrence symptoms are central components of self-management techniques. In addition, the app encourages physical activity and positive lifestyle changes, helps identify recurrence-related symptoms, and provides reminders of activity goals. This study aims to investigate experiences with nurse-led consultations supported by eHealth technology among the patients who piloted the LETSGO intervention. Methods: Semi-structured qualitative interviews were conducted to analyze the participants’ experiences with the LETSGO intervention after six to seven months. Results: The participants in the LETSGO pilot felt safe and well cared for. They thought the nurse was less busy than the doctors appear to be, which made it easy for them to share any cancer-related challenges. Many participants reported increased empowerment and confidence in recognizing symptoms of cancer recurrence, and participants who used the app regularly were motivated to increase their physical activity levels. However, the participants also experienced some limitations and technical errors with the app. Conclusions: Generally, the participants positively received the nurse-led consultations and eHealth technology, but an intervention study is required for further evaluation. In addition, the reported technical app errors should be resolved and tested prior to eHealth application implementation. Regardless, this study may be useful in planning personalized survivorship care studies.

• Oommen, Hanna; Tveit, Tor Oddbjørn; Eskedal, Leif Torvald; Myr, Rachel; Swanson, David Michael & Vistad, Ingvild (2021). The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 100(12), p. 2294–2302. doi: 10.1111/aogs.14268. Full text in Research Archive Show summary

  Introduction: Intrapartum opioids in labor may interfere with the early breastfeeding phase and cause breastfeeding difficulties. This study examines the effects of intrapartum fentanyl given intravenously (IV) or through epidural analgesia (EDA) on early breastfeeding. Material and methods: This is a prospective observational study conducted in a regional maternity unit. We included 1101 healthy mothers of term singleton babies in vertex presentation born between 2016 and 2018 (468 nulliparous and 633 multiparous). The main data were collected prospectively, and additional data were retrieved from hospital records. The main outcome measures were exclusive breastfeeding at discharge, spontaneous suckling, and breastfeeding problems after birth. We assessed the outcomes in four groups categorized by intrapartum opioid exposure: none, IV fentanyl, EDA fentanyl and IV+EDA fentanyl. We also analyzed the dose–response relation of fentanyl administered by epidural or IV and early breastfeeding. Ultimately, we dichotomized the IV fentanyl group into two groups (≤200 µg and >200 µg) to further study the effect on early breastfeeding. Results: The odds of non-exclusive breastfeeding were doubled with EDA fentanyl (odds ratio [OR] 2.45, 95% CI 1.34–4.48, p = 0.004) and four times higher with IV+EDA fentanyl (OR 4.20, 95% CI 2.49–7.09, p < 0.001) compared with no opioid exposure. Spontaneous suckling was negatively associated with intrapartum fentanyl use (p < 0.001) irrespective of mode of administration. When the IV fentanyl doses exceeded 200 µg compared with less than 200 µg, we found a reduction in exclusive breastfeeding (81% vs. 89%; p = 0.014) and spontaneous suckling (68% vs. 83%; p < 0.001) and an increase in breastfeeding problems (41% vs. 27%; p = 0.004). Conclusions: Fentanyl in labor is associated with breastfeeding difficulties. However, IV fentanyl in low doses (≤200 µg) seems to affect breastfeeding less than EDA fentanyl and is therefore a viable alternative when labor analgesia is needed. This could be most relevant for multiparous women, where a shorter labor is expected. More research is needed to determine the optimal dose and route of administration of fentanyl for labor analgesia.

• Torstveit, Ann Helen; Løyland, Borghild; Grov, Ellen Karine; Guren, Marianne; Paul, Steven M. & Ritchie, Christine [Show all 9 contributors for this article] (2021). Distinctions Between Self-Report and Performance-Based Measures of Physical Function in Older Patients Prior to Chemotherapy. Cancer Nursing. ISSN 0162-220X. 44(6), p. E735–E744. doi: 10.1097/ncc.0000000000000964. Full text in Research Archive Show summary

  ABSTRACT Background: The maintenance of physical function (PF) is an extremely important outcome for older adults. Objective: The aims of this study were to, identify differences in subjective and objective measures of PF between younger older adults (YOA, 60-69 years of age) and older adults (OA, ≥70 years of age); compare the PF scores with age-matched samples from the general population; and evaluate for associations between subjective and objective measures of PF. Methods: Patients (n=139) were assessed using subjective (i.e., European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (QLQ-C30)) and objective (i.e., Short Physical Performance Battery (SPPB)) measures prior to chemotherapy (CTX). Data were analyzed using parametric and nonparametric tests. Results: No differences were found between the two age groups in any of the subjective or objective measures of PF. Compared to the age-matched general population; both YOA and OA had significantly lower scores in both measures of PF. Large effect sizes were found for differences in QLQ-C30 role function, SPPB balance, and SPPB total scores between the YOA group and the age-matched general population samples. Correlations between the subjective and objective measures were low. Conclusions: Older patients with cancer have lower PF than their age matched general population prior to CTX. Longitudinal studies are warranted to evaluate for changes in PF during and following CTX. Implications for Practice: Nurses need to perform routine assessments of PF in older oncology patients prior to CTX. Our findings suggest that SPPB gait speed may be a useful screening measure for PF in older patients.

• Utne, Inger; Løyland, Borghild; Grov, Ellen Karine; Rasmussen, Hege Lund; Torstveit, Ann Helen & Paul, Steven M. [Show all 11 contributors for this article] (2021). Age-related differences in self-report and objective measures of cognitive function in older patients prior to chemotherapy. Nursing Open. doi: 10.1002/nop2.1141. Full text in Research Archive Show summary

  Aim Evaluate for differences in demographic and clinical characteristics and subjective and objective measures of cognitive function (CF) between younger older adults (YOA, 60–69 years) and older adults (OA, ≥70 years). Design Cross-sectional. Methods Older oncology patients (n = 139) completed subjective (Attentional Function Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) CF scale) and objective (Montreal Cognitive Assessment, Trail Making Test (TMT) A & B) measures of CF prior to chemotherapy. Data were analyzed using parametric and nonparametric tests. Results No differences were found between the two groups for any of the subjective or objective CF measures, except that OA patients had higher TMT B scores. Compared with the general population, OAs had significantly higher EORTC CF scores and YOAs had significantly worse scores for all of the objective tests. Clinically meaningful difference between group differences was found for the TMT B test.

• Vistad, Ingvild; Skorstad, Mette; Demmelmaier, Ingrid; Småstuen, Milada Cvancarova; Lindemann, Kristina Yvonne Kathe & Wisløff, Torbjørn [Show all 8 contributors for this article] (2021). Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology (LETSGO study): A study protocol for a multicentre longitudinal interventional study using mobile health technology and biobanking. BMJ Open. 11(7). doi: 10.1136/bmjopen-2021-050930. Full text in Research Archive Show summary

  Introduction The number of gynaecological cancer survivors is increasing and there is a need for a more sustainable model of follow-up care. Today’s follow-up model is time-consuming and patients have reported unmet needs regarding information about their cancer and strategies for managing the consequences of treatment. The main aim of this study is to assess health-related empowerment—in terms of patient education, psychosocial support, and promotion of physical activity—in a new follow-up model by comparing it to standard follow-up in a quasi-randomised study involving intervention hospitals and control hospitals. Methods and analysis At the intervention hospitals, patients will be stratified by risk of recurrence and late effects to either 1 or 3 years’ follow-up. Nurses will replace doctors in half of the follow-up visits and focus in particular on patient education, self-management and physical activity. They will provide patients with information and guide them in goal setting and action planning. These measures will be reinforced by a smartphone application for monitoring symptoms and promoting physical activity. At the control hospitals, patients will be included in the standard follow-up programme. All patients will be asked to complete questionnaires at baseline and after 3, 6, 12, 24 and 36 months. Blood samples will be collected for biobanking at 3, 12 and 36 months. The primary outcome is health-related empowerment. Secondary outcomes include health-related quality of life, adherence to physical activity recommendations, time to recurrence, healthcare costs and changes in biomarkers. Changes in these outcomes will be analysed using generalised linear mixed models for repeated measures. Type of hospital (intervention or control), time (measurement point), and possible confounders will be included as fixed factors. Ethics and dissemination The study is approved by the Regional Committee for Medical Research Ethics (2019/11093). Dissemination of findings will occur at the local, national and international levels.

