Marianne Jensen Hjermstad

• Lundeby, Tonje; Bye, Asta; Yri, Olav Erich; Wester, Torunn Elin; Aass, Nina Kathrine & Hanssen, Sjur Bjørnar [Vis alle 8 forfattere av denne artikkelen] (2026). Living with brain metastases—A longitudinal qualitative study of patient experiences from time of diagnosis. Neuro-Oncology Practice. ISSN 2054-2577. 13(4), s. 723–732. doi: 10.1093/nop/npag019. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Brain metastases (BM) are prevalent intracranial neoplasms in adults, affecting 20%-40% of cancer patients. With improved systemic therapies and neuroimaging, the frequency of BM diagnoses is rising. Despite advancements and longer survival time, the prognosis remains poor, with survival rates ranging from 3 months to over a year, depending on the diagnosis. This qualitative study provides insight into the patients' needs, experiences, and perspectives upon BM diagnosis. The aim of the study was to explore how patients experience being diagnosed with BM, their care and follow-up, and how BM impacts their lives and concerns. Methods A qualitative study using longitudinal semi-structured interviews with patients recently diagnosed with first-time BM. Participants were recruited from one Norwegian hospital, with interviews conducted at 3 intervals over 4 months. Inclusion criteria included age ≥18, verified BM diagnosis, and ability to consent and participate in interviews. Inductive thematic analyses were performed to identify overarching themes. Results Twenty-two patients participated, with interviews revealing 4 themes: (1) BM as either an additional burden or more of the same, (2) trust in the healthcare system despite unmet needs, (3) distancing from illness, and (4) acceptance of and adjustment to symptom burden. Patients expressed varied emotional responses, practical challenges, and evolving information needs over time. Conclusion Patients diagnosed with BM face multifaceted challenges. A patient-centered approach, emphasizing clear communication, symptom management, and tailored care, is essential. Understanding patient experiences can help healthcare providers offer personalized care. Continued research is needed to address the unique needs of this population and improve care practices.

• Guldhav, Kristin Vassbotn; Mcaleavey, Andrew Athan; Aass, Nina Kathrine; Andersen, Sigve; Christensen, Bente Mirjam & Dajani, Olav [Vis alle 19 forfattere av denne artikkelen] (2026). Caregiver satisfaction with early integrated palliative care in oncology: secondary outcomes from the PALLiON cluster-RCT. Frontiers in Oncology. 16, s. 1–13. doi: 10.3389/fonc.2026.1787814. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Palliative care is often introduced late in the disease trajectory. Earlier access to palliative care has been reported to benefit patient outcomes, but few studies have explored its impact on caregivers. PALLiON (PALLiative care Integrated in ONcology) was a cluster-randomized controlled trial designed to integrate systematic palliative care earlier in oncology settings. The aim of this follow-up study was to assess whether the intervention influenced caregivers’ satisfaction with care in the intervention group compared to the standard care group, and to explore whether patients’ quality of life (QoL) at inclusion influenced caregivers’ satisfaction with care over time. Methods The trial was conducted across 12 Norwegian hospitals. The intervention included a physician education program, a patient-centered care pathway, and systematic symptom assessment. Adult patients with advanced cancer and their caregivers were recruited. Caregivers’ satisfaction with care was assessed longitudinally using the FAMCARE-20 scale, while patients’ QoL was measured with the EORTC QLQ-C15-PAL questionnaire. Linear mixed-effects regression models were used to examine the intervention’s effects, and partial least squares regression to examine associations between the intervention and responses to each FAMCARE-20 item. Results A total of 432 caregivers of 660 patients participated between 2017 and 2021. The average caregiver age was 61.8 years (SD = 13.2), and 71% were spouses or partners. The intervention had no significant effect on caregivers’ overall satisfaction with care ( B  = -0.070, 95% CI [-0.23, 0.082], β  = 0.02, p  = 0.35), and the groups did not significantly differ in slope of satisfaction with care over the first 6 months ( B = 0.040, 95% CI = [0.003, 0.08], β  = 0.07, p  = 0.07). Lower patient QoL at baseline was significantly associated with greater increases in caregiver satisfaction over time in both groups ( B  = 0.001, 95% CI [0.0001, 0.003], β  = 0.06, p  = 0.03). Conclusions Caregivers’ satisfaction with care did not differ between the intervention and control groups. Satisfaction seemed to be more affected by patients’ baseline QoL rather than early palliative care. Thus, a systematic, person-centered approach rooted in needs may be more beneficial than a purely time-based palliative care model.

• Kathrin, Cresswell,; An, Jacobs,; Anne-Lore, Scherrens,; Lise, Rosquin,; Antonio, Luyten, Julien & Lundereng, Elias David [Vis alle 16 forfattere av denne artikkelen] (2026). Exploring perceptions of digital patient reported outcome measures: a multi-site qualitative case study in four European oncology outpatient clinics | Health and Quality of Life Outcomes | Springer Nature Link. Health and Quality of Life Outcomes. doi: 10.1186/s12955-026-02574-0. Fulltekst i vitenarkiv Vis sammendrag

  Digital Patient Reported Outcome Measures (PROMs) can help to promote patient-centred care (PCC). However, they are currently not routinely used, potentially compromising patient outcomes. In this work we sought to (i) explore existing processes, patient and healthcare professionals’ (HCP) perceptions of current gaps in PCC and (ii) their views on how a PROMs-based digital system could help to address these gaps in four European oncology outpatient clinics. We conducted a qualitative multi-site case study including healthcare staff (organisational leaders, managers and HCPs), patients being treated for cancer and caregivers in four outpatient clinics in Brussels (Belgium), Edinburgh (United Kingdom), Oslo (Norway), and Valencia (Spain). Data were collected through a series of semi-structured interviews to explore existing work practices, needs and attitudes. We also conducted non-participant observations of staff meetings and clinic activities to explore existing processes. Data were analysed through a mixture of inductive and deductive approaches drawing on the Technology, People, Organizations, and Macroenvironmental (TPOM) factors framework. We conducted 99 interviews with HCPs, patients and caregivers and 30 observations across the four sites. PCC was regarded as important across all sites. We observed limited existing efforts on systematically recording psychosocial needs of patients. Participants reported concerns that a new digital system to record PROMs may result in increased workloads for clinical staff and adversely impact patient-clinician relationships. Attitudes were influenced by previous experience with digital systems. Organisational leadership and support were viewed as crucial in facilitating adoption, including efforts to train and engage clinical and patient users, making available sufficient resources, and including end-users in system design. While digital PROMs have the potential to enhance PCC in cancer, their routine use is often hindered by sociotechnical challenges. This issue persists across different countries. Success in developing and implementing digital PROMs will require tailored system design and implementation strategies being cognisant of various stakeholder needs. This may include supplementing technological aspects of interventions with educational strategies, supporting local adaptations of designs, and aligning with clinician and organisational drivers for implementation.

