Stein Kaasa

• Balstad, Trude Rakel; Brunelli, Cinzia; Pettersen, Caroline Hild; Schønberg, Svanhild Margrethe Arentz; Skorpen, Frank; Fallon, Marie T.; Kaasa, Stein; Bye, Asta; Laird, Barry J. A.; Stene, Guro Birgitte & Solheim, Tora Skeidsvoll (2020). Power comparisons and clinical meaning of outcome measures in assessing treatment effect in cancer cachexia: secondary analysis from a randomised pilot multimodal intervention trial. Frontiers in Nutrition.  ISSN 2296-861X.  7:602775, s 1- 9 . doi: 10.3389/fnut.2020.602775 Full text in Research Archive.
• Brenne, Anne-Tove; Knudsen, Anne Kari; Raj, Sunil Xavier; Skjelvan, Laila Strand; Lund, Jo-Åsmund; Thronæs, Morten; Løhre, Erik Torbjørn; Hågensen, Liv Ågot; Brunelli, Cinzia & Kaasa, Stein (2020). Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model. Pain and Therapy.  ISSN 2193-8237.  9, s 297- 318 . doi: 10.1007/s40122-020-00163-7 Full text in Research Archive. Show summary

  Introduction Early access to cancer palliative care is recommended. Descriptions of structures and processes of outpatient palliative care clinics operated within smaller hospitals are scarce. This paper presents the development and operation of a fully integrated cancer and palliative care outpatient clinic at a local hospital in a rural region of Mid-Norway offering palliative care concurrent with cancer treatment. A standardized care pathway was applied. Methods Palliative care is in Norway part of the public healthcare system. Official recommendations recent years point out action points to improve delivery of palliative care. An integrated cancer and palliative care outpatient clinic at a local hospital and an innovative care delivery model was developed and operated in this setting. Patients were recruited for a descriptive study of the patient population. Clinical data were collected by clinical staff and 13 symptom intensities were reported by the patients. Results Cancer and palliative care were provided by one team of healthcare professionals trained in both fields. There was a close collaboration with the other departments at the hospital, with its affiliated tertiary hospital, and with community health and care services to provide timely referral, enhanced continuity, and improved coordination of care. Eighty-eight patients were included. Mean age was 65.6 years, the most common cancer diagnoses were digestive organs (22.7%), male genital organs (20.5%) or breast (25.0%), 75.0% had metastatic or locally advanced cancer, 59.1% were treated with non-curative intention and 93.1% had Karnofsky Performance Status ≥ 80%. Median scores of individual symptoms ranged from 0 to 3 (numerical rating scale, 0–10) and 61.0% reported at least one clinically significant symptom rating (≥ 4). Conclusion This delivery model of integrated outpatient cancer and palliative care is particularly relevant in rural regions allowing cancer patients access to palliative care earlier in the disease trajectory and closer to home.

• Brunelli, Cinzia; Borreani, Claudia; Caraceni, Augusto Tomasso Giovanni; Roli, Anna; Bellazzi, Marco; Lombi, Linda; Zito, Emanuela; Pellegrini, Chiara; Spada, Pierangelo; Kaasa, Stein; Foschi, Anna Maria & Apolone, Giovanni (2020). PATIENT VOICES, a project for the integration of the systematic assessment of patient reported outcomes and experiences within a comprehensive cancer center: a protocol for a mixed method feasibility study. Health and Quality of Life Outcomes.  ISSN 1477-7525.  18(1) . doi: 10.1186/s12955-020-01501-1 Full text in Research Archive. Show summary

  Abstract Background Listening to “patient voices” in terms of symptoms, emotional status and experiences with care, is crucial for patient empowerment in clinical practice. Despite convincing evidence that routine patient reported outcomes and experience measurements (PRMs) with rapid feed-back to oncologists can improve symptom control, patient well-being and cost effectiveness, PRMs are not commonly used in cancer care, due to barriers at various level. Part of these barriers may be overcome through electronic PRMs collection (ePRMs) integrated with the electronic medical record (EMR). The PATIENT VOICES initiative is aimed at achieving a stepwise integration of ePRMs assessment into routine cancer care. The feasibility project presented here is aimed at assessing the knowledge, use and attitudes toward PRMs in a comprehensive cancer centre; developing and assessing feasibility of a flexible system for ePRM assessment; identifying barriers to and developing strategies for implementation and integration of ePRMs clinical practice. Methods The project has been organized into four phases: a) pre-development; b) software development and piloting; c) feasibility assessment; d) post-development. A convergent mixed method design, based on concurrent quantitative and qualitative data collection will be applied. A web-survey on health care providers (HCPs), qualitative studies on patients and HCPs (semi-structured interviews and focus groups) as well as longitudinal and cross-sectional quantitative studies will be carried out. The quantitative studies will enroll 600 patients: 200 attending out-patient clinics (physical symptom assessement), 200 attending inpatient wards (psychological distress assessment) and 200 patients followed by multidisciplinary teams (patient experience with care assessment). The Edmonton symptom assessment scale, the Distress Thermometer, and a tool adapted from existing patient reported experience with cancer care questionnaires, will be used in quantitative studies. A multi-disciplinary stakeholder team including researchers, clinicians, health informatics professionals, health system administrators and patients will be involved in the development of potentially effective implementation strategies in the post development phase. Discussion The documentation of potential advantages and implementation barriers achieved within this feasibility project, will serve as a starting point for future and more focused interventions aimed at achieving effective ePRMs routine assessment in cancer care.

• Colombo, Francesca; Pintarelli, Giulia; Galvan, Antonella; Noci, Sara; Corli, Oscar; Skorpen, Frank; Klepstad, Pål; Kaasa, Stein; Pigni, Alessandra; Brunelli, Cinzia; Roberto, Anna; Piazza, Rocco; Pirola, Alessandra; Gambacorti-Passerini, Carlo & Caraceni, Augusto Tomasso Giovanni (2020). Identification of genetic polymorphisms modulating nausea and vomiting in two series of opioid-treated cancer patients. Scientific Reports.  ISSN 2045-2322.  10(1) . doi: 10.1038/s41598-019-57358-y
• Ekström, Magnus P.; Palmqvist, Sebastian; Currow, David C.; Sjøgren, Per; Kurita, Geana Paula; Jakobsen, Gunnhild; Kaasa, Stein & Hjermstad, Marianne Jensen (2020). Mild to Moderate Cognitive Impairment Does Not Affect the Ability to Self-Report Important Symptoms in Patients With Cancer: A Prospective Longitudinal Multinational Study (EPCCS). Journal of Pain and Symptom Management.  ISSN 0885-3924.  60(2), s 346- 354.e2 . doi: 10.1016/j.jpainsymman.2020.03.007 Full text in Research Archive.
• Frydenberg, Hanne; Harsem, Nina Kittelsen; Ofigsbø, Åsa; heid, hanne skoglund; Brandengen, Morten; Kaasa, Stein & Guren, Marianne (2020). Chemotherapy During Pregnancy for Advanced Colon Cancer: A Case Report. Clinical colorectal cancer.  ISSN 1533-0028.  19(2), s 141- 144 . doi: 10.1016/j.clcc.2020.02.013 Full text in Research Archive.
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Andersen, Sigve; Brunelli, Cinzia; Dajani, Olav; Ahmed, Herish; Hamre, Hanne Mari; Haukland, Ellinor Christin; Holmberg, Mats; Jordal, Frode; Krogstad, Hilde; Lundeby, Tonje; Løhre, Erik T; Mjåland, Svein; Nordbø, Arve; Paulsen, Ørnulf; Staff, Erik Schistad; Wester, Torunn Elin; Kaasa, Stein & Loge, Jon Håvard (2020). PALLiON - PALLiative care Integrated in ONcology: Study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials.  ISSN 1745-6215.  21:303, s 1- 17 . doi: 10.1186/s13063-020-4224-4 Full text in Research Archive.
• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Rosland, Jan Henrik; Aass, Nina Kathrine; Albert, Eva; Kaasa, Stein; Fayers, Peter; Klepstad, Pål & Paulsen, Ørnulf (2020). The short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer in a randomized, placebo-controlled, double-blind trial. Supportive Care in Cancer.  ISSN 0941-4355. . doi: 10.1007/s00520-020-05693-6 Full text in Research Archive. Show summary

  Purpose: Although corticosteroids are frequently used in patients with advanced cancer, few studies have examined the impact of these drugs on patient-reported sleep. We aimed to examine the short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer. Methods: Patient-reported sleep was a predefined secondary outcome in a prospective, randomized, placebo-controlled, double-blind trial that evaluated the analgesic efficacy of corticosteroids in advanced cancer patients (18+), using opioids, and having pain ≥ 4 past 24 h (NRS 0-10). Patients were randomized to the methylprednisolone group with methylprednisolone 16 mg × 2/day or placebo for 7 days. The EORTC QLQ-C30 (0-100) and the Pittsburgh Sleep Quality Index questionnaire (PSQI) (0-21) were used to assess the impact of corticosteroids on sleep at baseline and at day 7. Results: Fifty patients were randomized of which 25 were analyzed in the intervention group and 22 in the control group. Mean age was 64 years, mean Karnofsky performance status was 67 (SD 13.3), 51% were female, and the mean oral daily morphine equivalent dose was 223 mg (SD 222.77). Mean QLQ-C30 sleep score at baseline was 29.0 (SD 36.7) in the methylprednisolone group and 24.2 (SD 27.6) in the placebo group. At day 7, there was no difference between the groups on QLQ-C30 sleep score (methylprednisolone 20.3 (SD 32.9); placebo 28.8 (SD 33.0), p = 0.173). PSQI showed similar results. Conclusions: Methylprednisolone 16 mg twice daily for 7 days had no impact on patient-reported sleep in this cohort of patients with advanced cancer.