• Greimel, Elfriede; Nagele, Eva; Lanceley, Anne; Oberguggenberger, Anne; Nordin, Andy & Kuljanic, K. [Show all 21 contributors for this article] (2021). Psychometric validation of the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). European Journal of Cancer. ISSN 0959-8049. 154, p. 235–245. doi: 10.1016/j.ejca.2021.06.003. Full text in Research Archive
• Skorstad, Mette; Rooij, Belle H. de; Jeppesen, Mette Moustgaard; Bergholdt, Stinne Holm; Ezendam, Nicole Paulina Maria & Bohlin, Tonje [Show all 10 contributors for this article] (2021). Self-management and adherence to recommended follow-up after gynaecological cancer: results from the international InCHARGE study. International Journal of Gynecological Cancer. ISSN 1048-891X. 31(8), p. 1106–1115. doi: 10.1136/ijgc-2020-002377. Full text in Research Archive Show summary

  Objective: To assess the relationship between self-management skills and adherence to follow-up guidelines among gynecological cancer survivors in the Netherlands, Norway, and Denmark, and to assess the relationship between adherence to follow-up programs and use of additional healthcare services. Methods: For this international, multicenter, cross-sectional study, we recruited gynecological cancer survivors 1-5 years after completion of treatment. Information on follow-up visits, use of healthcare resources, self-management (measured by the Health Education Impact Questionnaire), clinical characteristics, and demographics were obtained by validated questionnaires. Participants were categorized as adherent if they attended the number of follow-up visits recommended by national guidelines, non-adherent if they had fewer visits than recommended, or over-users if they had more visits than recommended. Results: Of 4455 invited survivors, 2428 (55%) returned the questionnaires, and 911 survivors were included in the analyses. Survivors with high self-management most frequently adhered to recommended follow-up. Non-adherent survivors showed lower self-management in the health-directed activity domain (OR 1.54, 95% CI 1.03 to 2.32) than adherent survivors. No other associations between self-management and follow-up adherence were revealed. Non-adherent survivors tended to have endometrial cancer, surgical treatment only, be older, and be Danish residents. Over-users reported more follow-up visits and also used additional healthcare services more frequently than adherent survivors. Conclusion: Low self-management appears to reduce the likelihood of adherence to national guidelines for gynecological cancer follow-up. Focusing on patient education for survivors at risk of low self-management to ensure adherence to recommended follow-up may improve personalization of follow-up.

• Forsse, David Erik; Barbero, Mark Lewis B Barbero; Werner, Henrica Maria Johanna; Woie, Kathrine; Nordskar, Nina Jebens & Nilsen, Elisabeth Berge [Show all 14 contributors for this article] (2021). Longitudinal effects of adjuvant chemotherapy and lymph node staging on patient-reported outcomes in endometrial cancer survivors: a prospective cohort study. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. 226(1), p. 90.e1–90.e20. doi: 10.1016/j.ajog.2021.08.011. Full text in Research Archive Show summary

  Background Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. Objective We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. Study Design We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patient-reported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. Results Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year follow-up, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n=177), hysterectomy and lymph node staging without adjuvant therapy (n=133), or adjuvant chemotherapy irrespective of staging procedure (n=138). Overall, patients reported improved global health status and quality of life (+9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age- and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (−6 vs +2; P=.002) at year 1, more neuropathy (+30 vs +5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (+11 vs +2; P=.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. Conclusion Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph node removal to tailor adjuvant therapy seems justified from the patient’s viewpoint; however, efforts should increase to find alternatives to traditional chemotherapy.

• Dahl, Alv A; Bentzen, Anne Gry; Fosså, Sophie Dorothea; Hess, Siri Lothe; Steen, Rita & Vistad, Ingvild [Show all 7 contributors for this article] (2020). Sexual inactivity during the last 4 weeks in long-term cervical cancer survivors: Prevalence and associated factors. Journal of Sexual Medicine. ISSN 1743-6095. 17(7), p. 1359–1369. doi: 10.1016/j.jsxm.2020.03.010. Full text in Research Archive Show summary

  Background Most studies of cervical cancer (CC) survivors describe sexual inactivity in relation to treatment modalities, but few consider that inactivity varies with age and partner status. Aim The aim of this study was to investigate the prevalence of sexual inactivity in long-term CC survivors according to age and partner status, and to examine cancer-related, health, demographic, and psychological factors related to sexual inactivity. Methods All 974 women treated for CC from 2000 through 2007 in 2 areas of Norway, who were alive and cancer-free by the end of 2013, received a mailed questionnaire. Among them, 523 delivered valid data on current sexual activity (response rate 57%). The prevalence rates of sexual inactivity in relation to age groups and partner status were compared to normative sample (NORMs). Main Outcome Measure Sexual inactivity during the 4 weeks before the survey was administered. Results Median age of the sample at survey was 53 years (range 32–77) and median time since diagnosis was 11 years (range 6–15). Of the survivors aged 35–69 years, 39% (95% CI 35–44%) were sexually inactive at survey compared to 36% (95% CI 32–38%) in the NORMs. Compared with sexually active survivors, inactive ones were significantly older, more frequently had single partner status, and had less frequently been childbearing. Inactive survivors more frequently had low education, did not hold paid work at survey, had poorer self-rated health, and were more often obese. They also had higher prevalence of depression, high neuroticism, and chronic fatigue. On most cancer-related quality of life measures, sexually inactive survivors had significantly lower mean scores than sexually active ones. They significantly more often had been treated with chemotherapy and/or radiation than with conization or major surgery. In multivariable regression analysis, only older age, no prior childbearing, and single partner status remained significantly associated with sexual inactivity. Clinical implications Sociodemographic variables may be more relevant than clinical and cancer-related variables concerning sexual inactivity in long-term CC survivors. Strengths & Limitations Our study had a considerable sample size and used instruments with established psychometric qualities. The moderate response rates of the study and of the NORMs imply risks for selection biases. Conclusion Close to 4 in 10 survivors were sexually inactive which is similar to the rate among NORMs. Demographic factors were most strongly associated with sexual inactivity. Some other significant factors are eventually amenable to treatment and should be checked by the health-care providers.

• Vistad, Ingvild; Lindemann, Kristina; Bentzen, Anne Gry; Dahl, Alv A; Steen, Rita & Kiserud, Cecilie E. (2020). Preferences for follow up in long-term survivors after cervical cancer. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 69(9), p. 1253–1259. doi: 10.1111/aogs.13855. Full text in Research Archive Show summary

  Introduction An increasing number of cervical cancer survivors combined with lack of data on the efficacy of long-term surveillance, challenges existing follow-up models. However, before introducing new follow-up models, cervical cancer survivors’ own views on follow up are important. We aimed to explore preferences for follow up in long-term cervical cancer survivors and their associations with self-reported late-effects. Material and methods In 2013, we mailed 974 Norwegian long-term cervical cancer survivors treated during 2000-2007 a questionnaire with items covering preferences for follow up after treatment, clinical variables and validated questionnaires covering anxiety, neuroticism and depression. Results We included 471 cervical cancer survivors (response rate 57%) with a median follow up of 11 years. In all, 77% had FIGO stage I disease, and 35% were attending a follow-up program at the time of survey. Of the patients, 55% preferred more than 5 years of follow up. This was also preferred by 57% of cervical cancer survivors who were treated with conization only. In multivariable analyses, chemo-radiotherapy or surgery with radiation and/or chemotherapy (heavy treatment) and younger age were significantly associated with a preference for more than 5 years’ follow up. Late effects were reported by more than 70% of the cervical cancer survivors who had undergone heavy treatment. Conclusions Our study reveals the need for targeted patient education about the benefits and limitations of follow up. To meet increasing costs of cancer care, individualized follow-up procedures adjusted to risk of recurrence and late-effects in cervical cancer survivors are warranted.