• Landschoot, Femke van; Scherrens, Anne Lore; Jacobs, An; Deliens, Luc; Pardon, Koen & Kaasa, Stein [Vis alle 19 forfattere av denne artikkelen] (2026). IT Barriers and Enablers for Implementing Electronic Patient Reported Outcome Measures: A Multi-Site Qualitative Study in Nine European Oncology Clinics. Studies in Health Technology and Informatics. ISSN 0926-9630. 336, s. 2475–2476. doi: 10.3233/SHTI260715. Fulltekst i vitenarkiv
• Foss, Line; Caraceni, Augusto Tomasso Giovanni; Centeno, Carlos; Chlebopaševienė, Greta; Clemmensen, Stine N. & Fraterman, Itske [Vis alle 16 forfattere av denne artikkelen] (2026). EU Joint Action: Integrating Palliative Care in the EU Cancer Agenda: Insights From JANE-2. Journal of Pain and Symptom Management. ISSN 0885-3924. 71(5). doi: 10.1016/j.jpainsymman.2026.02.009. Fulltekst i vitenarkiv
• Lia, Kjersti; Galleberg, Renate Berget; Rostoft, Siri; Jørgensen, Rasmus R.K.; Smeland, Knut Bjøro & Hjermstad, Marianne Jensen [Vis alle 13 forfattere av denne artikkelen] (2026). Self-reported late effects, daily functioning, and health-related quality of life in older Hodgkin lymphoma survivors – a national population-based cross-sectional survey. Leukemia and Lymphoma. ISSN 1042-8194. 67(5), s. 1125–1135. doi: 10.1080/10428194.2026.2633180. Fulltekst i vitenarkiv Vis sammendrag

  In a Norwegian national cross-sectional survey, we assessed the burden of selected late effects (LEs) by a 95-item questionnaire in tumor-free Hodgkin lymphoma survivors (HLSs) diagnosed at age ≥60 years. Responses were compared to age- and sex-matched controls. A total of 290 older HLSs diagnosed 2000–2021 received the questionnaire, 193 (67%) were included. Median age at survey was 76 years (range 63–92) and median time since diagnosis 7 years (2–23). Compared to controls, HLSs reported significantly higher rates of heart failure (10% vs. 6%), atrial fibrillation (19% vs. 14%), memory problems (48% vs. 37%), other cognitive difficulties (34% vs. 17%) and chronic fatigue (29% vs. 13%). HLSs scored lower on physical and mental health-related quality of life (HRQoL) and more often reported needing help with basic (P-ADL) and instrumental activities of daily living (I-ADL). However, differences were small, only for fatigue and dependence in I-ADL did the difference reach moderate statistical effect size.

• Lundereng, E.D.; Brkic, A.; Fallon, M.; Cresswell, K.; Deliens, L. & Pardon, K. [Vis alle 70 forfattere av denne artikkelen] (2026). Opportunities and challenges in implementing digital patient-centred cancer care in Europe—a qualitative study of several ESMO Designated Centres. ESMO Real World Data and Digital Oncology. 12, s. 100696–100696. doi: 10.1016/j.esmorw.2026.100696. Fulltekst i vitenarkiv Vis sammendrag

  Guided by expert perspectives from the ESMO Designated Centres (DCs), the European Union-funded MyPath project is developing a digital solution incorporating patient-reported outcome measures to operationalise PCC across diverse European contexts. This study aims to explore challenges and opportunities for implementing digital solutions to enhance PCC in oncology, ensuring relevance and scalability across Europe using insights from ESMO DCs. The findings show that effective digital PCC depends not only on technical integration and clinical training but also on adaptability to different care settings, infrastructures, and professional cultures. This study highlights the conditions for scalable implementation of digital PCC across Europe, offering practical implications for health system leaders and policymakers.

• Lundereng, Elias David; Brkic, Alen; Absolom, Kate; Andvik, Elisabeth; Beernaert, Kim & Cresswell, Kathrin [Vis alle 21 forfattere av denne artikkelen] (2026). Balancing ideals and realities: health care professionals’ perspectives of and attitudes toward digital patient-centered cancer care. Quality of Life Research. ISSN 0962-9343. 35. doi: 10.1007/s11136-025-04103-w. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Patient-centered care (PCC) improves quality of life, symptom management and healthcare outcomes in oncology. However, integration into routine cancer care remains limited. Digital solutions using patient-reported outcome measures (PROMs) offer a potential mechanism to operationalize PCC. This study explored healthcare professionals’ (HCPs) pre-implementation perspectives on using digital PROMs to support PCC in Norwegian oncology outpatient clinics, informing the design and implementation strategies of the European MyPath digital solution. Methods Semi-structured interviews (n = 29) and three focus groups (n = 16) were conducted with varied HCPs across four Norwegian hospitals. Interviews explored perceptions of PCC, experiences with PROMs, and requirements for digital implementation. Data were analyzed using thematic analysis, combining inductive and deductive coding guided by the TPOM framework. Results Four themes emerged: (1) balancing PCC with disease-centered practices, (2) integrating PCC into daily routines, (3) customization and patient acceptance of digital tools, and (4) combining patient-reported data with clinical autonomy. HCPs viewed digital PROMs as promising for facilitating PCC but emphasized that successful implementation requires workflow alignment, adaptable digital solutions, and strong stakeholder engagement. Concerns included patient digital literacy, workload implications, and overreliance on PROMs at the expense of direct patient interaction. Conclusion Our findings highlight a tension between HCPs’ needs for technical functionality and workflow alignment, and the support required to adapt their practice to fully realize PCC through digital tools. Integrating PCC successfully requires organizational, cultural, and workflow adaptations, alongside active HCP engagement in design and implementation. These changes are essential to reposition PCC as an integral rather than competing component of high-quality cancer care.