• Kochovska, Slavica; Huang, Chao; Johnson, Miriam J.; Agar, Meera; Fallon, Marie; Kaasa, Stein; Hussain, Jamilla A.; Portenoy, Russell K.; Higginson, Irene J. & Currow, David C. (2020). Intention-to-Treat Analyses for Randomized Controlled Trials in Hospice/Palliative Care: The Case for Analyses to be of People Exposed to the Intervention. Journal of Pain and Symptom Management.  ISSN 0885-3924.  59(3), s 637- 645 . doi: 10.1016/j.jpainsymman.2019.10.026
• Krogstad, Hilde; Loge, Jon Håvard; Grotmol, Kjersti S.; Kaasa, Stein; Kiserud, Cecilie E.; Salvesen, Øyvind & Hjermstad, Marianne Jensen (2020). Symptoms in the general Norwegian adult population - prevalence and associated factors. BMC Public Health.  ISSN 1471-2458.  20 . doi: 10.1186/s12889-020-09109-2 Full text in Research Archive.
• Lindemann, Kristina; Martinsson, L.; Kaasa, Stein & Lindquist, David (2020). Elderly gynaecological cancer patients at risk for poor end of life care: a population-based study from the Swedish Register of Palliative Care. Acta Oncologica.  ISSN 0284-186X.  59(6), s 636- 643 . doi: 10.1080/0284186X.2020.1744717 Full text in Research Archive.
• Sandmæl, Jon Arne; Bye, Asta; Solheim, Tora S; Balstad, Trude Rakel; Thorsen, Lene; Skovlund, Eva; Kaasa, Stein; Lund, Jo-Åsmund & Oldervoll, Line Merethe (2020). Physical rehabilitation in patients with head and neck cancer: Impact on health-related quality of life and suitability of a post-treatment program. Laryngoscope Investigative Otolaryngology (LIO).  ISSN 2378-8038.  5(2), s 330- 338 . doi: 10.1002/lio2.368 Full text in Research Archive. Show summary

  Objective: Physical rehabilitation programs hold the potential to mitigate deterioration in health-related quality of life (HRQoL) in patients with head and neck cancer. The objective was to assess development in relevant domains of HRQoL following a physical exercise and nutrition intervention administrated during or after treatment. Methods: In a pilot study, 41 patients were randomized to resistance training and oral nutritional supplements during (EN-DUR, n = 20) or after (EN-AF, n = 21) radiotherapy. Global health status/QoL (GHS) and physical functioning (PF) were measured by the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire at baseline, week 6, and week 14. Differences between the groups were assessed by analysis of covariance. A difference of ≥10 points in GHS and PF was interpreted as clinically relevant. Results: No statistically significant differences were detected between the groups; however, clinically relevant changes and differences in GHS and PF were observed. From baseline to week 6, GHS decreased 9 points in the EN-DUR group and 23 points in the EN-AF group and PF decreased 13 points and 21 points, respectively. From week 6 to week 14, GHS increased 14 points in the EN-DUR group and 26 points EN-AF group and PF did not change (0 points) in the EN-DUR group and increased 16 points in the EN-AF group. Conclusion: The findings from the present pilot study are promising and indicate that a physical rehabilitation program may have a positive impact on HRQoL during treatment and enhance recovery after treatment. A definitive randomized trial is warranted. Level of evidence: 1b-Individual randomized controlled trial.

• Bennett, Michael I.; Kaasa, Stein; Barke, Antonia; Korwisi, Beatrice; Rief, Winfried & Treede, Rolf-Detlef (2019). The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain.  ISSN 0304-3959.  160(1), s 38- 44 . doi: 10.1097/j.pain.0000000000001363
• Boland, Jason W.; Allgar, Victoria; Boland, Elaine G.; Bennett, Mike I; Kaasa, Stein; Hjermstad, Marianne Jensen & Johnson, Miriam (2019). The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.. European Journal of Clinical Pharmacology.  ISSN 0031-6970. . doi: 10.1007/s00228-019-02801-2 Full text in Research Archive.
• Boland, Jason W.; Allgar, Victoria; Boland, Elaine G.; Kaasa, Stein; Hjermstad, Marianne Jensen & Johnson, Miriam J. (2019). Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study. Palliative Medicine.  ISSN 0269-2163.  33(2), s 206- 2012 . doi: 10.1177/0269216318811011 Full text in Research Archive.
• Bye, Asta; Meli, Kari; Solheim, Tora Skeidsvoll; Laird, Barry J; Kaasa, Stein; Stene, Guro Birgitte & Balstad, Trude Rakel (2019). Food intake by Patient-Generated Subjective Global Assessment (PG-SGA) corresponds to energy and protein intake as well as weight change in patients with advanced cancer. Clinical Nutrition Experimental.  ISSN 2352-9393.  25, s 20- 28 . doi: 10.1016/j.yclnex.2019.03.003 Full text in Research Archive.
• Dolan, Ross D.; Laird, Barry J.A.; Klepstad, Pål; Kaasa, Stein; Horgan, Paul G.; Paulsen, Ørnulf & McMillan, Donald C. (2019). An exploratory study examining the relationship between performance status and systemic inflammation frameworks and cytokine profiles in patients with advanced cancer. Medicine.  ISSN 0025-7974.  98(37), s 1- 7 . doi: 10.1097/MD.0000000000017019 Full text in Research Archive. Show summary

  The role of cytokines in the systemic inflammatory response (SIR) is now well established. This is in keeping with the role of the SIR in tumorigenesis, malignant spread, and the development of cachexia. However, the relationship between performance status/systemic inflammation frameworks and cytokine profiles is not clear. The aim of the present study was to examine the relationship between the Eastern cooperative oncology group performance status/modified Glasgow prognostic score (ECOG-PS/mGPS) and cooperative oncology group performance status/neutrophil platelet score (ECOG-PS/NPS) frameworks and their cytokine profile in patients with advanced cancer.This was a retrospective interrogation of data already collected as part of a recent clinical trial (NCT00676936). The relationship between the independent variables (ECOG-PS/mGPS and ECOG-PS/NPS frameworks), and dependent variables (cytokine levels) was examined using independent Mann-Whitney U and Kruskal Wallis tests where appropriate.Of the 40 patients included in final analysis the majority had evidence of an SIR assessed by mGPS (78%) or NPS (53%). All patients died on follow-up and the median survival was 91 days (4-933 days). With increasing ECOG-PS there was a higher median value of Interleukin 6 (IL-6, P = .016) and C-reactive protein (CRP, P < .01) and lower albumin (P < .01) and poorer survival (P < .001). With increasing mGPS there was a higher median value of IL-6 (P = .016), Macrophage migration inhibitory factor (MIF, P = .010), erythrocyte sedimentation rate (ESR, P < .01) and poorer survival (P < .01). With increasing NPS there was a higher median value of TGF-β (P < .001) and C-reactive protein (P = .020) and poor survival (P = .001). When those patients with an ECOG-PS 0/1 and mGPS0 were compared with those patients with an ECOG-PS 2 and mGPS2 there was a higher median value of IL-6 (P = .017) and poorer survival (P < .001). When those patients with an ECOG-PS 0/1 and NPS0 were compared with those patients with an ECOG-PS 2 and NPS1/2 there was a higher median value of IL-6 (P = .002), TGF-β (P < .001) and poorer survival (P < .01).In patients with advanced cancer IL-6 was associated with the ECOG-PS/mGPS and ECOG-PS/NPS frameworks and survival in patients with advanced cancer. Therefore, the present work provides supporting evidence that agents targeting IL-6 are worthy of further exploration.