• Andenæs, Randi; Småstuen, Milada Cvancarova; Misvær, Nina; Ribu, Lis; Vistad, Ingvild & Helseth, Sølvi (2020). Associations between menopausal hormone therapy and sleep disturbance in women during the menopausal transition and post-menopause: data from the Norwegian prescription database and the HUNT study. BMC Women's Health. 20(1), p. 1–9. doi: 10.1186/s12905-020-00916-8. Full text in Research Archive
• Fidjeland, Heidi Lidal; Vistad, Ingvild; Gjelstad, Svein & Brekke, Mette (2019). Exploring why patients with cancer consult general practitioners: A 1-year data extraction. British Journal of General Practice Open. 3(4), p. 1–9. doi: 10.3399/BJGPOPEN19X101663. Full text in Research Archive Show summary

  Background Survival rates of patients with cancer are increasing owing to improvements in diagnostics and therapies. The traditional hospital-based follow-up model faces challenges because of the consequent increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs. The hypothesis of the study was that, regardless of the hospital-based follow-up care, GPs see their patients with cancer both for cancer-related problems as well as for other reasons. Thus, a formalised follow-up by GPs would not mean too large a change in GPs’ workloads. Aim To explore to what extent patients with cancer consult their GPs, and for what reasons. Design & setting A 1-year explorative study was undertaken, based on data from 91 Norwegian GPs from 2016–2017. Method The data were electronically extracted from GPs' electronic medical records (EMR). Results Data were collected from 91 GPs. There were 11 074 consultations in total, generated by 1932 patients with cancer. The mean consultation rate was higher among the patients with cancer compared with Norwegian patients in general. In one-third of the consultations, cancer was the main diagnosis. Apart from cancer, cardiovascular and musculoskeletal diagnoses were common. Patients with cancer who had multiple diagnoses or psychological diagnoses did not consult their GP significantly more often than patients with cancer without such comorbidity. Conclusion This study confirms that patients with cancer consult their GP more often than other patients, both for cancer-related reasons and for various comorbidities. A formalised follow-up by GPs would probably be feasible, and GPs should prepare for this responsibility.

• O'Brien, Eileen C.; Segurado, Ricardo; Geraghty, Aisling A.; Alberdi, Goiuri; Rogozinska, Ewelina & Astrup, Arne [Show all 50 contributors for this article] (2019). Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. BMJ Open. 9:e025620(8), p. 1–12. doi: 10.1136/bmjopen-2018-025620. Full text in Research Archive Show summary

  Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources: Major electronic databases, from inception to February 2017. Eligibility criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias: Cochrane risk of bias tool was used. Data synthesis: Principle measures of effect were OR and regression coefficient. Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B −0.055; 95% CI −0.098 to −0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B −0.053; 95% CI −0.069 to −0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

• Rohde, Gudrun E.; Söderhamn, Ulrika & Vistad, Ingvild (2019). Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study. BMJ Open. 9(3). doi: 10.1136/bmjopen-2018-023463. Full text in Research Archive Show summary

  Objectives Patients with colorectal cancer undergoing palliative treatment receive extensive treatment-related information throughout their disease trajectory. We aimed to explore the experiences of patients with incurable colorectal cancer while in palliative care and their reflections on the information provided by physicians and nurses. Our main focus was the patients’ thoughts about how information about disease status and life expectancy was communicated, from the first time that they were informed about the incurable nature of their disease through to postsurgery palliative treatment. Settings Patients with colorectal cancer receiving palliative chemotherapy. Research design We used a qualitative approach, and the data were analysed by qualitative content analysis. Participants 20 patients (34–75 years of age) were included in the study; 12 received first-line chemotherapy and 8 received second-line chemotherapy. Eleven patients were treated by oncologists, and nine were treated by junior physicians. Results Data-driven empirical analysis identified three themes: (1) inadequate information during the initial phase of the disease trajectory; (2) hope and information further into the disease trajectory and (3) personal, professional and organisational factors that influenced information and communication throughout the disease trajectory. Conclusion The participants’ experience of being told for the first time that they had an incurable disease was perceived as inadequate, while postsurgery palliative chemotherapy, physicians and nurses offered hope. The participants preferred customised information about their treatment and likely future prospects and physicians and nurses who took a holistic and compassionate approach focusing on their lifeworld. To be a sensitive, holistic and compassionate physician or nurse requires knowledge and confidence. To achieve this requires training and guidance at universities and in hospitals.

• Hillesund, Elisabet Rudjord; Seland, Siv; Bere, Elling; Sagedal, Linda Reme; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 8 contributors for this article] (2018). Preeclampsia and gestational weight gain in the Norwegian Fit for Delivery trial. BMC Research Notes. 11(282). doi: 10.1186/s13104-018-3396-4. Full text in Research Archive
• Haakstad, Lene Annette Hagen; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial. BMC Pregnancy and Childbirth. 18(127). doi: 10.1186/s12884-018-1771-8. Full text in Research Archive Show summary

  Background: To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. Methods: This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum. Results: Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: “... I do not have the time” (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: “... afraid to harm the baby” (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: “... I do not believe/think that I can do it” (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. Conclusion: The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum.

• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2018). What is the effect of physical activity on duration and mode of delivery? Secondary analysis from the Norwegian Fit for Delivery trial. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(7), p. 861–871. doi: 10.1111/aogs.13351. Full text in Research Archive Show summary

  Introduction: The beneficial effects of physical activity during pregnancy for the mother and offspring have been reported by several studies but there are conflicting results concerning the possible effect of physical activity on the course of labor and risk of cesarean delivery. This study presents secondary analyses from the Norwegian Fit for Delivery randomized controlled trial, aiming at studying the effect of a lifestyle intervention including group exercise classes, as well as the possible influence of physical activity level in late pregnancy, on labor outcomes. Material and methods: Healthy nulliparous women with singleton pregnancy were randomized to an intervention group, n = 303 (dietary counseling and twice‐weekly exercise classes) or a control group, n = 303 (standard care). The participants were analyzed both by randomization and as a cohort comparing women with lowest (quartile 1, 0 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 140) vs. highest (quartile 4, ≥16 metabolic equivalent of task‐hours moderate‐to‐vigorous physical activity/week) (n = 131) physical activity level in late pregnancy, assessed with the International Physical Activity Questionnaire. Result: The intervention group had a longer first stage of labor compared with the control group (293 ± 202 min vs. 257 ± 181 min, p = 0.030). No differences between the randomization groups were seen for time spent in second stage of labor, prolonged labor or mode of delivery. In the total sample, women with the highest physical activity level had lower odds ratio (OR) of acute cesarean delivery (OR 0.33, 95% CI 0.11–0.97, p = 0.044) than did those with the lowest physical activity‐level. Conclusion: A significantly longer first stage of labor was observed in the intervention group than in the control group. A high physical activity level in late pregnancy was associated with lower odds of acute cesarean delivery compared with a low physical activity level.