• Christiansen, Gyda G.; Farnes, Ingvild; Hjermstad, Marianne Jensen & Labori, Knut Jørgen (2025). Association between baseline quality of life and survival in patients with non-metastatic, advanced pancreatic cancer. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 61(1), s. 53–60. doi: 10.1080/00365521.2025.2585113. Fulltekst i vitenarkiv
• Shkodra, Morena; Urrizola, Amaia; Fallon, Marie; Sjøgren, Per; Everdingen, Marieke van den Beuken-van & Hagen, Katarina Margareta Rønning [Vis alle 12 forfattere av denne artikkelen] (2025). The MyPath Pain Pathway: Developing a Digital Patient-Centred Care Pathway for Cancer Pain. Journal of Pain and Symptom Management. ISSN 0885-3924. 70(6), s. 592–601. doi: 10.1016/j.jpainsymman.2025.08.012. Fulltekst i vitenarkiv
• Astrup, Guro Lindviksmoen; Siksjø, Monica; Aass, Nina Kathrine; Alves, Guido Werner; Brønnick, Kolbjørn Kallesten & Hjermstad, Marianne Jensen [Vis alle 12 forfattere av denne artikkelen] (2025). Cognitive function in long-term survivors after treatment for brain metastases compared with normative samples. Neuro-Oncology Practice. ISSN 2054-2577. doi: 10.1093/nop/npaf083. Fulltekst i vitenarkiv Vis sammendrag

  Background: Few studies have examined cognitive function in long-term survivors with brain metastases (BM). The aim of this study was to assess performance-based cognitive function and compare it with normative samples. Methods: Patients with ≥2-year survival after a first-time BM diagnosis completed neuropsychological tests assessing the following neurocognitive domains: processing speed, executive functioning, mental flexibility, visual learning and memory, verbal learning and memory, attention, and working memory. Test scores were converted into standardized z-scores using normative sample means and standard deviations (SD). The proportions of patients with an individual z-score of ≤−1 and ≤−1.5 SD below the normative sample means were calculated to indicate subclinical and clinically significant impairment. Results: Forty-one patients (median age 58, 24 women) completed assessments at a median of 32 months (min–max: 26–47) after the BM diagnosis. On a group level, patients performed poorer than normative samples in tests within all domains except verbal learning and memory. The deviation was most pronounced in a subtest assessing mental flexibility. The proportion of patients with subclinical or clinically significant impairment ranged from 29% to 59% and 7% to 51% between domains, respectively. Seventy-three percent had at least subclinical and 59% had clinically significant impairment in at least 1 domain. Conclusions: Long-term survivors with BM performed poorer than normative samples within nearly all neurocognitive domains, particularly executive functioning and mental flexibility. This domain is important for daily living and social functioning, and clinicians should provide information about the implications of BM and tailor patient care to optimize functioning and quality of life.

• Rootwelt, Rebecca; Hjermstad, Marianne Jensen; Yri, Olav Erich; Skovlund, Eva; Aass, Nina Kathrine & Astrup, Guro Lindviksmoen [Vis alle 9 forfattere av denne artikkelen] (2025). Survival, quality of life, and motor function in brain metastases surgery: The role of complete resection. Neuro-Oncology Practice. ISSN 2054-2577. 12(4), s. 644–653. doi: 10.1093/nop/npaf011. Fulltekst i vitenarkiv Vis sammendrag

  Background One in 3 patients with advanced cancer develops brain metastases. Surgical resection of brain metastases is done in 15%–20% of these patients. While gross total resection (GTR) is believed to extend overall survival (OS), concerns exist regarding increased morbidity. This study examines the impact of surgical resection, particularly GTR, on self-reported symptoms, focusing on quality of life (QoL) and motor dysfunction. Methods We conducted a prospective cohort study involving adult patients undergoing surgical resection for brain metastases from solid tumors in a defined region of Norway between 2017 and 2021. Clinical data were collected at inclusion prior to surgery and every 3 months the first year. Patients completed monthly questionnaires assessing QoL and motor dysfunction. QoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL, while motor dysfunction was evaluated using the EORTC QLQ-BN20. Results A total of 155 patients were included and median OS was 13 months. GTR was achieved in 69 (44%) patients and was associated with longer median OS compared to subtotal resection (17.7 vs. 10.9 months, P = .04). Mean QoL remained stable throughout the follow-up period. Improved motor dysfunction 1 month after surgery was reported by 23% of the patients, while 25% reported worse motor dysfunction. Factors associated with a high motor dysfunction score at 1 month were age >70 years, higher baseline motor dysfunction, and multiple brain metastases. Neither GTR nor location of metastases in motor-associated areas were associated with worsened motor dysfunction. Conclusion Self-reported QoL is maintained after surgery for brain metastases. Complete resection is associated with extended OS without compromising self-reported motor function.

• Gudmundstuen, Anne Marte; Iversen, Per Ole; Pesonen, Maiju; Hjermstad, Marianne Jensen; Bye, Asta & Tjønnfjord, Geir Erland [Vis alle 7 forfattere av denne artikkelen] (2025). Comparing indirect calorimetry and predictive equations for energy expenditure - 1 year follow-up of adult hematopoietic stem cell transplanted recipients. Clinical Nutrition ESPEN. ISSN 2405-4577. 70, s. 218–226. doi: 10.1016/j.clnesp.2025.09.027. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) often undergo body composition changes that may impact their energy expenditure (EE), however, the accurate energy requirements may be difficult to estimate. Indirect calorimetry (IC) is recommended as the gold standard to assess measured energy expenditure (mEE), but its use is resource-demanding and thus rarely applied compared to predictive energy equations. Here we evaluated the agreement between mEE by IC and EE estimated by several predictive energy equations, or the ESPEN recommendation, during 1-year follow-up of adult allo-HSCT recipients. Methods We examined 117 adult patients with hematological malignancies who received allo-HSCT. mEE was assessed by IC in non-fasting patients before transplantation, and at 3, 6, 9 and 12 months post-allo-HSCT. Agreement between mEE and predictive values using the Harris-Benedict-HB, Mifflin St. Jeor-MSJ, Ireton Jones-IJ equations and the fixed ESPEN recommendation of 25 kcal/kg/day was evaluated using Bland–Altman analysis and accuracy within ± 10 %. Changes in mEE over time were analyzed using linear mixed model with age as a covariate. Results A total of 509 mEE measurements by IC were obtained. HB and MSJ overestimated mEE on average (mean bias: + 2.9 and + 3.8 kcal/kg/day), while IJ, and the fixed ESPEN recommendation underestimated mEE (biases: – 0.7 and – 4.7 kcal/kg/day, respectively). None of the equations or the fixed ESPEN recommendation achieved > 50 % accuracy within ± 10 % of mEE by IC. IJ had the highest variability and widest limits of agreement. mEE changed significantly over time (p < 0.001), with no significant differences between the initially randomized intervention and control group (p = 0.982). Mean mREE was 24.74 ± 3.80 kcal/kg/day and 31.14 ± 4.91 kcal/kg/day when adjusted for FFM. Age was not significantly associated with mREE (p = 0.198). Conclusion Our findings indicate that commonly used predictive equations and the fixed ESPEN recommendation showed limited accuracy compared with mEE in allo-HSCT recipients. Only mEE obtained by IC captured longitudinal changes in EE during the first year post-transplantation. mEE by IC varied significantly the first year post-transplant. ClinicalTrials.gov, ID NCT01181076.