• Habberstad, Ragnhild H; Hjermstad, Marianne Jensen; Brunelli, Cinzia; Kaasa, Stein; Bennett, Michael I; Pardon, Koen & Klepstad, Pål (2019). Which factors can aid clinicians to identify a risk of pain during the following month in patients with bone metastases? A longitudinal analyses. Supportive Care in Cancer.  ISSN 0941-4355.  27(4), s 1335- 1343 . doi: 10.1007/s00520-018-4405-9 Full text in Research Archive.
• Jakobsen, Gunnhild; Engstrøm, Morten; Thronæs, Morten; Løhre, Erik Torbjørn; Kaasa, Stein; Fayers, Peter; Hjermstad, Marianne Jensen & Klepstad, Pål (2019). Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy. Supportive Care in Cancer.  ISSN 0941-4355.  s 1- 9 . doi: 10.1007/s00520-019-04998-5 Full text in Research Archive.
• Landmark, Tormod; Romundstad, Pål Richard; Butler, Stephen; Kaasa, Stein & Borchgrevink, Petter Chr. (2019). Development and course of chronic widespread pain: the role of time and pain characteristics (the HUNT pain study). Pain.  ISSN 0304-3959.  160(9), s 1976- 1981 . doi: 10.1097/j.pain.0000000000001585 Full text in Research Archive.
• Løhre, Erik Torbjørn; Thronæs, Morten; Brunelli, Cinzia; Kaasa, Stein & Klepstad, Pål (2019). An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Supportive Care in Cancer.  ISSN 0941-4355.  s 1- 12 . doi: 10.1007/s00520-019-04836-8 Full text in Research Archive.
• Ricchini, Francesca; Caraceni, Augusto Tomasso Giovanni; Zecca, Ernesto; Pigni, Alessandra; Centurioni, Fabio; Manzoni, Andrea; Kaasa, Stein & Brunelli, Cinzia (2019). Effect of opioid exposure on efficacy and tolerability of sublingual fentanyl and subcutaneous morphine for severe cancer pain episodes. Secondary analysis from a double-blind double-dummy, randomized trial. Journal of Pain and Symptom Management.  ISSN 0885-3924.  s 1- 9 . doi: 10.1016/j.jpainsymman.2019.06.016
• Røen, Ingebrigt; Stifoss-Hanssen, Hans; Grande, Gunn; Kaasa, Stein; Sand, Kari & Knudsen, Anne Kari (2019). Supporting carers: health care professionals in need of system improvements and education - a qualitative study. BMC Palliative Care.  ISSN 1472-684X.  18(1), s 58- 68 . doi: 10.1186/s12904-019-0444-3 Full text in Research Archive. Show summary

  Abstract Background: Health care professionals should prevent and relieve suffering in carers of patients with advanced cancer. Despite known positive effects of systematic carer support, carers still do not receive sufficient support. Carers have reported to be less satisfied with coordination of care and involvement of the family in treatment and care decisions than patients. In a rural district of Mid-Norway, cancer palliative care services across specialist and community care were developed. Participants’ experiences and opinions were investigated as part of this development process. Methods: The aim of this qualitative study was to explore and describe health care professionals’ experiences with carer support from their own perspective. Data were collected in focus groups. Purposeful sampling guided the inclusion. Six groups were formed with 21 professionals. The discussions were audio-recorded, transcribed, and analyzed using systematic text condensation. Results: In the analyzis of the focus group discussions, ten categories emerged from the exploration of health care professionals’ carer support, assessment of needs, and factors hampering carer support: 1) dependent on profession, role, and context, 2) personal relationship, 3) personal skills and competence, 4) adjusted to the stage of the disease, 5) informal assessment of carers’ needs, 6) lack of education 7) lack of systems for carer consultations, 8) lack of systems for documentation, 9) lack of systems for involving GPs, and 10) lack of systematic spiritual care. Conclusions: Health care professionals built a personal relationship with the carers as early as possible, to facilitate carer support throughout the disease trajectory. Systematic carer support was hampered by lack of education and system insufficiencies. Organizational changes were needed, including 1) education in carer support, communication, and spiritual care, 2) use of standardized care pathways, including systematic carer needs assessment, 3) systematic involvement of general practitioners, and 4) a system for documentation of clinical work with carers. Keywords: Health care professionals, Oncology, Palliative care, Family carers, Carer support, Needs assessment, Integration

• Scholz, Joachim; Finnerup, Nanna B.; Attal, Nadine; Aziz, Qasim; Baron, Ralf; Bennett, Michael I.; Benoliel, Rafael; Cohen, Milton; Cruccu, Giorgio; Davis, Karen D.; Evers, Stefan; First, Michael; Giamberardino, Maria Adele; Hansson, Per; Kaasa, Stein; Korwisi, Beatrice; Kosek, Eva; Lavand'homme, Patricia; Nicholas, Michael; Nurmikko, Turo; Perrot, Serge; Raja, Srinivasa N.; Rice, Andrew S.C.; Rowbotham, Michael C.; Schug, Stephan; Simpson, David M.; Smith, Blair H.; Svensson, Peter; Vlaeyen, Johan W.S.; Wang, Shuu-Jiun; Barke, Antonia; Rief, Winfried & Treede, Rolf-Detlef (2019). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain.  ISSN 0304-3959.  160(1), s 53- 59 . doi: 10.1097/j.pain.0000000000001365
• Stene, Guro Birgitte; Balstad, Trude Rakel; Leer, Anne Silja Mäkitalo; Bye, Asta; Kaasa, Stein; Fallon, Marie T.; Laird, Barry J; Maddocks, Matthew & Solheim, Tora Skeidsvoll (2019). Deterioration in muscle mass and physical function differs according to weight loss history in cancer cachexia. Cancers.  ISSN 2072-6694.  11(12), s 1- 14 . doi: 10.3390/cancers11121925 Full text in Research Archive. Show summary

  Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline. Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III–IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks. Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (−5.3 cm2, p = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (−2.8 cm2, p = 0.146), but demonstrated a statistically significant decline in PF; KPS (−3.8 points, p = 0.030), self-PF (−8.8 points, p = 0.027), and HGS (−2.7 kg, p = 0.026). Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further.

• Thronæs, Morten; Balstad, Trude Rakel; Brunelli, Cinzia; Løhre, Erik Torbjørn; Klepstad, Pål; Vagnildhaug, Ola Magne; Kaasa, Stein; Knudsen, Anne Kari & Solheim, Tora Skeidsvoll (2019). Pain management index (PMI)-does it reflect cancer patients' wish for focus on pain?. Supportive Care in Cancer.  ISSN 0941-4355.  s 1- 10 . doi: 10.1007/s00520-019-04981-0 Full text in Research Archive. Show summary

  Background The pain management index (PMI) was developed to combine information about the prescribed analgesics and the self-reported pain intensity in order to assess physicians’ response to patients’ pain. However, PMI has been used to explore undertreatment of cancer pain. The present study explores prevalence of negative PMI and its associations to clinical variables, including the patient-perceived wish for more attention to pain. Methods A single-center, cross-sectional, observational study of cancer patients was conducted. Data on demographics and clinical variables, as well as patient-perceived wish for more attention to pain, were registered. PMI was calculated. Negative PMI indicates that the analgesics prescribed might not be appropriate to the pain intensity reported by the patient, and associations to negative PMI were explored by logistic regression models. Results One hundred eighty-seven patients were included, 53% had a negative PMI score. Negative PMI scores were more frequent among patients with breast cancer (OR 4.2, 95% CI 1.3, 13.5), in a follow-up setting (OR 12.1, 95% CI 1.4, 101.4), and were inversely associated to low performance status (OR 0.14, 95% CI 0.03, 0.65). Twenty-two percent of patients with negative PMI scores reported that they wanted more focus on pain management, versus 13% among patients with a non-negative PMI score; the difference was not statistically significant. Conclusion A high prevalence of negative PMI was observed, but only 1/5 of patients with a negative PMI wanted more attention to pain by their physician. Our findings challenge the use of PMI as a measure of undertreatment of cancer pain.

• Treede, Rolf-Detlef; Rief, Winfried; Barke, Antonia; Aziz, Qasim; Bennett, Michael I.; Benoliel, Rafael; Cohen, Milton; Evers, Stefan; Finnerup, Nanna B.; First, Michael B.; Giamberardino, Maria Adele; Kaasa, Stein; Korwisi, Beatrice; Kosek, Eva; Lavand'homme, Patricia; Nicholas, Michael; Perrot, Serge; Scholz, Joachim; Schug, Stephan; Smith, Blair H.; Svensson, Peter; Vlaeyen, Johan W.S. & Wang, Shuu-Jiun (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain.  ISSN 0304-3959.  160(1), s 19- 27 . doi: 10.1097/j.pain.0000000000001384
• Tøndel, Hanne; Solberg, Arne; Lydersen, Stian; Jensen, Christer André; Kaasa, Stein & Lund, Jo-Åsmund (2019). Rectal volume variations and estimated rectal dose during 8 weeks of image-guided radical 3D conformal external beam radiotherapy for prostate cancer. Clinical and Translational Radiation Oncology.  ISSN 2405-6308.  15, s 113- 117 . doi: 10.1016/j.ctro.2019.02.003 Full text in Research Archive.
• Vagnildhaug, Ola Magne; Brunelli, Cinzia; Hjermstad, Marianne Jensen; Strasser, Florian; Baracos, Vickie; Wilcock, Andrew; Nabal, María; Kaasa, Stein; Laird, Barry J & Solheim, Tora Skeidsvoll (2019). A prospective study examining cachexia predictors in patients with incurable cancer. BMC Palliative Care.  ISSN 1472-684X.  18:46, s 1- 10 . doi: 10.1186/s12904-019-0429-2 Full text in Research Archive. Show summary

  Background Early intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors. Methods A secondary analysis of a prospective, observational, multicentre study was conducted. Patients, who attended a palliative care programme, had incurable cancer and did not have cachexia at baseline, were amenable to the analysis. Cachexia was defined as weight loss (WL) > 5% (6 months) or WL > 2% and body mass index< 20 kg/m2. Clinical and demographic markers were evaluated as possible predictors with Cox analysis. A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with a calibration plot, Harrell’s c-statistic and receiver operating characteristic curve analysis. Results Six-hundred-twenty-eight patients were included in the analysis. Median age was 65 years (IQR 17), 359(57%) were female and median Karnofsky performance status was 70(IQR 10). Median follow-up was 109 days (IQR 108), and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p ≤ 0.04). A five-level model was created with each level carrying an increasing risk of cachexia development. For Risk-level 1-patients (WL < 3%, breast or hematologic cancer and no or little appetite loss), median time to cachexia development was not reached, while Risk-level 5-patients (WL 3–5%) had a median time to cachexia development of 51 days. Accuracy of cachexia predictions at 3 months was 76%. Conclusion Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.