• Froeding, Ligita Paskeviciute; Greimel, Elfriede; Lanceley, Anne; Oberguggenberger, Anne; Schmalz, Claudia & Radisic, Vesna Bjelic [Show all 12 contributors for this article] (2018). Assessing Patient-reported Quality of Life Outcomes in Vulva Cancer Patients: A Systematic Literature Review. International Journal of Gynecological Cancer. ISSN 1048-891X. 28(4), p. 808–817. doi: 10.1097/IGC.0000000000001211. Full text in Research Archive
• Leeuwen, Marieke van; Husson, Olga; Alberti, Paola; Arraras, Juan Ignacio; Chinot, Olivier L. & Costantini, Anna [Show all 30 contributors for this article] (2018). Understanding the quality of life (QOL) issues in survivors of cancer: Towards the development of an EORTC QOL cancer survivorship questionnaire. Health and Quality of Life Outcomes. 16:114, p. 1–15. doi: 10.1186/s12955-018-0920-0. Full text in Research Archive
• Vistad, Ingvild; Småstuen, Milada Cvancarova; Astrup, Guro Lindviksmoen; Rustøen, Tone & Liavaag, Astrid Helene (2018). Symptom Experience and Self-rated Physical Functioning in Patients with Ovarian Cancer Receiving Chemotherapy: A Longitudinal Study. International Journal of Gynecological Cancer. ISSN 1048-891X. 28(6), p. 1167–1175. doi: 10.1097/IGC.0000000000001287. Full text in Research Archive
• Fidjeland, Heidi Lidal; Brekke, Mette; Stokstad, Trine & Vistad, Ingvild (2018). Gynecological cancer patients' attitudes toward follow-up care after cancer treatment: Do preferences reflect patients' experience? A cross-sectional questionnaire study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 97(11), p. 1325–1331. doi: 10.1111/aogs.13396. Full text in Research Archive Show summary

  Introduction Due to an increasing number of cancer patients, new follow‐up models are being debated, among them follow‐up by general practitioners. Before changing surveillance, it is important to explore patients’ views. The purpose of this study was to compare attitudes toward follow‐up care among patients treated for gynecological cancer who had not yet started a follow‐up regimen, with those who had been attending a hospital‐based follow‐up regimen for more than one year. Material and methods We conducted a cross‐sectional survey among gynecological cancer patients recruited from three Norwegian hospitals in 2013‐2015: Sørlandet Hospital Kristiansand, Sørlandet Hospital Arendal and St. Olavs Hospital, Trondheim. Results In all, 239 patients agreed to participate, 100 who had not yet started follow‐up and 139 who had been attending more than one year of follow‐up. Patients reported that they preferred to be followed up by a gynecologist rather than by their GP, whom they viewed as less competent for this purpose. However, patients who had not yet started follow‐up were more willing to be followed up by a GP. Overall, patients rated detection of recurrence as the most important aspect of follow‐up visits. Conclusions The gynecological cancer patients in our study preferred a hospital‐based follow‐up model. However, patients who had not yet started follow‐up were more willing to be followed up by a GP. If follow‐up is to be provided by GPs for selected patients, it is important that these patients are informed early of the value and limitations of follow‐up visits, to ensure that they feel safe.

• Hillesund, Elisabet Rudjord; Bere, Elling Tufte; Sagedal, Linda Reme; Vistad, Ingvild; Lohne-Seiler, Hilde & Torstveit, Monica Klungland [Show all 7 contributors for this article] (2018). Pre-pregnancy and early pregnancy dietary behavior in relation to maternal and newborn health in the Norwegian Fit for Delivery study - a post hoc observational analysis. Food & Nutrition Research (FNR). ISSN 1654-6628. 62. doi: 10.29219/fnr.v62.1273. Full text in Research Archive
• Sanda, Birgitte; Vistad, Ingvild; Haakstad, Lene Annette Hagen; Berntsen, Sveinung; Sagedal, Linda Reme & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2017). Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women. BMC sports science, medicine and rehabilitation. 9:7(7), p. 1–10. doi: 10.1186/s13102-017-0070-4. Full text in Research Archive Show summary

  Background: The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy. Method: Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3–6, >6 and >3 Metabolic Equivalents (METs), respectively. Results: Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were−84 ± 402 min/week for MPA,−85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were−197 ± 326 min/week for MPA,−205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%. Conclusion: IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

• Meltzer-Gunnes, Christin Julia; Småstuen, Milada C; Kristensen, Gunnar S Balle; Tropé, Claes Gøran; Lie, Agnes Kathrine & Vistad, Ingvild (2017). Vulvar carcinoma in Norway: A 50-year perspective on trends in incidence, treatment and survival. Gynecologic Oncology. ISSN 0090-8258. 145(3), p. 543–548. doi: 10.1016/j.ygyno.2017.03.008. Full text in Research Archive
• Sagedal, Linda Reme; Sanda, Birgitte; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 10 contributors for this article] (2017). The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(1), p. 111–121. doi: 10.1111/1471-0528.13863. Full text in Research Archive
• Sagedal, Linda Reme; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland; Seiler, Hilde Lohne & Småstuen, Milada Cvancarova [Show all 9 contributors for this article] (2017). Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(1), p. 97–109. doi: 10.1111/1471-0528.13862. Full text in Research Archive
• Rossen, Janne; Lucovnik, Miha; Eggebø, Torbjørn Moe; Tul, Natasa; Murphy, Martina & Vistad, Ingvild [Show all 7 contributors for this article] (2017). A method to assess obstetric outcomes using the 10-Group Classification System: A quantitative descriptive study. BMJ Open. 7(7). doi: 10.1136/bmjopen-2017-016192. Full text in Research Archive Show summary

  Objectives Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information. Design This research is a methodological study to describe the use of the TGCS. Setting Stavanger University Hospital (SUH), Norway, National Maternity Hospital Dublin, Ireland and Slovenian National Perinatal Database (SLO), Slovenia. Participants 9848 women from SUH, Norway, 9250 women from National Maternity Hospital Dublin, Ireland and 106 167 women, from SLO, Slovenia. Main outcome measures All women were classified according to the TGCS within which caesarean section, oxytocin augmentation, epidural analgesia, operative vaginal deliveries, episiotomy, sphincter rupture, postpartum haemorrhage, blood transfusion, maternal age >35 years, body mass index >30, Apgar score, umbilical cord pH, hypoxic–ischaemic encephalopathy, antepartum and perinatal deaths were incorporated. Results There were significant differences in the sizes of the groups of women and the incidences of events and outcomes within the TGCS between the three perinatal databases. Conclusions The TGCS is a standardised objective classification system where events and outcomes of labour and delivery can be incorporated. Obstetric core events and outcomes should be agreed and defined to set standards of care. This method provides continuous and available observations from delivery wards, possibly used for further interpretation, questions and international comparisons. The definition of quality may vary in different units and can only be ascertained when all the necessary information is available and considered together.

• Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum. PLOS ONE. 12(11). doi: 10.1371/journal.pone.0188102. Full text in Research Archive Show summary

  Background: Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women. Method: The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum. Results: At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups. Conclusion: The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period.

• Haakstad, Lene Annette Hagen; Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde & Torstveit, Monica Klungland (2017). Evaluation of implementing a community-based exercise intervention during pregnancy. Midwifery. ISSN 0266-6138. 46, p. 45–51. doi: 10.1016/j.midw.2017.01.010. Full text in Research Archive Show summary

  Objective: To evaluate the implementation of a community-based exercise intervention (the Norwegian Fit for Delivery study) during pregnancy. Design: Descriptive, explorative. Setting: Healthcare clinics in southern Norway, including urban and rural settings. Participants: Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥18 years and body mass index ≥19 kg/m2. Methods: Women were randomized to either twice-weekly supervised exercise sessions combined with nutritional counselling (n=303) or standard prenatal care (n=303). The exercise program was based on ACOG guidelines, with the same low-impact workout for all participants, including 60 minutes of moderate-intensity cardiovascular and strength training, performed in a group of maximum 25 women. The aim of the present secondary analysis was to report on the intervention group's experience with participating in an exercise program in the 2nd and 3rd trimester, including satisfaction, adherence, adverse effects, as well as motives and barriers for attending the classes. Results: Of 303 women randomized to exercise, 274 (92.6%) attended at least one class and 187 (68.2%) completed a questionnaire after completion of the trial assessing their experience with the group sessions. For 71.7%, self-reported exercise dosage was ≥75% of the twice-weekly exercise program and more than seven out of 10 reported to be satisfied or very satisfied with the exercise sessions. A total of 95.1% answered that they would recommend this type of exercise for pregnant friends. Reported motives and health benefits included better aerobic capacity, increased energy levels and exercise enjoyment. No harmful effects of the exercise intervention were noted in the mother or the fetus. Key conclusions and implications for practice: Results demonstrated that regular group exercise was feasible, safe, and well tolerated in pregnancy, which may encourage incorporating this program into a routine health care setting.