• Paulsen, Ørnulf; Hjermstad, Marianne Jensen & Kaasa, Stein (2025). Design and delivery of clinical trials: from idea to final publication. I Higginson, Irene J; Bruera, Eduardo; Costantini, Massimo; Currow, David; Larkin, Philip J & Preston, Nancy (Red.), Research Methods in Palliative, Supportive, and End-of-Life Care. Oxford University Press. ISSN 9780191924644. s. 82–98. doi: 10.1093/9780191924644.003.0009. Fulltekst i vitenarkiv Vis sammendrag

  Clinical trials are essential to advance clinical practice with RCTs being the gold standard for evaluation of health care interventions. Patients in palliative, supportive, and end-of-life care represent vulnerable populations for research. Thus, clinical trials involving these populations must be carefully planned. This chapter gives an introduction on how to plan and run a clinical trial. With practical advice, it provides guidance ranging from the initial idea through to the stepwise process of planning, organizing, and conducting a trial. The chapter also highlights some pitfalls to be avoided during these processes.

• Hustad, Kristin Solheim; Koteng, Lisa Heide; Urrizola, Amaia; Arends, J.; Bye, Asta & Dajani, Olav [Vis alle 71 forfattere av denne artikkelen] (2025). Practical cancer nutrition, from guidelines to clinical practice: a digital solution to patient-centred care. ESMO Open. 10(4). doi: 10.1016/j.esmoop.2025.104529. Fulltekst i vitenarkiv Vis sammendrag

  Background Malnutrition affects 20%-70% of cancer patients, depending on tumour type, disease stage, and clinical setting. While nutritional care is essential for improving patients’ quality of life and clinical outcomes, it is not systematically integrated into routine cancer care. MyPath is a European Union project aiming to implement patient-centred care (PCC) at nine European cancer centres using implementation science. Multidisciplinary teams have developed standardised digitally supported PCC pathways based on patient-reported outcomes (PROs) with linked evidence-based management options. Through systematic assessment and management of common symptoms and psychosocial problems in cancer patients, MyPath aims to facilitate changes in clinical practice to improve PCC for all. As part of this, the MyPath Nutrition Care Pathway (NCP) aims to facilitate necessary clinical changes to routinely assess and address nutrition in all patients. Materials and methods Between September 2022 and August 2024, an international multidisciplinary team reviewed evidence-based nutrition guidelines to select relevant PROs and other variables necessary to systematically assess patients, allowing for tailored nutritional care. Results The MyPath NCP assessment relies on nutritional status (Malnutrition Screening Tool for malnutrition risk, modified Global Leadership Initiative on Malnutrition criteria for malnutrition, and body mass index/weight change for obesity/unintentional weight gain), health status (functional status, cancer diagnosis and prognosis, and prehabilitation needs), and inflammatory status (C-reactive protein levels). Based on this assessment, the digital solution suggests tailored, evidence-based nutritional interventions. Continuous monitoring through PROs and clinical consultations will customise care to patients’ dynamic nutritional needs. The first version of this digital solution will be piloted in 2025. Conclusions Inconsistent implementation of nutrition guidelines is a key challenge in cancer care. The MyPath NCP offers an accessible, patient-centred assessment and management system that integrates nutritional care into routine cancer care, providing a versatile solution that can be implemented across diverse health care settings.

• Skaarud, Kristin Aneta Joan; Gudmundstuen, Anne Marte; Pesonen, Maiju; Hjermstad, Marianne Jensen; Iversen, Per Ole & Tjønnfjord, Geir Erland (2025). The role of fat-soluble vitamins for graft-versus host disease after myeloablative conditioning in allogeneic stem cell transplanted patients. Scientific Reports. 15. doi: 10.1038/s41598-024-84805-2. Fulltekst i vitenarkiv Vis sammendrag

  Whether the fat-soluble vitamins A, D, E, and K are associated with development of graft-versus-host disease (GvHD) after allogeneic stem cell transplantation, is unclear. We assessed if the levels of these vitamins were associated with development of GvHD during the first year after transplantation using data from a two-armed randomized nutritional intervention trial. Changes in plasma levels during 1-year follow-up were analyzed using a linear mixed model for repeated measurements. Vitamin A, D, E, and K levels changed significantly the first year in both study arms (p < 0.001). Higher levels of vitamin E over time were associated with less acute GvHD grades 3–4 (OR = 0.997, 95% CI: (0.994, 0.999), p = 0.017). No associations were found with vitamin A, D, E and K levels and chronic GvHD. Multivariable analysis adjusted for treatment group, age, pre-transplant vitamin level and risk factors for GvHD did not change the results. Six weeks post-transplantation, higher levels of vitamin E were associated with less acute GvHD grades 3–4, (p = 0.012). In conclusion, we found an association between higher levels of vitamin E over time and less severe acute GvHD. Whether this reflects a causal relationship warrants further study. ClinicalTrials.gov (NCT01181076).

• Karlsson, Astrid Telhaug; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Skovlund, Eva; Astrup, Guro Lindviksmoen & Kaasa, Stein [Vis alle 7 forfattere av denne artikkelen] (2025). Patient-Reported Outcomes Before and After Radiotherapy for Brain Metastases—A Prospective Cohort Study of 239 Non-Small-Cell Lung Cancer Patients. Cancers. 17(9). doi: 10.3390/cancers17091529. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Radiotherapy (RT) is a frequently offered treatment option for brain metastases (BMs) in patients with non-small-cell lung cancer (NSCLC). This study presents patient-reported outcomes (PROs) in a cohort of NSCLC with BMs treated with RT. This study researched how PRO scores at the start of RT may be useful in survival estimates and how PROs change over time after RT. Methods: NSCLC patients with first-time BMs treated with RT were identified in a prospective observational study. PROs were collected at the start of RT and monthly for up to 1 year. Differences in PRO mean scores at the start of RT (M0) and at month 2 (M2) after treatment are reported. Prognostic values of PROs were analyzed in a stepwise adjusted Cox model. Results: Of 294 patients identified, 239 (81%) responded at M0; 105/239 (44%) responded at both M0 and M2. High scores for weakness of legs at M0 were associated with short survival when adjusting for performance status and status of extracranial metastases. Those responding at M0 only had worse mean scores for overall QoL and PF but similar scores for fatigue and dyspnea compared to patients responding over time. At M2, patients with <6 months survival after RT reported worse scores for overall QoL, PF, fatigue, and dyspnea; long-term survivors reported stable scores. Conclusions: NSCLC patients diagnosed with BMs and expected survival < 6 months should be offered optimal palliative care rather than RT.