• Verkissen, Mariëtte N.; Hjermstad, Marianne Jensen; van Belle, Simon; Kaasa, Stein; Deliens, Luc & Pardon, Koen (2019). Quality of life and symptom intensity over time in people with cancer receiving palliative care: Results from the international European Palliative Care Cancer Symptom study. PLOS ONE.  ISSN 1932-6203.  14:e022988(10), s 1- 16 . doi: 10.1371/journal.pone.0222988 Full text in Research Archive.
• Solheim, Tora Skeidsvoll; Laird, Barry J. A.; Balstad, Trude Rakel; Bye, Asta; Stene, Guro Birgitte; Baracos, Vickie; Strasser, Florian; Griffiths, Gareth; Maddocks, Matthew; Fallon, Marie; Kaasa, Stein & Fearon, Kenneth (2018). Cancer cachexia: Rationale for the MENAC (Multimodal - Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial. BMJ Supportive & Palliative Care.  ISSN 2045-435X.  8, s 258- 265 . doi: 10.1136/bmjspcare-2017-001440 Full text in Research Archive.
• Balstad, Trude Rakel; Kaasa, Stein & Solheim, Tora Skeidsvoll (2018). Multimodal behandling av kakeksi hos kreftpasienter. Bestpractice Onkologi/Hematologi.  ISSN 2245-0440.  36, s 38- 40 . doi: https://bestprac.no/multimodal-behandling-av-kakeksi-hos-kreftpasienter
• Berger, Ola; Grønberg, Bjørn Henning; Loge, Jon Håvard; Kaasa, Stein & Sand, Kari (2018). Cancer patients' knowledge about their disease and treatment before, during and after treatment: a prospective, longitudinal study. BMC Cancer.  ISSN 1471-2407.  18:381, s 1- 11 . doi: 10.1186/s12885-018-4164-5 Full text in Research Archive.
• Grotmol, Kjersti Støen; Lie, Hanne Cathrine; Loge, Jon Håvard; Aass, Nina Kathrine; Haugen, Dagny Faksvåg; Stone, Patrick C; Kaasa, Stein & Hjermstad, Marianne Jensen (2018). Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients. Palliative & Supportive Care.  ISSN 1478-9515.  s 1- 7 . doi: 10.1017/S1478951517001183 Full text in Research Archive.
• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Abramova, Tatiana Mikhailovna; Baas, Theo; Mørkeset, Siri Tessem; Caraceni, Augusto; Laird, Barry J; Boland, Jason W.; Rossi, Romina; Garcia-Alonso, Elena; Stensheim, Hanne; Loge, Jon Håvard; Hjermstad, Marianne Jensen; Bjerkeset, Ellen; Bye, Asta; Lund, Jo-Åsmund; Solheim, Tora Skeidsvoll; Vagnildhaug, Ola Magne; Brunelli, Cinzia; Damås, Jan Kristian; Mollnes, Tom Eirik; Kaasa, Stein & Klepstad, Pål (2018). The Palliative Radiotherapy and Inflammation Study (PRAIS) - Protocol for a longitudinal observational multicenter study on patients with cancer induced bone pain. BMC Palliative Care.  ISSN 1472-684X.  17(110) . doi: 10.1186/s12904-018-0362-9 Full text in Research Archive.
• Jakobsen, Gunnhild; Engstrøm, Morten; Fayers, Peter; Hjermstad, Marianne Jensen; Kaasa, Stein; Kloke, Marianne; Sabatowski, Rainer & Klepstad, Pål (2018). Sleep quality with WHO Step III opioid use for cancer pain. BMJ Supportive & Palliative Care.  ISSN 2045-435X. . doi: 10.1136/bmjspcare-2017-001399 Full text in Research Archive.
• Jakobsen, Gunnhild; Engstrøm, Morten; Paulsen, Ørnulf; Sjue, Karin; Raj, Sunil Xavier; Thronæs, Morten; Hjermstad, Marianne Jensen; Kaasa, Stein; Fayers, Peter & Klepstad, Pål (2018). Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer: study protocol for a double-blind, randomized, placebo-controlled, clinical multicenter trial. Trials.  ISSN 1745-6215.  19:707, s 1- 9 . doi: 10.1186/s13063-018-3088-3 Full text in Research Archive.
• Kaasa, Stein; Loge, Jon Håvard; Aapro, Matti S.; Albreht, Tit; Anderson, Rebecca; Bruera, Eduardo; Brunelli, Cinzia; Caraceni, Augusto; Cervantes, Andres; Currow, David C.; Deliens, Luc; Fallon, Marie; Gómez-Batiste, Xavier; Grotmol, Kjersti S; Hannon, Breffni; Haugen, Dagny Faksvåg; Higginson, Irene J.; Hjermstad, Marianne Jensen; Hui, David; Jordan, Karin; Kurita, Geana Paula; Larkin, Philip J.; Miccinesi, Guido; Nauck, Friedemann; Pribakovic, Rade; Rodin, Gary; Sjøgren, Per; Stone, Patrick C.; Zimmermann, Camilla & Lundeby, Tonje (2018). Integration of oncology and palliative care: a Lancet Oncology Commission. The Lancet Oncology.  ISSN 1470-2045.  19(11), s e588- e653 . doi: 10.1016/S1470-2045(18)30415-7 Full text in Research Archive.
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein; Loge, Jon Håvard; Raj, Sunil Xavier; Steinsbekk, Aslak & Sand, Kari (2018). Usability testing of EirV3-a computer-based tool for patient-reported outcome measures in cancer. Supportive Care in Cancer.  ISSN 0941-4355.  s 1- 10 . doi: 10.1007/s00520-018-4435-3 Full text in Research Archive.
• Landmark, Tormod; Dale, Ola; Romundstad, Pål Richard; Woodhouse, Astrid; Kaasa, Stein & Borchgrevink, Petter Chr. (2018). Development and course of chronic pain over 4 years in the general population: The HUNT pain study. European Journal of Pain.  ISSN 1090-3801.  22(9), s 1606- 1616 . doi: 10.1002/ejp.1243 Full text in Research Archive.
• Løhre, Erik Torbjørn; Hjermstad, Marianne Jensen; Brunelli, Cinzia; Knudsen, Anne Kari; Kaasa, Stein & Klepstad, Pål (2018). Pain Intensity Factors Changing Breakthrough Pain Prevalence in Patients with Advanced Cancer: A Secondary Analysis of a Cross-Sectional Observational International Study. Pain and Therapy.  ISSN 2193-8237.  7(2), s 193- 203 . doi: 10.1007/s40122-018-0107-8 Full text in Research Archive.
• Petersen, Morten Aa.; Aaronson, Neil K.; Arraras, Juan I; Chie, Wei-Chu; Conroy, Thierry; Costantini, Anna; Dirven, Linda; Fayers, Peter; Gamper, Eva-Maria; Giesinger, Johannes M; Habets, Esther J.J.; Hammerlid, Eva; Helbostad, Jorunn L.; Hjermstad, Marianne Jensen; Holzner, Bernhard; Johnson, Colin; Kemmler, Georg; King, Madeleine T.; Kaasa, Stein; Loge, Jon Håvard; Reijneveld, Jaap C.; Singer, Susanne; Taphoorn, Martin J. B.; Thamsborg, Lise H.; Tomaszewski, Krzysztof A.; Velikova, Galina; Verdonck-de Leeuw, Irma M.; Young, Teresa & Groenvold, Mogens (2018). The EORTC CAT Core?The computer adaptive version of the EORTC QLQ-C30 questionnaire. European Journal of Cancer.  ISSN 0959-8049.  100, s 8- 16 . doi: 10.1016/j.ejca.2018.04.016 Full text in Research Archive.
• Røen, Ingebrigt; Stifoss-Hanssen, Hans; Grande, Gunn; Brenne, Anne-Tove; Kaasa, Stein; Sand, Kari & Knudsen, Anne Kari (2018). Resilience for family carers of advanced cancer patients-how can health care providers contribute? A qualitative interview study with carers.. Palliative Medicine.  ISSN 0269-2163.  32(8), s 1410- 1418 . doi: 10.1177/0269216318777656 Full text in Research Archive.
• Tøndel, Hanne; Lund, Jo-Åsmund; Lydersen, Stian; Wanderås, Anne Dybdahl; Aksnessæther, Bjørg Yksnøy; Jensen, Christer André; Kaasa, Stein & Solberg, Arne (2018). Dose to penile bulb is not associated with erectile dysfunction 18 months post radiotherapy: A secondary analysis of a randomized trial.. Clinical and Translational Radiation Oncology.  ISSN 2405-6308.  13, s 50- 56 . doi: 10.1016/j.ctro.2018.09.006 Full text in Research Archive.
• Tøndel, Hanne; Lund, Jo-Åsmund; Lydersen, Stian; Wanderås, Anne Dybdahl; Aksnessæther, Bjørg Yksnøy; Jensen, Christer André; Kaasa, Stein & Solberg, Arne (2018). Radiotherapy for prostate cancer - Does daily image guidance with tighter margins improve patient reported outcomes compared to weekly orthogonal verified irradiation? Results from a randomized controlled trial. Radiotherapy and Oncology.  ISSN 0167-8140.  126(2), s 229- 235 . doi: 10.1016/j.radonc.2017.10.029 Full text in Research Archive.
• Wedde, Trude Baastad; Småstuen, Milada Cvancarova; Brabrand, Sigmund; Fosså, Sophie Dorothea; Kaasa, Stein; Tafjord, Gunnar; Russnes, Kjell Magne; Hellebust, Taran Paulsen & Lilleby, Wolfgang (2018). Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort. Radiotherapy and Oncology.  ISSN 0167-8140.  s 1- 7 . doi: 10.1016/j.radonc.2018.10.013 Full text in Research Archive.
• Sandmæl, Jon Arne Myhre; Bye, Asta; Solheim, Tora Skeidsvoll; Stene, Guro Birgitte; Thorsen, Lene; Kaasa, Stein; Lund, Jo-Åsmund & Oldervoll, Line Merethe (2017). Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: A pilot randomized trial. Cancer.  ISSN 0008-543X.  123(22), s 4440- 4448 . doi: 10.1002/cncr.30901
• Arends, Jann; Bachmann, Peter; Baracos, Vickie; Barthelemy, N; Bertz, H; Bozzetti, Frederico; Fearon, KC; Hütterer, E; Isenring, E; Kaasa, Stein; Krznaric, Z; Laird, Barry J.; Larsson, M; Laviano, A; Mühlebach, S; Muscaritoli, Maurizio; Oldervoll, Line Merethe; Ravasco, Paula; Solheim, Tora Skeidsvoll; Strasser, Florian; de van der Schueren, Marian & Preiser, JC (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition.  ISSN 0261-5614.  36(1), s 11- 48 . doi: 10.1016/j.clnu.2016.07.015 Full text in Research Archive.
• Grotmol, Kjersti Støen; Lie, Hanne Cathrine; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Currow, David; Kaasa, Stein; Moum, Torbjørn Åge; Pigni, Alessandra & Loge, Jon Håvard (2017). Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer. Journal of Pain and Symptom Management.  ISSN 0885-3924.  54(6), s 889- 897 . doi: 10.1016/j.jpainsymman.2017.04.010 Full text in Research Archive.
• Gunnarsdottir, Sigridur; Sigurdardottir, Valgerdur; Kloke, Marinne; Radbruch, Lukas; Sabatowski, Rainer; Kaasa, Stein & Klepstad, Pål (2017). A multicenter study of attitudinal barriers to cancer pain management. Supportive Care in Cancer.  ISSN 0941-4355. . doi: 10.1007/s00520-017-3791-8
• Hui, David; Mori, Masanori; Meng, Yee-Choon; Watanabe, Sharon M.; Caraceni, Augusto; Strasser, Florian; Saarto, Tiina; Cherny, Nathan; Glare, Paul; Kaasa, Stein & Bruera, Eduardo (2017). Automatic referral to standardize palliative care access: an international Delphi survey. Supportive Care in Cancer.  ISSN 0941-4355.  26(1), s 175- 180 . doi: 10.1007/s00520-017-3830-5
• Jacobsen, Ellisiv Lærum; Bye, Asta; Aass, Nina Kathrine; Fosså, Sophie Dorothea; Grotmol, Kjersti Støen; Kaasa, Stein; Loge, Jon Håvard; Moum, Torbjørn Åge & Hjermstad, Marianne Jensen (2017). Norwegian reference values for the Short-Form Health Survey 36: development over time. Quality of Life Research.  ISSN 0962-9343.  s 1- 12 . doi: 10.1007/s11136-017-1684-4 Full text in Research Archive.
• Johns, Neil; Stretch, C; Tan, BH; Solheim, Tora Skeidsvoll; Sørhaug, Sveinung; Stephens, NA; Gioulbasanis, Ioannis; Skipworth, RJ; Deans, DA; Vigano, Antonio A.L.; Ross, JA; Bathe, OF; Tremblay, ML; Kaasa, Stein; Strasser, Florian; Gagnon, B; Baracos, VE; Damaraju, S & Fearon, KC (2017). New genetic signatures associated with cancer cachexia as defined by low skeletal muscle index and weight loss.. Journal of Cachexia, Sarcopenia and Muscle.  ISSN 2190-5991.  8(1), s 122- 130 . doi: 10.1002/jcsm.12138 Full text in Research Archive.
• Jordan, Karin; Aapro, Matti S.; Kaasa, Stein; Ripamonti, Carla; Scotte, Florian; Strasser, Florian; Young, Annie; Bruera, Eduardo; Herrstedt, Jørn; Keefe, Dorothy; Laird, Barry J.; Walsh, Declan; Douillard, Jean-Yves & Cervantes, Andres (2017). European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Annals of Oncology.  ISSN 0923-7534.  29(1), s 36- 43 . doi: 10.1093/annonc/mdx757
• Kaasa, Stein; Knudsen, Anne Kari; Lundeby, Tonje & Loge, Jon Håvard (2017). Integraton between oncology and palliatve care: A plan for the next decade?. Tumori (Milano).  ISSN 0300-8916.  103(1), s 1- 8 . doi: 10.5301/tj.5000602 Full text in Research Archive.
• Kristensen, Are Korsnes; Solheim, Tora Skeidsvoll; Amundsen, Tore; Hjelde, Harald Harris; Kaasa, Stein; Sørhaug, Sveinung & Grønberg, Bjørn Henning (2017). Measurement of health-related quality of life during chemotherapy -the importance of timing. Acta Oncologica.  ISSN 0284-186X.  56(5), s 737- 745 . doi: 10.1080/0284186X.2017.1279748 Full text in Research Archive.
• Krogstad, Hilde; Brunelli, Cinzia; Sand, Kari; Andersen, Eivind; Garresori, Herish; Halvorsen, Tarje Onsøien; Haukland, Ellinor Christin; Jordal, Frode; Kaasa, Stein; Loge, Jon Håvard; Løhre, Erik Torbjørn; Raj, Sunil Xavier & Hjermstad, Marianne Jensen (2017). Development of EirV3 - a computer-based tool for patient reported outcome measures in cancer. JCO Clinical Cancer Informatics.  ISSN 2473-4276. . doi: 10.1200/cci.17.00051 Full text in Research Archive. Show summary