• Astrup, Guro Lindviksmoen; Hofsø, Kristin; Bjordal, Kristin; Guren, Marianne; Vistad, Ingvild & Cooper, Bruce [Show all 8 contributors for this article] (2017). Patient factors and quality of life outcomes differ among four subgroups of oncology patients based on symptom occurrence. Acta Oncologica. ISSN 0284-186X. 56(3), p. 462–470. doi: 10.1080/0284186X.2016.1273546. Full text in Research Archive
• Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise; Rayanagoudar, Girish; Ruifrok, Anneloes E. & Dodds, Julie [Show all 57 contributors for this article] (2017). Effects of antenatal diet and physical activity on maternal and fetal outcomes: Individual patient data meta-analysis and health economic evaluation. Health Technology Assessment. ISSN 1366-5278. 21:41, p. 1–194. doi: 10.3310/hta21410. Full text in Research Archive Show summary

  Abstract Background Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. Objectives To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search). Review methods Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. Results Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg). Limitations The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies. Conclusion Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes. Future work The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. Study registration This study is registered as PROSPERO CRD42013003804. Funding The National Institute for Health Research Health Technology Assessment programme.

• Skreden, Marianne; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2017). Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC Pregnancy and Childbirth. 17(1). doi: 10.1186/s12884-017-1291-y. Full text in Research Archive Show summary

  Background: A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. Methods: Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9–20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. Results: The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). Conclusions: We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. Trial registration: ClinicalTrials.gov database, NCT01001689. https://clinicaltrials.gov/ct2/show/ NCT01001689?term=NCT01001689&rank=1. Keywords: Fruits, Preconception, Pregnancy, Vegetables

• Sagedal, Linda Reme; Vistad, Ingvild; Øverby, Nina Cecilie; Bere, Elling; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 9 contributors for this article] (2017). The effect of a prenatal lifestyle intervention on glucose metabolism: Results of the Norwegian Fit for Delivery randomized controlled trial. BMC Pregnancy and Childbirth. 17:167, p. 1–12. doi: 10.1186/s12884-017-1340-6. Full text in Research Archive Show summary

  Background: The effectiveness of prenatal lifestyle intervention to prevent gestational diabetes and improve maternal glucose metabolism remains to be established. The Norwegian Fit for Delivery (NFFD) randomized, controlled trial studied the effect of a combined lifestyle intervention provided to a general population, and found significantly lower gestational weight gain among intervention participants but no improvement in obstetrical outcomes or the proportion of large infants. The aim of the present study is to examine the effect of the NFFD intervention on glucose metabolism, including an assessment of the subgroups of normal-weight and overweight/obese participants. Methods: Healthy, non-diabetic women expecting their first child, with pre-pregnancy body mass index (BMI) ≥19 kg/m2, age ≥ 18 years and a singleton pregnancy of ≤20 gestational-weeks were enrolled from healthcare clinics in southern Norway. Gestational weight gain was the primary endpoint. Participants (n = 606) were individually randomized to intervention (two dietary consultations and access to twice-weekly exercise groups) or control group (routine prenatal care). The effect of intervention on glucose metabolism was a secondary endpoint, measuring glucose (fasting and 2-h following 75-g glucose load), insulin, homeostatic assessment of insulin resistance (HOMA-IR) and leptin levels at gestational-week 30. Results: Blood samples from 557 (91.9%) women were analyzed. For the total group, intervention resulted in reduced insulin (adj. Mean diff −0.91 mU/l, p = 0.045) and leptin levels (adj. Mean diff -207 pmol/l, p = 0.021) compared to routine care, while glucose levels were unchanged. However, the effect of intervention on both fasting and 2-h glucose was modified by pre-pregnancy BMI (interaction p = 0.030 and p = 0.039, respectively). For overweight/obese women (n = 158), intervention was associated with increased risk of at least one glucose measurement exceeding International Association of Pregnancy and Diabetes Study Group thresholds (33.7% vs. 13.9%, adj. OR 3.89, p = 0.004). Conclusions: The Norwegian Fit for Delivery intervention lowered neither glucose levels nor GDM incidence, despite reductions in insulin and leptin. Prenatal combined lifestyle interventions designed for a general population may be unsuited to reduce GDM risk, particularly among overweight/obese women, who may require earlier and more targeted interventions. Trial registration: ClinicalTrials.gov ID NCT01001689, registered July 2, 2009, confirmed completed October 26, 2009 (retrospectively registered). Keywords: Gestational diabetes, Intervention, Lifestyle, Overweight, Obesity

• Vistad, Ingvild; Bjørge, Line; Popova, Olesya; Fiane, Bent; Sachse, Kurt & Tjugum, Jostein [Show all 13 contributors for this article] (2017). A national, prospective observational study of first recurrence after primary treatment for gynecological cancer in Norway. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 96(10), p. 1162–1169. doi: 10.1111/aogs.13199. Full text in Research Archive Show summary

  INTRODUCTION: Gynecological cancer patients are routinely followed up for five years after primary treatment. However, the value of such follow up has been debated, as retrospective studies indicate that first recurrence is often symptomatic and occurs within two to three years of primary treatment. We prospectively investigated time to first recurrence, symptoms at recurrence, diagnostic procedures, and recurrence treatment in gynecological cancer patients after primary curative treatment. MATERIAL AND METHODS: Clinicians from 21 hospitals in Norway interviewed 680 patients with first recurrence of gynecological cancer (409 ovarian, 213 uterine, and 58 cervical cancer patients) between 2012 and 2016. A standardized questionnaire was used to collect information on self-reported and clinical variables. RESULTS: Within two years of primary treatment, 72% of ovarian, 64% of uterine, and 66% of cervical cancer patients were diagnosed with first recurrence, and 54, 67, and 72%, respectively, had symptomatic recurrence. Of symptomatic patients, 25-50% failed to make an appointment before their next scheduled follow-up visit. Computer tomography was the most common diagnostic procedure (89% of ovarian, 76% of uterine, and 62% of cervical cancer patients), and recurrence treatment in terms of chemotherapy was most frequently planned (86% of ovarian, 46% of uterine, and 62% of cervical cancer patients). CONCLUSIONS: A majority of patients experienced symptomatic recurrence, but many patients failed to make an appointment earlier than scheduled. Most first recurrences occurred within two years of primary treatment; the mean annual incidence rate for years 3-5 after primary treatment was <7%. New models for follow up of gynecological cancer patients could be considered.

• Skreden, Marianne; Øverby, Nina Cecilie; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 7 contributors for this article] (2016). Change in active transportation and weight gain in pregnancy. International Journal of Behavioral Nutrition and Physical Activity. 13(10). doi: 10.1186/s12966-016-0332-7. Full text in Research Archive Show summary

  Background: Pregnancy is characterised by large weight gain over a short period, and often a notable change in mode of transportation. This makes pregnancy suitable for examining the plausible, but in the scientific literature still unclear, association between active transportation and weight gain. We hypothesize that women continuing an active mode of transportation to work or school from pre- to early pregnancy will have a lower gestational weight gain (GWG) than those who change to a less active mode of transportation. Methods: We analysed prospective data from the Norwegian Fit for Delivery (NFFD) trial. Between September 2009 and February 2013 606 women were consecutively enrolled in median gestational week 16 (range; 8–20). Of 219 women who used an active mode of transportation (biking, walking, public transportation) pre-pregnancy, 66 (30 %) converted to a less active mode in early pregnancy (“active-less active” group), and 153 (70 %) continued with active transportation (“active-active” group). Pre-pregnancy weight was self-reported. Weight at gestational (GA) weeks 16, 30, 36, and at term delivery was objectively measured. Weight gain was compared between the two groups. Linear mixed effects analysis of the repeated weight measures was performed including the group*time interaction. Results: A significant overall group effect was observed for the four time points together (“active-active” group: 77.3 kg vs. “active-less active” group: 78.8 kg, p = 0.008). The interaction term group*time was significant indicating different weight gain throughout pregnancy for the two groups; the mean differences between the groups were 0.7 kg at week 16, 1.4 kg at week 30, 2.1 kg at week 36, and 2.2 kg at term delivery, respectively. Conclusion: The findings indicate that active transportation is one possible approach to prevent excessive weight gain in pregnancy. Keywords: Active transportation, Biking, BMI, Pregnancy, Public transportation, Walking, Weight gain