• Dajani, Olav; Philips, Iain; Størkson, Ester Kristine; Balstad, Trude Rakel; Brown, Leo R. & Bye, Asta [Vis alle 23 forfattere av denne artikkelen] (2025). Oncological and Survival Endpoints in Cancer Cachexia Clinical Trials: Systematic Review 6 of the Cachexia Endpoints Series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 16(2), s. 1–24. doi: 10.1002/jcsm.13756. Fulltekst i vitenarkiv
• Skåre, Terese Solvoll; Lundeby, Tonje; Lund, Jo-Åsmund; Hjermstad, Marianne Jensen & Midtbust, May Helen (2025). First-time use of electronic patient-reported outcome measures in a cluster randomized trial: a qualitative study. Journal of Patient-Reported Outcomes. 9, s. 1–11. doi: 10.1186/s41687-025-00840-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Although there is clear evidence supporting the beneficial effects of regularly assessing patient-reported outcomes (PROs), the comprehensive integration of patient-reported outcome measures (PROMs) into routine cancer care remains limited. This study aimed to explore the facilitators and barriers encountered by principal investigators (PIs) (oncologists) and study nurses during the implementation of the Eir ePROM within a cluster randomized trial (c-RCT) in cancer outpatient clinics. Additionally, we sought to examine the influence of Eir on the working routines of the participants. Methods Individual semi-structured interviews and a focus group were conducted with nine oncologists and study nurses involved in the implementation of the ePROM tool Eir. Interviews elucidated their experiences of barriers and facilitators when implementing Eir through a cluster randomized trial. Data were analysed according to Framework Analysis, using both an inductive and deductive approach. The Consolidated Framework for Implementation Research (CFIR) was used in the deductive stages of analysis. Results Three overarching themes were identified from the data: (1) Willingness to invest; accepting that new eras come with a cost, (2) Management anchoring; changes start at the top, and (3) Creation of a cohesive framework; fostering collective comprehension. We found a notable disparity between oncologists and nurses in their willingness to invest time and effort in implementing the tool. While participants recognized the need to transform patient consultation methods to benefit from digital symptom management, opinions varied on whether the potential benefits justified the associated cost. Furthermore, the degree of management anchoring at various levels significantly impacted the implementation process. At the local level, it was seen as either a facilitator or a barrier, influencing the outcome of the implementation. Additionally, establishing a cohesive framework was crucial, as this fostered a collective understanding among those involved in the implementation. Conclusions Our study underscores the importance of considering the diverse perspectives of health care professionals and fostering interprofessional collaboration for the successful implementation of ePROMs in healthcare settings. Future research should explore strategies to bridge professional disparities and promote a shared understanding of the value provided by ePROMs.

• Karlsson, Astrid Telhaug; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Skovlund, Eva; Kaasa, Stein & Yri, Olav Erich (2024). Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients. Cancers. 16(8). doi: 10.3390/cancers16081486. Fulltekst i vitenarkiv Vis sammendrag

  Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (n = 141), and 7.5 months after SRT (n = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival.

• Urrizola, Amaia; Dajani, Olav; Aass, Nina Kathrine; Bjerkeset, Ellen; Hjermstad, Marianne Jensen & Kaasa, Stein [Vis alle 11 forfattere av denne artikkelen] (2024). Nutrition impact symptom monitoring and weight loss outcomes: a longitudinal radiotherapy study. BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2024-004939. Fulltekst i vitenarkiv
• Huynh, Thuy-Tien Maria; Falk, Ragnhild Sørum; Hellebust, Taran Annette Paulsen; Dale, Einar; Astrup, Guro Lindviksmoen & Hjermstad, Marianne Jensen [Vis alle 12 forfattere av denne artikkelen] (2024). Chronic fatigue in long-term survivors of head and neck cancer treated with radiotherapy. Radiotherapy and Oncology. ISSN 0167-8140. 195. doi: 10.1016/j.radonc.2024.110231. Fulltekst i vitenarkiv Vis sammendrag

  Background There is lack of evidence on chronic fatigue (CF) following radiotherapy (RT) in survivors of head and neck cancer (HNC). We aimed to compare CF in HNC survivors > 5 years post-RT with a reference population and investigate factors associated with CF and the possible impact of CF on health-related quality of life (HRQoL). Material and methods In this cross-sectional study we included HNC survivors treated in 2007–2013. Participants filled in patient-reported outcome measures and attended a one-day examination. CF was measured with the Fatigue Questionnaire and compared with a matched reference population using t-tests and Cohen’s effect size. Associations between CF, clinical and RT-related factors were investigated using logistic regression. HRQoL was measured with the EORTC Quality of Life core questionnaire. Results The median age of the 227 HNC survivors was 65 years and median time to follow-up was 8.5 years post-RT. CF was twice more prevalent in HNC survivors compared to a reference population. In multivariable analyses, female sex (OR 3.39, 95 % CI 1.82–6.31), comorbidity (OR 2.17, 95 % CI 1.20–3.94) and treatment with intensity-modulated RT (OR 2.13, 95 % CI 1.16–3.91) were associated with CF, while RT dose parameters were not. Survivors with CF compared to those without, had significantly worse HRQoL. Conclusions CF in HNC survivors is particularly important for female patients, while specific factors associated with RT appear not to play a role. The high CF prevalence in long-term HNC survivors associated with impaired HRQoL is important information beneficial for clinicians and patients to improve patient follow-up.