  Background. Immediate transfer of patient reported outcome measures (PROMs) for use in medical consultations is facilitated by electronic assessments. Objective. Describe the rationale and development towards Eir version3 (V3), a computer-based symptom assessment tool for cancer; with emphasis on content and user-friendliness. Methods. Eir’s specifications and content were developed through multi-professional, stepwise and iterative processes (2013-16), with literature reviews on traditional and electronic assessment and classification methods, formative iterative usability tests with end-users and patient preferences for paper versus electronic assessments. Results. EirV3 has two modules: Eir-Patient for PROMs registration on tablets and Eir-Doctor for presentation of PROMs in a user-friendly interface on computers. Eir-Patient starts with 19 common cancer symptoms followed by specific, in-depth questions for endorsed symptoms. The pain section includes a body map for pain location and intensity, whereas physical functioning, nutritional intake and wellbeing are standard questions for all. Data are wirelessly transferred to Eir-Doctor. Symptoms with intensity scores >3 (0-10 scale) are marked in red, with brighter colors corresponding to higher intensity, supplemented with graphs displaying symptom development over time. Usability results showed that patients and health care providers found Eir intuitive, easy to use and relevant. When comparing PROM-assessments on paper versus tablets (N=114), 19% preferred paper, 41% and 40% preferred tablets or had no preference. Median intraclass-correlation coefficients between paper and tablets was excellent (0.815). Conclusions. Iterative test-rounds followed by continuous improvements led to a user-friendly, applicable EirV3, developed for and by end-users. EirV3 is undergoing international testing of clinical and cross-cultural adaptability. Keywords: Patient reported outcome measures, PROMS, computers, usability, feasibility