• Szczesny, Witold; Vistad, Ingvild; Kærn, Janne; Nakling, Ole Jakob; Tropé, Claes Gøran & Paulsen, Torbjørn (2016). Impact of hospital type and treatment on long-term survival among patients with FIGO Stage IIIC epithelial ovarian cancer: Follow-up through two recurrences and three treatment lines in search for predictors for survival. European Journal of Gynaecological Oncology. ISSN 0392-2936. 37(3), p. 305–311. doi: 10.12892/ejgo3007.2016. Full text in Research Archive
• Rohde, Gudrun-Elin; Kersten, Christian; Vistad, Ingvild & Mesel, Terje (2016). Spiritual well-being in patients with metastatic colorectal cancer receiving noncurative chemoterapy. Cancer Nursing. ISSN 0162-220X. 00. doi: 10.1097/NCC.0000000000000385. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2016). Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. Journal of Developmental Origins of Health and Disease. ISSN 2040-1744. 7(5), p. 538–547. doi: 10.1017/S2040174416000258. Full text in Research Archive
• Cameron, Marte; Kersten, Christian; Vistad, Ingvild; Helvoirt, Rene van; Weyde, Kjetil & Undseth, Christine [Show all 10 contributors for this article] (2016). Palliative pelvic radiotherapy for symptomatic rectal cancer–a prospective multicenter study. Acta Oncologica. ISSN 0284-186X. 55(12), p. 1400–1407. doi: 10.1080/0284186X.2016.1191666. Full text in Research Archive
• Øverby, Nina Cecilie; Hillesund, Elisabet Rudjord; Sagedal, Linda Reme; Vistad, Ingvild & Bere, Elling (2015). The Fit for Delivery study: rationale for the recommendations and test-retest reliability of a dietary score measuring adherence to 10 specific recommendations for prevention of excessive weight gain during pregnancy. Maternal & Child Nutrition. ISSN 1740-8695. 11(1), p. 20–32. doi: 10.1111/mcn.12026. Full text in Research Archive Show summary

  Aiming at preventing excessive weight gain during pregnancy, ten specific dietary recommendations are given to pregnant women in the intervention arm of the Norwegian Fit for Delivery (FFD) study. This paper presents the rationale and test-retest reliability of the food frequency questionnaire (FFQ) and a dietary score measuring adherence to the recommendations. The study is part of the ongoing FFD study, a randomized controlled intervention study in nulliparous pregnant women. A 43-item FFQ was developed for the FFD study. A dietary score was constructed from ten subscales corresponding to the ten dietary recommendations. Adding the subscales yielded a score from 0 to 10 with increasing score indicating healthier dietary behavior. The score was divided into tertiles, grouping participants into low, medium and high adherence to the dietary recommendations. Pregnant women attending ultrasound screening at about week 19 of pregnancy were asked to complete the FFQ twice, two weeks apart. Of 154 pregnant women completing the first questionnaire, 106 (69%) completed the form on both occasions and was included in the study. The test-retest correlations of the score and subscales were r=0.68 and r=0.56-0.84 respectively (both p≤0.001). There was 68% test-retest correct classification of the score and 70-87% of the subscales. In conclusion, acceptable test-retest reliability of the FFQ and the dietary score was found. The score will be used in the FFD study to measure adherence to the dietary recommendations throughout pregnancy and in the following year post-partum.

• Cameron, Marte; Kersten, Christian; Vistad, Ingvild; Helvoirt, Rene van; Weyde, Kjetil & Undseth, Christine [Show all 10 contributors for this article] (2015). Palliative pelvic radiotherapy for symptomatic incurable prostate cancer - A prospective multicenter study. Radiotherapy and Oncology. ISSN 0167-8140. 115(3), p. 314–320. doi: 10.1016/j.radonc.2015.05.021. Full text in Research Archive Show summary

  Background and purpose Radiotherapy is used to palliate pelvic symptoms of castration resistant prostate cancer (CRPC). However, magnitude and time course of effects and toxicities are poorly documented. Study aims were to evaluate changes in patient-reported target symptoms (TS), health-related quality of life (HRQOL) and toxicity following palliative pelvic radiotherapy (PPRT) of CRPC. Material and methods 47 patients with CRPC and a symptomatic pelvic mass prescribed PPRT with 30–39 Gy were prospectively included. Primary endpoint was patient-reported improvement or complete resolution of the TS twelve weeks after PPRT. HRQOL changes were explored. Toxicity was physician-evaluated. Results Lower urinary tract symptoms (LUTS) (45%), hematuria (26%) and pain (19%) were the most common TS. In the 40 evaluable patients, overall TS response twelve weeks after PPRT was 70%. TS responses were 8/18 for LUTS, 11/12 for hematuria, and 7/9 for pain. Global HRQOL improved transiently. The most common toxicity was grade 1 or 2 diarrhea (50%). There was no grade 4 toxicity. Conclusions In the majority of patients with CRPC and a symptomatic pelvic tumor, PPRT with 30–39 Gy contributes to relief of hematuria, pain and other pelvic symptoms, with acceptable toxicity. Future studies should investigate whether PPRT regimens can be simplified.

• Vistad, Ingvild; Klungsøyr, Kari; Albrechtsen, Susanne & Skjeldestad, Finn Egil (2015). Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 94(9), p. 997–1004. doi: 10.1111/aogs.12684. Full text in Research Archive
• Skreden, Marianne; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2015). Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Public Health Nutrition (PHN). ISSN 1368-9800. 18(7), p. 1187–1196. doi: 10.1017/S136898001400189X. Full text in Research Archive Show summary

  Objective: To describe changes in consumption of different types of beverages from pre-pregnancy to early pregnancy, and to examine associations with maternal age, educational level and BMI. Design: Cross-sectional design. Participants answered an FFQ at inclusion into a randomized controlled trial, the Fit for Delivery (FFD) trial, in median gestational week 15 (range: 9–20), reporting current consumption and in retrospect how often they drank the different beverages pre-pregnancy. Setting: Eight local antenatal clinics in southern Norway from September 2009 to February 2013. Subjects: Five hundred and seventy-five healthy pregnant nulliparous women. Results: Pre-pregnancy, 27% reported drinking alcohol at least once weekly, compared with none in early pregnancy (P<0·001). The percentage of women drinking coffee (38 % v. 10 %, P < 0·001), sugar-sweetened beverages (10 % v. 6 %, P=0·011) and artificially sweetened beverages (12% v. 9%, P=0·001) at least daily decreased significantly from pre-pregnancy to early pregnancy, while the percentage of women who reported to drink water (85% v. 92%, P<0·001), fruit juice (14% v. 20%, P=0·001) and milk (37% v. 42%, P=0·001) at least daily increased significantly. From pre-pregnancy to early pregnancy higher educated women reduced their consumption frequency of coffee significantly more than women with lower education. Older women reduced their consump- tion frequency of coffee and artificially sweetened beverages and increased their consumption frequency of fruit juice and milk significantly more than younger women. Conclusions: There is a significant change in beverage consumption from pre-pregnancy to early pregnancy among Norwegian nulliparous women. Keywords Beverage consumption Dietary change Pregnant women

• Skreden, Marianne; Øverby, Nina Cecilie; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Seiler, Hilde Lohne [Show all 7 contributors for this article] (2015). Changes in mode of transportation to work or school from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Preventive Medicine Reports. 2, p. 429–435. doi: 10.1016/j.pmedr.2015.05.002. Full text in Research Archive Show summary

  Objective To describe changes in mode of transportation to work or school from pre-pregnancy to early pregnancy, to describe levels of physical activity related to mode of transportation to work or school, and to examine associations between changes in mode of transportation to work or school and educational level, body mass index (BMI) and age. Methods Between September 2009 and February 2013, 575 healthy pregnant nulliparous women were included into the Norwegian Fit for Delivery (NFFD) trial. At inclusion they reported their current and their pre-pregnancy mode of transportation to work or school. Data were analysed by multilevel mixed models with dichotomized modes of transportation as dependent variables. Results There was a significant change towards less active transportation to work or school and a decrease in level of physical activity from pre-pregnancy to early pregnancy. Pre-pregnancy, 58% used private transportation to work or school, compared to 64% in early pregnancy (p = 0.001). The percentage of women who biked (11% v. 5%, p < 0.001) decreased significantly from pre-pregnancy to early pregnancy. Conclusions In this sample of Norwegian women there was a significant change towards less active transportation to work or school and lower levels of physical activity from pre-pregnancy to early pregnancy. Keywords: Active transportation, Biking, Commuting, IPAQ, MET-score, Physical activity, Pregnancy, Private transportation, Public transportation, Walking