• Oort, Q.; Reijneveld, J.C.; Sikkes, S.A.M.; Koekkoek, J.A.F.; Boele, F. & Young, T. [Vis alle 33 forfattere av denne artikkelen] (2024). Instrumental activities of daily living in neuro-oncology: International validation of the EORTC IADL-BN32 questionnaire. European Journal of Cancer. ISSN 0959-8049. 212. doi: 10.1016/j.ejca.2024.114335. Fulltekst i vitenarkiv Vis sammendrag

  Background Neurocognitive impairments are common in patients with a brain tumour, and may negatively impact on functioning in daily life, particularly on instrumental activities of daily living (IADL). The EORTC IADL-BN32 questionnaire was developed to measure IADL in this patient population. Methods In this international validation study, we evaluated the EORTC IADL-BN32 questionnaire on several psychometric properties in a large sample of patients with a primary or metastatic brain tumour. We administered the 32-item questionnaire three times: at ‘baseline’, after 2 weeks and after 3 months. Procedures were in accordance with EORTC Quality of Life Group module development guidelines. Results In total, 326 patients participated in the study. A bifactor scale structure showed satisfactory model fit measures, with five multi-item scales and two single items, and an IADL sum score. The internal consistency of the multi-item scales ranged from good to excellent (range Cronbach’s α: 0.86–0.97). We found significant differences in scale scores between patients with and without neurocognitive impairments or complaints, supporting the construct validity. Initial cross-cultural validity analyses showed indications of item response biases for certain items. Analyses indicated moderate to good test-retest agreement (intraclass correlation coefficient > 0.70) between baseline and the 2-week follow-up assessment for all but one scale. Deterioration of EORTC IADL-BN32 scale scores were consistent with clinically relevant deterioration on other functional measures with small to large effect sizes, however, subgroup sample sizes were small. Conclusion Overall, the EORTC IADL-BN32 questionnaire exhibited adequate to excellent psychometric properties. Cross-cultural validity and responsiveness should be further explored.

• Hjermstad, Marianne Jensen; Pirnat, Aleksandra; Aass, Nina Kathrine; Andersen, Sigve; Astrup, Guro Lindviksmoen & Dajani, Olav [Vis alle 19 forfattere av denne artikkelen] (2024). PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life. Palliative Medicine. ISSN 0269-2163. 38(2), s. 229–239. doi: 10.1177/02692163231222391. Fulltekst i vitenarkiv Vis sammendrag

  Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. Setting: A total of 12 Norwegian hospitals (03/2017-02/2021). Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated

• Vagnildhaug, Ola Magne; Balstad, Trude Rakel; Ottestad, Inger; Bye, Asta; Greil, Christine & Arends, Jann [Vis alle 24 forfattere av denne artikkelen] (2024). Appetite and dietary intake endpoints in cancer cachexia clinical trials: Systematic Review 2 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 15, s. 513–535. doi: 10.1002/jcsm.13434. Fulltekst i vitenarkiv Vis sammendrag

  There is no consensus on the optimal endpoint(s) in cancer cachexia trials. Endpoint variation is an obstacle when comparing interventions and their clinical value. The aim of this systematic review was to summarize and evaluate endpoints used to assess appetite and dietary intake in cancer cachexia clinical trials. A search for studies published from 1 January 1990 until 2 June 2021 was conducted using MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Eligible studies examined cancer cachexia treatment versus a comparator in adults with assessments of appetite and/or dietary intake as study endpoints, a sample size ≥40 and an intervention lasting ≥14 days. Reporting was in line with PRISMA guidance, and a protocol was published in PROSPERO (2022 CRD42022276710). This review is part of a series of systematic reviews examining cachexia endpoints. Of the 5975 articles identified, 116 were eligible for the wider review series and 80 specifically examined endpoints of appetite (65 studies) and/or dietary intake (21 studies). Six trials assessed both appetite and dietary intake. Appetite was the primary outcome in 15 trials and dietary intake in 7 trials. Median sample size was 101 patients (range 40–628). Forty-nine studies included multiple primary tumour sites, while 31 studies involved single primary tumour sites (15 gastrointestinal, 7 lung, 7 head and neck and 2 female reproductive organs). The most frequently reported appetite endpoints were visual analogue scale (VAS) and numerical rating scale (NRS) (40%). The appetite item from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30/C15 PAL (38%) and the appetite question from North Central Cancer Treatment Group anorexia questionnaire (17%) were also frequently applied. Of the studies that assessed dietary intake, 13 (62%) used food records (prospective registrations) and 10 (48%) used retrospective methods (24-h recall or dietary history). For VAS/NRS, a mean change of 1.3 corresponded to Hedge's g of 0.5 and can be considered a moderate change. For food records, a mean change of 231 kcal/day or 11 g of protein/day corresponded to a moderate change. Choice of endpoint in cachexia trials will depend on factors pertinent to the trial to be conducted. Nevertheless, from trials assessed and available literature, NRS or EORTC QLQ C30/C15 PAL seems suitable for appetite assessments. Appetite and dietary intake endpoints are rarely used as primary outcomes in cancer cachexia. Dietary intake assessments were used mainly to monitor compliance and are not validated in cachexia populations. Given the importance to cachexia studies, dietary intake endpoints must be validated before they are used as endpoints in clinical trials.

• Hjermstad, Marianne Jensen; Jakobsen, Gunnhild; Arends, Jann; Balstad, Trude Rakel; Brown, Leo R. & Bye, Asta [Vis alle 26 forfattere av denne artikkelen] (2024). Quality of life endpoints in cancer cachexia clinical trials: Systematic review 3 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 15(3), s. 794–815. doi: 10.1002/jcsm.13453. Fulltekst i vitenarkiv Vis sammendrag

  The use of patient-reported outcomes (PROMs) of quality of life (QOL) is common in cachexia trials. Patients' self-report on health, functioning, wellbeing, and perceptions of care, represent important measures of efficacy. This review describes the frequency, variety, and reporting of QOL endpoints used in cancer cachexia clinical trials. Electronic literature searches were performed in Medline, Embase, and Cochrane (1990–2023). Seven thousand four hundred thirty-five papers were retained for evaluation. Eligibility criteria included QOL as a study endpoint using validated measures, controlled design, adults (>18 years), ≥40 participants randomized, and intervention exceeding 2 weeks. The Covidence software was used for review procedures and data extractions. Four independent authors screened all records for consensus. Papers were screened by titles and abstracts, prior to full-text reading. PRISMA guidance for systematic reviews was followed. The protocol was prospectively registered via PROSPERO (CRD42022276710). Fifty papers focused on QOL. Twenty-four (48%) were double-blind randomized controlled trials. Sample sizes varied considerably (n = 42 to 469). Thirty-nine trials (78%) included multiple cancer types. Twenty-seven trials (54%) featured multimodal interventions with various drugs and dietary supplements, 11 (22%) used nutritional interventions alone and 12 (24%) used a single pharmacological intervention only. The median duration of the interventions was 12 weeks (4–96). The most frequent QOL measure was the EORTC QLQ-C30 (60%), followed by different FACIT questionnaires (34%). QOL was a primary, secondary, or exploratory endpoint in 15, 31 and 4 trials respectively, being the single primary in six. Statistically significant results on one or more QOL items favouring the intervention group were found in 18 trials. Eleven of these used a complete multidimensional measure. Adjustments for multiple testing when using multicomponent QOL measures were not reported. Nine trials (18%) defined a statistically or clinically significant difference for QOL, five with QOL as a primary outcome, and four with QOL as a secondary outcome. Correlation statistics with other study outcomes were rarely performed. PROMs including QOL are important endpoints in cachexia trials. We recommend using well-validated QOL measures, including cachexia-specific items such as weight history, appetite loss, and nutritional intake. Appropriate statistical methods with definitions of clinical significance, adjustment for multiple testing and few co-primary endpoints are encouraged, as is an understanding of how interventions may relate to changes in QOL endpoints. A strategic and scientific-based approach to PROM research in cachexia trials is warranted, to improve the research base in this field and avoid the use of QOL as supplementary measures.