• Kurita, Geana Paula; Benthien, Kirstine Skov; Sjøgren, Per; Kaasa, Stein & Hjermstad, Marianne Jensen (2017). Identification of the predictors of cognitive impairment in patients with cancer in palliative care: a prospective longitudinal analysis. Supportive Care in Cancer.  ISSN 0941-4355.  25(3), s 941- 949 . doi: 10.1007/s00520-016-3485-7
• Mochamat, *; Cuhls, Henning; Marinova, Milka; Kaasa, Stein; Stieber, Christiane; Conrad, Rupert; Radbruch, Lukas & Mucke, Martin (2017). A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project. Journal of Cachexia, Sarcopenia and Muscle.  ISSN 2190-5991.  8(1), s 25- 39 . doi: 10.1002/jcsm.12127 Full text in Research Archive.
• Paque, Kristel; Elseviers, Monique; Vander Stichele, Robert H; Pardon, Koen; Hjermstad, Marianne Jensen; Kaasa, Stein; Dilles, Tinne; De Laat, Martine; Van Belle, Simon; Christiaens, Thierry & Deliens, Luc (2017). Changes in medication use in a cohort of patients with advanced cancer: The international multicentre prospective European Palliative Care Cancer Symptom study. Palliative Medicine.  ISSN 0269-2163. . doi: 10.1177/0269216317746843
• Paulsen, Ørnulf; Laird, Barry J; Aass, Nina Kathrine; Lea, Tor Erling; Fayers, Peter; Kaasa, Stein & Klepstad, Pål (2017). The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer. PLOS ONE.  ISSN 1932-6203.  12(5) . doi: 10.1371/journal.pone.0177620 Full text in Research Archive.
• Pettersen, Kristine; Andersen, Sonja Benedikte; Degen, Simone; Tadini, Valentina; Grosjean, Joël; Hatakeyama, Shinji; Tesfahun, Almaz Nigatu; Moestue, Siver Andreas; Kim, Jana; Nonstad, Unni; Romundstad, Pål Richard; Skorpen, Frank; Sørhaug, Sveinung; Amundsen, Tore; Grønberg, Bjørn Henning; Strasser, Florian; Stephens, Nathan; Hoem, Dag; Molven, Anders; Kaasa, Stein; Fearon, Kenneth; Jacobi, Carsten & Bjørkøy, Geir (2017). Cancer cachexia associates with a systemic autophagy-inducing activity mimicked by cancer cell-derived IL-6 trans-signaling. Scientific Reports.  ISSN 2045-2322.  7(1), s 1- 16 . doi: 10.1038/s41598-017-02088-2 Full text in Research Archive.
• Raj, Sunil Xavier; Brunelli, Cinzia; Klepstad, Pål & Kaasa, Stein (2017). COMBAT study - Computer based assessment and treatment - A clinical trial evaluating impact of a computerized clinical decision support tool on pain in cancer patients.. Scandinavian Journal of Pain.  ISSN 1877-8860.  17, s 99- 106 . doi: 10.1016/j.sjpain.2017.07.016
• Solheim, Tora Skeidsvoll; Laird, Barry J; Balstad, Trude Rakel; Stene, Guro Birgitte; Bye, Asta; Johns, Neil; Pettersen, Caroline Hild Hakvåg; Fallon, Marie; Fayers, Peter; Fearon, Kenneth & Kaasa, Stein (2017). A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. Journal of Cachexia, Sarcopenia and Muscle.  ISSN 2190-5991.  8, s 778- 788 . doi: 10.1002/jcsm.12201 Full text in Research Archive.
• Vagnildhaug, Ola Magne; Balstad, Trude Rakel; Almberg, Sigrun Saur; Brunelli, Cinzia; Knudsen, Anne Kari; Kaasa, Stein; Thronæs, Morten; Laird, Barry J & Solheim, Tora Skeidsvoll (2017). A cross-sectional study examining the prevalence of cachexia and areas of unmet need in patients with cancer. Supportive Care in Cancer.  ISSN 0941-4355.  s 1- 10 . doi: 10.1007/s00520-017-4022-z Full text in Research Archive. Show summary

  Purpose The semantics of defining cancer cachexia over the last decade has resulted in uncertainty as to the prevalence. This has further hindered the recognition and subsequent treatment of this condition. Following the consensus definition for cancer cachexia in 2011, there is now a need to establish estimates of prevalence. Therefore the primary aim of the present study was to assess the prevalence of cachexia in an unselected cancer population. A secondary aim was to assess patient-perceived need of attention to cachexia. Methods A cross-sectional study in hospital patients was undertaken. Key inclusion criteria were: age >18 years, cancer diagnosis, and no surgery the preceding 24 hours. Data on demographics, disease, performance status, symptoms, cachexia and patients’ perceived need of attention to weight loss and nutrition was registered Results Data were available on 386 of 426 eligible patients. Median age (IQR) was 65 years (56-72), 214(55%) were male and 302(78%) had a performance status of 0-1 (Eastern Cooperative Oncology Group). Prevalence of cachexia (inpatients/outpatients) was 51%/22%. Prevalence was highest in patients with gastrointestinal cancer (62%/42%) and lung cancer (83%/36%). There was no major difference in prevalence between patients with metastatic (55%/24%) and localized disease (47%/19%). 20% of inpatients and 15% of outpatients wanted more attention to weight loss and nutrition. Cachexia (p<0.001), symptoms of mood disorder (p<0.001) and male gender (p<0.01) were independently associated with increased need of attention. Conclusion Cachexia is a prevalent condition, affecting both patients with localized and metastatic cancer. Clinical attention to the condition is a sizeable unmet need.

• Vagnildhaug, Ola Magne; Blum, David; Wilcock, Andrew; Fayers, Peter; Strasser, Florian; Baracos, Vickie E.; Hjermstad, Marianne Jensen; Kaasa, Stein; Laird, Barry J & Solheim, Tora Skeidsvoll (2017). The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis. Journal of Cachexia, Sarcopenia and Muscle.  ISSN 2190-5991.  8(5), s 789- 797 . doi: 10.1002/jcsm.12220 Full text in Research Archive. Show summary

  Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains [anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS ≤ 70). The overall effect of the WLGS on survival was significant as expressed by change in −2 log likelihood (P

• Wheelwright, Sally J.; Hopkinson, Jane B.; Darlington, Anne-Sophie; Fitzsimmons, Deborah F.; Fayers, Peter; Balstad, Trude Rakel; Bredart, Anne; Hammerlid, Eva; Kaasa, Stein; Nicolatou-Galitis, Ourania; Pinto, Monica; Schmidt, Heike; Solheim, Tora Skeidsvoll; Strasser, Florian; Tomaszewska, IM & Johnson, Colin D. (2017). Development of the EORTC QLQ-CAX24, A Questionnaire for Cancer Patients With Cachexia. Journal of Pain and Symptom Management.  ISSN 0885-3924.  53(2), s 232- 242 . doi: 10.1016/j.jpainsymman.2016.09.010 Full text in Research Archive.
• Bekelman, Justin E.; Halpern, Scott D.; Blankart, Carl Rudolf; Bynum, Julie P.; Cohen, Joachim; Fowler, Robert; Kaasa, Stein; Kwietniewski, Lukas; Melberg, Hans Olav; Onwuteaka-Philipsen, Bregje D.; Oosterveld-Vlug, Mariska; Pring, Andrew; Schreyögg, Jonas; Ulrich, Connie M.; Verne, Julia; Wunsch, Hannah & Emanuel, Ezekiel J. (2016). Comparison of site of death, health care utilization, and hospital expenditures for patients dying With cancer in 7 developed countries. Journal of the American Medical Association (JAMA).  ISSN 0098-7484.  315(3), s 272- 283 . doi: 10.1001/jama.2015.18603
• Brenne, Elisabeth; Loge, Jon Håvard; Lie, Hanne Cathrine; Hjermstad, Marianne Jensen; Fayers, Peter & Kaasa, Stein (2016). The Edmonton Symptom Assessment System: Poor performance as a screener for major depression in patients with incurable cancer. Palliative Medicine.  ISSN 0269-2163.  30(6), s 587- 598 . doi: 10.1177/0269216315620082 Full text in Research Archive.
• Ekström, Magnus P.; Johnson, Miriam J.; Schiöler, Linus; Kaasa, Stein; Hjermstad, Marianne Jensen & Currow, David Christopher (2016). Who experiences higher and increasing breathlessness in advanced cancer? The longitudinal EPCCS Study. Supportive Care in Cancer.  ISSN 0941-4355.  24(9), s 3803- 3811 . doi: 10.1007/s00520-016-3207-1
• Halvorsen, Tarje Onsøien; Herje, Martin; Levin, Nina; Bremnes, Roy M.; Brustugun, Odd Terje; Fløtten, Øystein; Kaasa, Stein; Sundstrøm, Stein Harald & Grønberg, Bjørn Henning (2016). Tumour size reduction after the first chemotherapy-course and outcomes of chemoradiotherapy in limited disease small-cell lung cancer. Lung Cancer.  ISSN 0169-5002.  102, s 9- 14 . doi: 10.1016/j.lungcan.2016.10.003 Full text in Research Archive.
• Halvorsen, Tarje Onsøien; Sundstrøm, Stein Harald; Fløtten, Øystein; Brustugun, Odd Terje; Brunsvig, Paal Fr.; Aasebø, Ulf; Bremnes, Roy M.; Kaasa, Stein & Grønberg, Bjørn Henning (2016). Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer. Acta Oncologica.  ISSN 0284-186X.  55(11), s 1349- 1354 . doi: 10.1080/0284186X.2016.1201216 Full text in Research Archive.
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Aielli, F; Bennett, Michael I.; Brunelli, Cinzia; Caraceni, Augusto; Cavanna, L; Fassbender, K; Feio, M; Haugen, Dagny Faksvåg; Jakobsen, Gunnhild; Laird, Barry J; Løhre, Erik T; Martinez, M; Nabal, María; Noguera-Tejedor, A; Pardon, Koen; Pigni, Alessandra; Piva, L; Porta-Sales, Josep; Rizzi, F; Rondini, E; Sjøgren, Per; Strasser, Florian; Turriziani, A & Kaasa, Stein (2016). Characteristics of the case mix, organization and delivery in cancer palliative care: a challenge for good-quality research. BMJ Supportive & Palliative Care.  ISSN 2045-435X.  8(4), s 456- 467 . doi: 10.1136/bmjspcare-2015-000997
• Hjermstad, Marianne Jensen; Kaasa, Stein; Caraceni, Augusto; Loge, Jon Håvard; Pedersen, Tore; Haugen, Dagny Faksvåg & Aass, Nina Kathrine (2016). Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer. BMJ Supportive & Palliative Care.  ISSN 2045-435X.  6(3), s 344- 352 . doi: 10.1136/bmjspcare-2015-000887 Show summary