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• Paulsen, Anita; Fegran, Liv & Vistad, Ingvild (2026). Seksuell helse ved gynekologisk kreft : Kvinners erfaringer med kommunikasjon. doi: https:/kreftrehabilitering.no/kreftrehab-2026-takk/. Full text in Research Archive
• Vistad, Ingvild & Paulsen, Anita (2025). Nye og bedre måter for å følge opp kvinner etter gynekologisk kreft. Full text in Research Archive Show summary

  Vi starter lørdagsuniversitetet i 2025 med å løfte frem et forskningsprosjekt som prøver ut nye måter å følge opp kvinner som har hatt kreft. Prosjektet utforsker mulighetene for en bedre oppfølging av kvinner etter gynekologisk kreft ved hjelp av digitale hjelpemidler, og en mer hensiktsmessig oppgavedeling i tjenestene. Dette er viktig i seg selv, men kan også gi inspirasjon og overføringsverdi til også andre felt. Prosjektet heter LETSGO, og er forankret på Sørlandets sykehus og Universitetet i Agder, og til lørdagsuniversitetet i Arendal i februar kommer prosjektleder og overlege på Sørlandets sykehus, professor Ingvild Vistad, og prosjektmedarbeider og sykepleier på Sørlandets sykehus, universitetslektor og doktorgradsstipendiat ved UiA, Anita Paulsen

• Fosstveit, Sindre Herskedal; Vistad, Ingvild; Larsen, Torill Marie Bogsnes; Lohne-Seiler, Hilde & Berntsen, Sveinung (2025). Assessing the Needs and Potential of a Motivational App to Support Cancer Survivors in Physical Activity Participation. Full text in Research Archive
• Vistad, Ingvild; Skorstad, Mette; Hagen, Milada; Demmelmaier, Ingrid; Bjørge, Line & Poll-Franse, Lonneke V. Van De [Show all 12 contributors for this article] (2025). The Impact Of The LETSGO Personalized Follow-Up Model On Empowerment And Quality Of Life In Gynaecological Cancer Survivors: A Multicenter Quasi-Experimental Study. International Journal of Gynecological Cancer. ISSN 1048-891X. 35(2). doi: 10.1016/j.ijgc.2024.100110. Full text in Research Archive Show summary

  Background: Increasing outpatient demands and unmet patient needs necessitate personalized follow‐up care for cancer survivors. This study investigated whether a self‐management–focused follow‐up model improves empowerment and quality of life (QoL) in gynecological cancer survivors compared to standard follow‐up. Methods: Twelve Norwegian hospitals participated in this cohort study. Patients initiating routine follow‐up after primary treatment were eligible and allocated to either intervention or standard care follow‐up groups based on their treatment hospital. The intervention included nurse‐led consultations using coaching techniques for education on symptom monitoring and healthy lifestyle, alternated with physician‐led consultations and access to a mobile app. Standard follow‐up consisted of physician‐led consultations only. The primary outcome was change in patient empowerment over 12 months, measured with the self‐monitoring and insight domain of the Health Education Impact Questionnaire (heiQ). Secondary outcomes included changes in remaining heiQ domains and QoL. Data were analyzed according to intention‐to‐treat principles using linear mixed effects models. Results: Among 741 participants (intervention: 378, standard: 363), baseline characteristics were comparable. At 12 months, no significant differences were observed in self‐monitoring and insight (Δ = 0.02 [95% confidence interval (CI), –0.04 to 0.08]; effect sizes [ES] = 0.29). However, health‐directed activity (Δ = 0.15 [95% CI, 0.04– 0.25]; ES = 0.15), emotional well‐being (Δ = 0.12 [95% CI, 0.02–0.20]; ES = 0.15), social functioning (Δ = 5.2 [95% CI, 1.1–9.3]; ES = 0.41), and physical functioning (Δ = 2.5 [95% CI, 0.0–5.0]; ES = 0.20) were significantly more improved in the intervention group. Conclusion: Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology follow‐up did not significantly impact self‐monitoring and insight, but positively influenced other survivorship domains, indicating its potential for enhancing self‐management and QoL in gynecological cancer survivors.

• Tarabar, Zaklina; Vistad, Ingvild & Børøsund, Elin (2025). Application for follow-up after treatment of gynecological cancer. Full text in Research Archive
• Vistad, Ingvild (2025). Setefødsler utenfor kvinneklinikk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(7). doi: 10.4045/tidsskr.25.0206. Full text in Research Archive
• Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2024). 207 Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations. doi: https:/eposters.emma.events/esgo2024eposters/poster/Poster_152041/Poster_152041.jpg?ver=1. Full text in Research Archive
• Torkildsen, Cecilie Fredvik; Lindemann, Kristina Yvonne Kathe; Bischof, Katharina; Aune, Guro; Vistad, Ingvild & Ingebrigtsen, Vibeke Anett [Show all 20 contributors for this article] (2024). 456 Molecular characteristics of gynaecological cancer patients in the IMPRESS-Norway trial – a national prospective, non-randomized clinical trial evaluating the efficacy of anti-cancer drugs on new indications. International Journal of Gynecological Cancer. ISSN 1048-891X. 34, p. A563–A564. doi: 10.1136/ijgc-2024-ESGO.1105. Full text in Research Archive
• Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Sexual health communication in gynecological cancer follow-up. doi: https:/www.nfks.no/NACS2023-program/. Full text in Research Archive
• Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). CN49 Nurse–patient sexual health communication in gynecological cancer follow-up: A qualitative study from nurses’ perspectives. doi: https:/www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2823%2902480-8. Full text in Research Archive
• Western, Benedikte; Ivarsson, Andreas; Demmelmaier, Ingrid; Vistad, Ingvild; Berntsen, Sveinung & Buffart, Laurien M. (2023). SUGGESTED TARGETS FOR IMPROVING EXERCISE INTERVENTION COMPLETION IN CANCER PATIENTS – AN INDIVIDUAL PATIENT DATA META-ANALYSIS FROM THE POLARIS STUDY. Full text in Research Archive
• Vistad, Ingvild & Bjørge, Line (2023). Advanced endometrial cancer: New medical treatment options on the horizon. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 102(2), p. 128–129. doi: 10.1111/aogs.14499. Full text in Research Archive
• Berntsen, Sveinung; Demmelmaier, Ingrid & Vistad, Ingvild (2022). Sufficiently active based on what? Full text in Research Archive
• Gissum, Karen Rosnes; Drageset, Sigrunn; Thomsen, Liv Cecilie Vestrheim; Vistad, Ingvild; Strand, Roger & Bjørge, Line (2022). Quality of Life of Patients with Ovarian Cancer: Biological Perspective Versus Patient Perspective. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Valand, Ida Ulrikke; Bere, Elling Tufte; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2019). Meals eaten with family in relation to dietary quality in 12-month-olds. A sub-study in the Norwegian Fit for Delivery study. Full text in Research Archive
• Gissum, Karen Rosnes; Drageset, Sigrunn; Vistad, Ingvild; Hoel, Jeanette & Bjørge, Line (2019). What you should know about tumor reductive surgery in advanced ovarian cancer – Clinical recommendations from a patient perspective. Full text in Research Archive
• Fidjeland, Heidi Lidal; Gjelstad, Svein; Vistad, Ingvild & Brekke, Mette (2019). Do cancer patients consult their general practitioners, and why? Full text in Research Archive
• Vistad, Ingvild (2019). Electronic patient-reported outcomes to monitor symptoms after gynecological cancer treatment. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 98(11), p. 1365–1366. doi: 10.1111/aogs.13734. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2017). Associations between dietary behavior and preterm birth in the Norwegian Fit for Delivery study – interaction with offspring gender. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2016). Dietary behavior in early pregnancy and subsequent risk of preeclampsia - an observationa study performed within the Norwegian Fit for Delivery study. Full text in Research Archive
• Fidjeland, Heidi Lidal; Brekke, Mette & Vistad, Ingvild (2016). Gynecological cancer survivors’ views on follow-up after cancer treatment. Full text in Research Archive
• Fidjeland, Heidi Lidal; Vistad, Ingvild & Brekke, Mette (2016). Gynecological cancer survivors`views on follow-up after cancer treatment. Full text in Research Archive
• Sanda, Birgitte; Vistad, Ingvild; Haakstad, Lene Annette Hagen; Berntsen, Sveinung; Sagedal, Linda Reme & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2016). Validity and reliability of physical activity questionnaire in pregnancy; does physical activity level matter? Full text in Research Archive
• Sanda, Birgitte; Sagedal, Linda Reme; Vistad, Ingvild; Lohne-Seiler, Hilde; Hakestad, Lene AH. & Torstveit, Monica Klungland (2015). A lifestyle intervention including an exercise program helps women increase physical activity level in pregnancy. Full text in Research Archive
• Sagedal, Linda Reme; Henriksen, Tore; Øverby, Nina Cecilie; Lohne-Seiler, Hilde; Torstveit, Monica Klungland & Bere, Elling [Show all 8 contributors for this article] (2015). Effect of a lifestyle intervention in pregnancy on infant size up to 1 year of age: results of Norwegian Fit for Delivery randomized controlled trial. Full text in Research Archive
• Skreden, Marianne; Øverby, Nina C; Sagedal, Linda Reme; Vistad, Ingvild; Torstveit, Monica Klungland & Lohne-Seiler, Hilde [Show all 7 contributors for this article] (2015). Changes in mode of transportation to work or school from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study. Full text in Research Archive
• Fidjeland, Heidi Lidal; Brekke, Mette & Vistad, Ingvild (2015). Gynecological cancer patients’ views on follow-up after cancer treatment. Full text in Research Archive
• Hillesund, Elisabet Rudjord; Bere, Elling; Sagedal, Linda Reme; Vistad, Ingvild & Øverby, Nina Cecilie (2015). Adherence to ten dietary principles and risk of preterm delivery - a study performed in the Norwegian Fit for Delivery study. Full text in Research Archive
• Skreden, Marianne; Bere, Elling; Vistad, Ingvild; Sagedal, Linda Reme & Øverby, Nina Cecilie (2015). Changes in vegetables, fruits and berries consumption habits from pre-pregnancy to early pregnancy among Norwegian women. Full text in Research Archive
• Meltzer-Gunnes, Christin Julia & Vistad, Ingvild (2025). Trends in vulvar squamous cell carcinoma in Norway: Epidemiological shifts, HPV association, and survivorship Challenges. Universitetet i Oslo. ISSN 9788234806490. Full text in Research Archive Show summary

  Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with two subtypes: HPV-independent and HPV-associated. The latter affects younger women and accounts for 25–40% of cases. International studies have shown rising VSCC incidence rates, especially among younger women, possibly linked to an increasing proportion of HPV-associated tumors. HPV status may also influence prognosis and given the impact of treatment on quality of life, better risk stratification is essential to avoid overtreatment and long-term morbidity. This thesis explored: 1) incidence and age trends in Norway over recent decades, 2) changes in HPV-associated VSCC and its impact on survival, and 3) survivorship challenges more than five years post-treatment. Using data from the Cancer Registry of Norway, we found that VSCC incidence rates rose 2.5-fold from 1961 to 2010, with the steepest increase among women under 60. HPV analysis of tumor samples from 1970–75 and 2000–05 showed a significant rise in HPV-positive tumors (23% to 35%). The predominant genotypes detected were HPV 16, 33, and 18, with similar distributions in both periods. Finally, we found that one-third of long-term survivors reported clinically significant issues, including impaired physical, emotional, cognitive, and social functioning, pain, and fatigue. Compared to normative samples, survivors had more vulvar and groin symptoms, were less likely to be sexually active and reported more sexual dysfunction. In conclusion, the incidence of VSCC in Norway has increased, particularly among younger women, with a growing proportion of HPV-associated cases. Survivors face substantial long-term challenges, underscoring the need for improved risk stratification and survivorship care.

• Sagedal, Linda Reme; Vistad, Ingvild; Øverby, Nina Cecilie & Henriksen, Tore (2017). Antenatal lifestyle intervention for the limitation of gestational weight gain: The Norwegian Fit for Delivery Trial. Faculty of Medicine, University of Oslo. ISSN 9788283770360. Full text in Research Archive
• Rossen, Janne; Eggebø, Torbjørn Moe & Vistad, Ingvild (2017). Oxytocin augmentation and its association with labor outcomes. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232623983. Full text in Research Archive Show summary

  Stimulering av rier med oxytocin og sammenheng med fødselsutfall Oxytocin blir ofte brukt under fødselen for å øke styrken på riene. Mangel på klare indikasjoner for bruk av oxytocin har ført til ulik praksis og tilfeldig bruk. Hensikten med studien var å undersøke om det kan være en sammenheng mellom bruken av oxytocin og hvordan fødselen blir for kvinnen og for barnet. Studie I Vi undersøkte retrospektivt risikofaktorer for blødning over 1000 ml etter fødselen og om dette hadde endret seg fra 1998 til 2007. Blødning over 1000 ml økte i studieperioden og risikoen var dobbelt så stor etter keisersnitt sammenlignet med vaginal fødsel (2.8 % vs. 5.9 %). Igangsetting av fødsel, stimulering av rier og keisersnittfrekvens økte, og disse faktorene viste sammenheng med alvorlig blødning etter fødselen. Bruk av oxytocin for stimulering av rier økte fra 5.8 % til 29.3 %. Studie II Målet med denne studien var å presentere en metode for å evaluere og kvalitetssikre utfall og hendelser for mor og barn i forbindelse med fødsel. Michael Robson har laget en metode der fødende kvinner kan klassifiseres i ti ulike grupper. Metoden ble først utviklet for å klassifisere bruken av keisersnitt. I denne studien presenterer vi hvordan vi kan klassifisere 16 fødselsutfall i henhold til de ti gruppene. Vi presenterer resultater fra fødeavdelinger i Stavanger, Dublin og nasjonale data fra Slovenia. Studie III Fødeavdelingen ved Stavanger universitetssjukehus endret indikasjonene og rutinene for oxytocinbruk i 2010. I løpet av en 5 års periode ble bruken av oxytocin under fødselen signifikant redusert fra 35.5 % til 23.6 %. Antall akutte keisersnitt og antall barn med lav pH i navlesnora gikk ned i samme tidsperiode og vi diskuterer om dette kan ha en sammenheng med redusert bruk av oxytocin. Flere kvinner opplevde blødning over 1000ml og varighet av fødsel over 12 timer. Studie IV Fødselsregistrene i Norge og Danmark ble brukt for å undersøke bruken av oxytocin for ristimulering hos førstegangsfødende kvinner med spontan fødselstart til termin. Vi fant at bruk av oxytocin økte med kvinnenes alder, bruk av epiduralbedøvelse og med akutte keisersnitt. Formålet med studien var å vurdere samspillet mellom disse faktorene. Ristimulering viste sammenheng med lavere forekomst av keisersnitt hos kvinner med epiduralbedøvelse, spesielt hos kvinner over 35 år. Konklusjon Målrettet bruk av oxytocin for stimulering av rier førte til redusert bruk av oxytocin og viste sammenheng med færre akutte keisersnitt og færre barn med lav pH i navlesnora. Kvinner med epiduralbedøvelse kan imidlertid ha fordel av ristimulering. Flere ulike faktorer har innvirkning på fødselsforløp og fordeler og ulemper må vurderes i forhold til hverandre. Robsons 10-gruppe klassifikasjonssystem kan være et nyttig hjelpemiddel for å kvalitetssikre fødselsutfall og for å sammenligne ulike fødeavdelinger

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