• Westgaard, Arne; Pirnat, Aleksandra; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Kaasa, Stein & Dajani, Olav (2024). Prognostic Value of Performance Status, Albumin, and CRP in Last-Line Chemotherapy for Pancreatic vs. Other Gastrointestinal Cancers—Simple Tools Matter. Current Oncology. ISSN 1198-0052. 31(9), s. 5462–5471. doi: 10.3390/curroncol31090404. Fulltekst i vitenarkiv Vis sammendrag

  Patients with advanced gastrointestinal cancers often receive chemotherapy near the end of life (EoL), raising concerns about overtreatment. The PALLiON trial, a cluster-randomized trial, assessed the impact of a complex intervention on frequency of EoL treatment; the intervention involved palliative care referrals and the use of PROMs. The present secondary analysis evaluated the prognostic value of baseline performance status (PS), albumin (alb), C-reactive protein (CRP), and body mass index (BMI) for overall survival, comparing pancreatic (PAN, n = 189) vs. other gastrointestinal cancer patients (GI, n = 286). Baseline PS, alb, CRP, mGPS (modified Glasgow prognostic score), and BMI were analyzed using Cox regression. Adjusted for age, sex, and hospital size, PS ≥ 2 and alb < 35 g/L predicted shorter survival in both PAN and GI cancers, while CRP > 10 predicted shorter survival only in GI cancers. In PAN, PS ≥ 2 predicted a 78.4% higher probability of shorter survival, and mGPS 2 predicted a 68.7% higher probability. In GI, mGPS 2 predicted a 70.8% higher probability, whereas PS was not significant. BMI did not improve predictive models. PS ≥ 2 and low albumin are strong predictors of short survival in PAN, whereas increased CRP and low albumin (mGPS 2) are predictors in GI.

• Scherrens, Anne-Lore; Jacobs, An; Beernaert, Kim; Pardon, Koen; Raemdonck, Eveline & Fallon, Marie [Vis alle 13 forfattere av denne artikkelen] (2024). Integrating patient-centred and tumour-centred cancer care: the EU-MyPath implementation project offers an innovative digital solution with care pathways. Palliative Care & Social Practice. 18. doi: 10.1177/26323524241296143. Fulltekst i vitenarkiv Vis sammendrag

  Cancer is one of the leading causes of mortality, with new cases expected to rise. Medical advances increase cure rates and prolong patient lives, but survivorship involves high symptom burden, loss of function and emotional distress. Improving patient-centred care (PCC) and quality of life throughout the care process is essential. Key to this improvement are systematic use of patient-reported outcome measures (PROMs) and patient-centred care pathways (PCCPs). Despite established benefits, current cancer care focuses on tumour-centred care approaches often neglecting the patient perspective. Evidence-based PCC guidelines fail to be routinely incorporated into clinical practices. The Horizon 2020-funded European MyPath project aims to address these gaps by developing, implementing and evaluating digital PCCPs with PROMs. MyPath will be tailored to enhance the organisational contexts of cancer centres across Europe through the application of implementation science strategies. This paper describes the current state of applying PCC in routine cancer care and presents a forward-looking perspective on how the MyPath project can successfully adopt and implement digital PROMs across countries. A literature search was conducted to provide the state-of-the art.

• Yri, Olav Erich; Astrup, Guro Lindviksmoen; Karlsson, Astrid Telhaug; Helvoirt, Rene van; Hjermstad, Marianne Jensen & Husby, Kristin Moksnes [Vis alle 15 forfattere av denne artikkelen] (2024). Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study. The Lancet Regional Health - Europe. 49, s. 1–15. doi: 10.1016/j.lanepe.2024.101181. Fulltekst i vitenarkiv Vis sammendrag

  Background: A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions. Methods: This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox' proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (E

• Brown, Leo R.; Sousa, Mariana S.; Yule, Michael S.; Baracos, Vickie E.; McMillan, Donald C. & Arends, Jann [Vis alle 24 forfattere av denne artikkelen] (2024). Body weight and composition endpoints in cancer cachexia clinical trials: Systematic Review 4 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 15(3), s. 816–852. doi: 10.1002/jcsm.13478. Fulltekst i vitenarkiv Vis sammendrag

  Significant variation exists in the outcomes used in cancer cachexia trials, including measures of body composition, which are often selected as primary or secondary endpoints. To date, there has been no review of the most commonly selected measures or their potential sensitivity to detect changes resulting from the interventions being examined. The aim of this systematic review is to assess the frequency and diversity of body composition measures that have been used in cancer cachexia trials. MEDLINE, Embase and Cochrane Library databases were systematically searched between January 1990 and June 2021. Eligible trials examined adults (≥18 years) who had received an intervention aiming to treat or attenuate the effects of cancer cachexia for >14 days. Trials were also of a prospective controlled design and included body weight or at least one anthropometric, bioelectrical or radiological endpoint pertaining to body composition, irrespective of the modality of intervention (e.g., pharmacological, nutritional, physical exercise and behavioural) or comparator. Trials with a sample size of <40 patients were excluded. Data extraction used Covidence software, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. This review was prospectively registered (PROSPERO: CRD42022276710). A total of 84 clinical trials, comprising 13 016 patients, were eligible for inclusion. Non-small-cell lung cancer and pancreatic cancer were studied most frequently. The majority of trial interventions were pharmacological (52%) or nutritional (34%) in nature. The most frequently reported endpoints were assessments of body weight (68 trials, n = 11 561) followed by bioimpedance analysis (BIA)-based estimates (23 trials, n = 3140). Sixteen trials (n = 3052) included dual-energy X-ray absorptiometry (DEXA)-based endpoints, and computed tomography (CT) body composition was included in eight trials (n = 841). Discrepancies were evident when comparing the efficacy of interventions using BIA-based estimates of lean tissue mass against radiological assessment modalities. Body weight, BIA and DEXA-based endpoints have been most frequently used in cancer cachexia trials. Although the optimal endpoints cannot be determined from this review, body weight, alongside measurements from radiological body composition analysis, would seem appropriate. The choice of radiological modality is likely to be dependent on the trial setting, population and intervention in question. CT and magnetic resonance imaging, which have the ability to accurately discriminate tissue types, are likely to be more sensitive and provide greater detail. Endpoints are of particular importance when aligned with the intervention's mechanism of action and/or intended patient benefit.