  Objectives: Breakthrough cancer pain (BTP) represents a treatment challenge. Objectives were to examine the prevalence and characteristics of BTP in an international sample of patients with cancer, and to investigate the relationship between BTP and quality of life (QoL). Methods: This was an observational cross-sectional multicentre study. Participating patients completed self-report questionnaires on a touch-screen laptop computer, including the Brief Pain Inventory, Alberta Breakthrough Pain Assessment Tool (ABPAT) and European Organisation for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire (EORTC QLQ-C30). The study was performed in 17 centres in 8 countries and involved 4 languages (Norwegian, Italian, German and English). Results: Records from a convenience sample of 978 patients with advanced cancer were analysed; mean age was 62.2 years, 48.3% were women and 84.4% had metastatic disease. A total of 296 patients (30%) had no pain, defined as worst pain in the past 24 hours <1 on a 0–10 scale. Of the 682 patients with a pain score ≥1, 393 (58%) reported no BTP on the screening item, while 289 (30%) confirmed flare ups of BTP. Patients with BTP reported significantly higher pain intensity scores (<0.001) than patients without BTP; 57.1% of patients rated BTP at its worst as being severe: ≥7 on a 0–10 scale. Time from onset to peak intensity was <10 min for 42.9%, and average time to pain relief was 27.1 min. BTP was commonly triggered by medication wearing off (28%). Patients with BTP had significantly worse mean outcomes on 10 of 15 functional and symptom scales of the EORTC QLQ-C30 (<0.001). Severe pain intensity in the last week was a powerful predictor of BTP (OR 4.1) and poor QoL (OR 1.9). Conclusions: BTP is highly prevalent with prolonged episodes despite analgaesics, and has a pervasive impact on QoL. Patients reporting high pain intensity should be carefully evaluated for BTP and efficacy of analgaesic treatment, to provide optimal pain management and improve QoL.

• Hui, David; Mori, Masanori; Watanabe, Sharon M.; Caraceni, Augusto; Strasser, Florian; Saarto, Tiina; Cherny, Nathan; Glare, Paul; Kaasa, Stein & Bruera, Eduardo (2016). Referral criteria for outpatient specialty palliative cancer care: an international consensus. The Lancet Oncology.  ISSN 1470-2045.  17(12), s e552- e559 . doi: 10.1016/S1470-2045(16)30577-0

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• Bahus, Marianne; Andersen, Sigve; Broen, Peder; Farsund, Helge; Flovik, Anne Marie; Hagerup, Søren Vincent; Husby, Bodil; Kaasa, Stein; Schjødt, Borrik & Slaaen, Joran (2020). Organisering av det palliative tilbudet Faglig begrunnet eller et udemokratisk politisk spill?. Fædrelandsvennen.  ISSN 0805-3790.
• Kaasa, Stein; Bahus, Marianne; Andersen, Sigve; Broen, Peder; Farsund, Helge; Flovik, Anne Marie; Hagerup, Søren Vincent; Husby, Bodil; Schjødt, Borrik & Slaaen, Joran (2020). De er døende. Gi dem lindring. Dagbladet.  ISSN 0805-3766.
• Fredheim, Olav Magnus; Kaasa, Stein & Borchgrevink, Petter Chr. (2019). Smertebehandling ved kronisk kreftsykdom. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  139(13) . doi: 10.4045/tidsskr.19.0226
• Bye, Asta; Meli, Kari; Solheim, Tora Skeidsvoll; Laird, Barry J.; Kaasa, Stein; Stene, Guro Birgitte & Balstad, Trude Rakel (2018). Food intake assessed by Patient-Generated Subjective Global Assessment (PG-SGA) corresponds to energy and protein intake in patients with advanced cancer.
• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Løhre, Erik Torbjørn; Fayers, Peter; Thronæs, Morten; Kaasa, Stein & Klepstad, Pål (2018). Sleep Quality in advanced cancer.
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein; Loge, Jon Håvard; Raj, Sunil Xavier; Steinsbekk, Aslak & Sand, Kari (2018). Usability testing of EirV3 - a computer-based tool for patient reported outcome measures in cancer.
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein; Loge, Jon Håvard; Raj, Sunil Xavier; Steinsbekk, Aslak & Sand, Kari (2018). Usability testing of EirV3 - a computer-based tool for patient reported outcome measures in cancer. Annals of Oncology.  ISSN 0923-7534.  29, s viii625- viii625 . doi: 10.1093/annonc/mdy300.068
• Lau, Ka Po; Knudsen, Anne Kari; Brunelli, Cinzia; Kaasa, Stein & Brenne, Anne-Tove (2018). Preferred Place of Death and its Associated Factors among Patients with Advanced cancer in Norway. Palliative Medicine.  ISSN 0269-2163.  32(1_suppl), s 167- 167
• Røen, Ingebrigt; Brunelli, Cinzia; Stifoss-Hanssen, Hans; Grande, Gunn; Kaasa, Stein; Brenne, Anne-Tove & Knudsen, Anne Kari (2018). Spiritual wellbeing in Family carers of Advanced cancer patients.
• Tøndel, Hanne; Lund, Jo-Åsmund; Lydersen, Stian; Wanderås, Anne Dybdahl; Aksnessæther, Bjørg Yksnøy; Jensen, Christer André; Kaasa, Stein & Solberg, Arne (2018). Randomized controlled trial of Cone Beam CT IGRT in prostate cancer.
• Vagnildhaug, Ola Magne; Brunelli, Cinzia; Hjermstad, Marianne Jensen; Strasser, Florian; Baracos, Vickie E.; Wilcock, Andrew; Nabal, María; Kaasa, Stein; Laird, Barry J & Solheim, Tora Skeidsvoll (2018). A prospective study examining cachexia predictors in patients with incurable cancer.. Show summary

  Background A predictive model of cachexia development would help identify those at greatest risk for early therapeutic intervention. The aims of this study were to identify predictors of cachexia development and to use these to create and evaluate the accuracy of a predictive model. Methods A secondary analysis of an international, prospective, observational multicentre study was conducted. Patients with incurable cancer and without cachexia, who attended a palliative care unit were amenable to the analysis. Cachexia was defined as weight loss (WL) >5% (6 months) or WL>2% and body mass index<20kg/m2. Disease related, demographic and patient reported markers were evaluated as possible predictors with Cox analysis. The predictor “cancer type” was divided into high risk (pancreatic or gastric cancer), low risk (sarcoma, breast or hematologic cancer) or neutral risk (all others). A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with receiver operating characteristic curve analysis. Results 628 patients, 57% female, were included in the analysis. Median (IQR) age was 65 (17) years and Karnofsky performance status 70 (10). Median (IQR) follow-up was 109 (108) days, and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p≤0.04). A four-level model was created with each level carrying an increasing risk of cachexia development. Level 1-patients (WL<3%, low risk cancer type and no or little appetite loss) had a relative hazard ratio (RHR) of 0.27 of cachexia development, while level 4-patients (WL 3-5%) had a RHR of 4.9. Accuracy of cachexia predictions at 3 months was 76%, and a risk level ≥3 (1-3% WL and neutral risk cancer type OR <3% weight loss and high risk cancer type) yielded a sensitivity of 46% and a specificity of 90% of cachexia development. Conclusion Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia. Patients with a risk level ≥3 have a high risk of cachexia development, and should be targeted for therapeutic intervention.

• Albrecht, Tit; Danova, Natashka; Dimitrov, Plamen; Heins, Marianne; Kaasa, Stein; Klemenc-Ketiš, Zalika; Knudsen, Anne Kari; Korevaar, Joke C.; Olesen, Frede; Pribakovi, Radivoje; Shellevis, Francois; Spronk, Inge; Strandzheva, Mirela & Vinko, Matej (2017). EU policy recommendations for quality improvement in cancer after-care at the community level, In Regine Kiasuwa; Tit Albreht & Marc Van den Bulcke (ed.),  European Guide on Quality Improvement in Comprehensive Cancer Control.  National Institute of Public Health, Slovenia.  ISBN 978-961-7002-28-7.  Chapter 6.  s 105 - 133
• Albreht, Tit; Borrás Andrés, Josep Maria; Dalmas, Miriam; De Lorenzo, Francesco; Ferrari, Claudia; Honing, Cora; Huovinen, Riikka; Kaasa, Stein; Kiasuwa, Regine; Knudsen, Anne Kari; Ko, Winne; Krogstad, Hilde; Mattioli, Vittorio; Barceló, Ana Molina; Pérez, Rosana Peiró; Pourcel, Graziella; Prades, Joan; Pylkkanen, Liisa; Tognetti, Julien; Travado, Luzia; van den Neucker, Ingrid & Yared, Wendy (2017). Survivorship and rehabilitation: policy recommendations for quality improvement in cancer survivorship and rehabilitation in EU Member States, In Regine Kiasuwa; Tit Albreht & Marc Van den Bulcke (ed.),  European Guide on Quality Improvement in Comprehensive Cancer Control.  National Institute of Public Health, Slovenia.  ISBN 978-961-7002-28-7.  Chapter 7.  s 135 - 158
• Didriksen, Mona; Brenne, Anne-Tove; Kaasa, Stein; Loge, Jon Håvard & Sand, Kari (2017). Implementation of Eir – an electronical symptom management tool for cancer patients – at a surgical department: Is it feasible?. Show summary

  BACKGROUND: Eir is a web-based communication platform for symptom assessment and clinical decision support in cancer care. Although Eir has been demonstrated to be a reasonable and feasible part of the symptom management for advanced cancer patients, the knowledge of how to implement this tool into clinical practice is lacking. PURPOSE: The overall aim of this study is to increase the knowledge of success criteria and barriers of implementation of the electronic symptom assessment tool Eir at a surgical department. MATERIAL AND METHODS: This project used a descriptive, qualitative study design, based on semi-structured interviews and observations. 11 patients and 26 health care professionals were included from a surgical department in a local hospital in Norway. RESULTS: Overall, the patients and health care professionals were satisfied with Eir. They found it easy to use, understandable and relevant. The health care professionals considered Eir to improve consultations and to increase the quality of the health care. However, it was emphasized that Eir should be integrated with already existing computer programs in clinical use. It was also a wish from the physicians that decision support should be available for all symptoms addressed in Eir. The health care professionals in this study identified three main categories of success criteria for implementation of Eir: 1) Anchoring in the management, 2) the process manager and nurses’ participation in the implementation process, and 3) perceived high value for clinical work. Also three main categories for barriers for implementation were identified: 1) Inaccessibility of tool, 2) health care professionals’ experience of unfavourable resource allocation in the clinic, and 3) the amount of part-time employees among the nurses. CONCLUSIONS: According to this study, it is feasible to implement Eir at a surgical department since the tool is found easy to use and of clinical value for the users. However, in order to achieve a successful implementation, Eir must be integrated into electronical patient record systems, and designated personnel in the clinic, preferably nurses, must constantly monitor the implementation process. For the latter part to succeed, it is unfavourable that nurses work part-time.

• Heikkilä, Reino & Kaasa, Stein (2017). Chemotherapy in end-of-life care. Annals of Oncology.  ISSN 0923-7534.  28(4), s 684- 685 . doi: 10.1093/annonc/mdx039
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Grotmol, Kjersti Støen; Kaasa, Stein; Lundeby, Tonje; Seljelid, Berit; Wester, Torunn & Loge, Jon Håvard (2017). Integration of oncology and palliative care - findings from the PALLiON pre-study survey.
• Jacobsen, Ellisiv Lærum; Bye, Asta; Aass, Nina Kathrine; Fosså, Sophie Dorothea; Grotmol, Kjersti Støen; Kaasa, Stein; Loge, Jon Håvard; Moum, Torbjørn Åge & Hjermstad, Marianne Jensen (2017). Correction to: Norwegian reference values for the Short-Form Health Survey 36: development over time. Quality of Life Research.  ISSN 0962-9343.  s 1- 3 . doi: 10.1007/s11136-017-1708-0 Full text in Research Archive.
• Kaasa, Stein; Andersen, Sigve; Bahus, Marianne Klungland; Broen, Peder; Farsund, Helge; Flovik, Anne Marie; Hagerup, Søren Vincent; Husby, Bodil; Pedersen, Natasha; Rønsen, Astrid; Schjødt, Borrik & Slaaen, Joran (2017). NOU 2017:16 : På liv og død : Palliasjon til alvorlig syke og døende : utredning fra utvalg oppnevnt ved kongelig resolusjon 11. mai 2016. Avgitt til Helse- og omsorgsdepartementet 20. desember 2017. NOU - Norges offentlige utredninger. 2017:16.
• Kaasa, Stein; Knudsen, Anne Kari; Lundeby, Tonje & Loge, Jon Håvard (2017). Author's reply to: Integration between oncology and palliative care: A plan for the next decade?. Tumori (Milano).  ISSN 0300-8916.  103(3), s e24 . doi: 10.5301/tj.5000631
• Krogstad, Hilde; Brunelli, Cinzia; Garresori, Herish; Kaasa, Stein; Kristensen, Are Korsnes; Loge, Jon Håvard; Sand, Kari & Hjermstad, Marianne Jensen (2017). A pilot study of electronic vs. paper-and-pencil completion of PROMs in cancer care.
• Krogstad, Hilde; Brunelli, Cinzia; Garresori, Herish; Kaasa, Stein; Kristensen, Are Korsnes; Loge, Jon Håvard; Sand, Kari & Hjermstad, Marianne Jensen (2017). A pilot study of electronic vs. paper-and-pencil completion of PROMs in cancer care. European Journal of Palliative Care.  ISSN 1352-2779.  s 210- 210 Show summary

  Background: Systematic use of Patient-Reported Outcomes Measures (PROMs) is essential for optimal patient care. Electronic PROMs collection may improve symptom assessment due to more efficient data capturing, immediate presentation of results and less response burden as opposed to paper forms. Aims: Aims were to 1) investigate the equivalence of PROMs scores on common cancer symptoms collected in randomized order by paper forms and iPads, 2) assess patient preferences for one of the two assessment modes Methods: A parallel form agreement study was done at six Norwegian hospitals. Patients were approached when coming for a scheduled appointment at the cancer outpatient clinics. After consent they were asked to score the intensity of 19 common cancer symptoms on 0-10 numerical rating scales; 0: no pain, nausea etc. and 10: worst imaginable on paper and iPads. The symptoms were identical to the initial ones used in Eir, an electronic PROMs tool currently undergoing international validation. Patients were randomised to start with either the paper or iPad version, followed by the other version 30 minutes later. Intraclass correlation coefficients (ICC) were used to examine equivalence of paper/iPad scores. Results: Of the included 114 patients, 110 (97%) completed both versions; 59 (54%) on iPad first, 51 (46%) on paper first. Mean age was 64.5 (27-86), median Karnofsky 90 (50-100). GI-cancer was most common (47%) followed by prostate (10%), breast and malignant melanoma (both 9%). 89% had metastatic disease. Overall, the median ICC was 0.815,>0.75 for 14 items and ranging from 0.64 (vomiting) to 0.92 (tiredness). Interquartile range was 0.145. Overall 41% of the patients preferred assessment on iPads, 19% preferred paper, while 40% had no preference. Conclusion: The equivalence of PROMs scores was good, and the majority of patients preferred iPads or had no preference. This is promising, considering the many advantages of electronic assessments.

• Røen, Ingebrigt; Stifoss-Hanssen, Hans; Grande, Gunn; Kaasa, Stein & Knudsen, Anne Kari (2017). Carers of advanced cancer patients – experiences, needs, and suggestions for improvement of care.
• Stene, Guro Birgitte; Balstad, Trude Rakel; Laird, Barry J.; Bye, Asta; Jones, Neil; Fearon, Kenneth C.H.; Kaasa, Stein & Solheim, Tora Skeidsvoll (2017). Grip strength as an important part of the diagnostic criteria for sarcopenia in advanced cancer.
• Vagnildhaug, Ola Magne; Almberg, Sigrun Saur; Thronæs, Morten; Knudsen, Anne Kari; Brunelli, Cinzia; Kaasa, Stein; Laird, Barry J & Solheim, Tora Skeidsvoll (2017). Cancer cachexia ̶ prevalence and patient-perceived need of health care attention. Journal of Cachexia, Sarcopenia and Muscle.  ISSN 2190-5991.  8, s 161- 183 . doi: 10.1002/jcsm.12182 Show summary

  Background There is considerable variance in prevalence estimates of cancer cachexia due to the heterogeneity of cachexia definitions. Lack of knowledge about cachexia among health care professionals has led to under-recognition and avoidance of the topic when faced with the patient. The objectives of this study are to provide an accurate estimate of cachexia prevalence in a general cancer population, to assess patient-perceived needs of attention to weight loss and nutrition, and to explore which factors signal such a need. Methods A cross-sectional study was undertaken in adult in- and outpatients with cancer at three different hospitals in Central-Norway. Trained personnel reported on disease specific items, while patients self-reported demographic data, weight, symptom intensity scores and need of health care personnel’s attention to weight loss and nutrition. Cachexia was defined as a) weight loss >5% or b) weight loss >2% and BMI <20kg/m2. Prevalence of cachexia as well as patient-perceived need of clinical attention to cachexia was estimated. Linear regression was used to explore which factors were associated with such a need. Results Data were available on 386 of 426 eligible patients. Median age (IQR) was 65(56-72), 214(55%) were male and 302(78%) had a performance status of 0-1 (ECOG). Prevalence of cachexia (inpatients/outpatients) was 51%/22%. Prevalence was highest in patients with gastrointestinal cancer (61%/42%) and lung cancer (83%/38%). There was no major difference in prevalence between patients with metastatic disease (55%/24%) and localized disease (47%/19%). 20% of inpatients and 15% of outpatients said they wanted more attention to weight loss and nutrition. Weight loss (p<0.001), depression and anxiety symptoms (p<0.001) and male gender (p=0.004) were independent factors associated with an increased need of attention. Conclusion Cachexia is a prevalent condition, affecting both patients with localized and metastatic cancer. Clinical attention to the condition is a sizeable unmet need.

• Hui, David; Bansal, Swati; Strasser, Florian; Morita, T.; Caraceni, Augusto; Davis, Mellar; Cherny, Nathan; Kaasa, Stein; Currow, David Christopher; Abernethy, Amy Pickar; Nekolaichuk, Cheryl & Bruera, Éduardo D. (2016). Reply to the letter to the editor 'Integration between oncology and palliative care: Does one size fit all?' By Verna et al. Annals of Oncology.  ISSN 0923-7534.  27(3), s 549- 550 . doi: 10.1093/annonc/mdv584

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