• Yule, Michael S.; Thompson, Joshua; Leesahatsawat, Khachonphat; Sousa, Mariana S.; Anker, Stefan D. & Arends, Jann [Vis alle 26 forfattere av denne artikkelen] (2024). Biomarker endpoints in cancer cachexia clinical trials: Systematic Review 5 of the cachexia endpoint series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 15(3), s. 853–867. doi: 10.1002/jcsm.13491. Fulltekst i vitenarkiv Vis sammendrag

  Regulatory agencies require evidence that endpoints correlate with clinical benefit before they can be used to approve drugs. Biomarkers are often considered surrogate endpoints. In cancer cachexia trials, the measurement of biomarkers features frequently. The aim of this systematic review was to assess the frequency and diversity of biomarker endpoints in cancer cachexia trials. A comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990–2023) was completed. Eligible trials met the following criteria: adults (≥18 years), prospective design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a biomarker(s) as an endpoint. Biomarkers were defined as any objective measure that was assayed from a body fluid, including scoring systems based on these assays. Routine haematology and biochemistry to monitor intervention toxicity were not considered. Data extraction was performed using Covidence, and reporting followed PRISMA guidance (PROSPERO: CRD42022276710). A total of 5975 studies were assessed, of which 52 trials (total participants = 6522) included biomarkers as endpoints. Most studies (n = 29, 55.7%) included a variety of cancer types. Pharmacological interventions (n = 27, 51.9%) were most evaluated, followed by nutritional interventions (n = 20, 38.4%). Ninety-nine different biomarkers were used across the trials, and of these, 96 were assayed from blood. Albumin (n = 29, 55.8%) was assessed most often, followed by C-reactive protein (n = 22, 42.3%), interleukin-6 (n = 16, 30.8%) and tumour necrosis factor-α (n = 14, 26.9%), the latter being the only biomarker that was used to guide sample size calculations. Biomarkers were explicitly listed as a primary outcome in six trials. In total, 12 biomarkers (12.1% of 99) were used in six trials or more. Insulin-like growth factor binding protein 3 (IGFBP-3) and insulin-like growth factor 1 (IGF-1) levels both increased significantly in all three trials in which they were both used. This corresponded with a primary outcome, lean body mass, and was related to the pharmacological mechanism. Biomarkers were predominately used as exploratory rather than primary endpoints. The most commonly used biomarker, albumin, was limited by its lack of responsiveness to nutritional intervention. For a biomarker to be responsive to change, it must be related to the mechanism of action of the intervention and/or the underlying cachexia process that is modified by the intervention, as seen with IGFBP-3, IGF-1 and anamorelin. To reach regulatory approval as an endpoint, the relationship between the biomarker and clinical benefit must be clarified.

• McDonald, James; Sayers, Judith; Anker, Stefan D.; Arends, Jann; Balstad, Trude Rakel & Baracos, Vickie [Vis alle 29 forfattere av denne artikkelen] (2023). Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. doi: 10.1002/jcsm.13321. Fulltekst i vitenarkiv Vis sammendrag

  In cancer cachexia trials, measures of physical function are commonly used as endpoints. For drug trials to obtain regulatory approval, efficacy in physical function endpoints may be needed alongside other measures. However, it is not clear which physical function endpoints should be used. The aim of this systematic review was to assess the frequency and diversity of physical function endpoints in cancer cachexia trials. Following a comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990–2021), records were retrieved. Eligible trials met the following criteria: adults (≥18 years), controlled design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a physical function endpoint. Physical function measures were classified as an objective measure (hand grip strength [HGS], stair climb power [SCP], timed up and go [TUG] test, 6-min walking test [6MWT] and short physical performance battery [SPPB]), clinician assessment of function (Karnofsky Performance Status [KPS] or Eastern Cooperative Oncology Group-Performance Status [ECOG-PS]) or patient-reported outcomes (physical function subscale of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaires [EORTC QLQ-C30 or C15]). Data extraction was performed using Covidence and followed PRISMA guidance (PROSPERO registration: CRD42022276710). A total of 5975 potential studies were examined and 71 were eligible. Pharmacological interventions were assessed in 38 trials (54%). Of these, 11 (29%, n = 1184) examined megestrol and 5 (13%, n = 1928) examined anamorelin; nutritional interventions were assessed in 21 trials (30%); and exercise-based interventions were assessed in 6 trials (8%). The remaining six trials (8%) assessed multimodal interventions. Among the objective measures of physical function (assessed as primary or secondary endpoints), HGS was most commonly examined (33 trials, n = 5081) and demonstrated a statistically significant finding in 12 (36%) trials (n = 2091). The 6MWT was assessed in 12 trials (n = 1074) and was statistically significant in 4 (33%) trials (n = 403), whereas SCP, TUG and SPPB were each assessed in 3 trials. KPS was more commonly assessed than the newer ECOG-PS (16 vs. 9 trials), and patient-reported EORTC QLQ-C30 physical function was reported in 25 trials. HGS is the most commonly used physical function endpoint in cancer cachexia clinical trials. However, heterogeneity in study design, populations, intervention and endpoint selection make it difficult to comment on the optimal endpoint and how to measure this. We offer several recommendations/considerations to improve the design of future clinical trials in cancer cachexia.

• Gudmundstuen, Anne Marte; Efficace, Fabio; Tjønnfjord, Geir Erland; Skaarud, Kristin Aneta Joan; Cottone, Francesco & Hjermstad, Marianne Jensen [Vis alle 7 forfattere av denne artikkelen] (2023). The prognostic value of patient-reported outcomes in allogeneic hematopoietic stem cell transplantation: exploratory analysis of a randomized nutrition intervention trial. Annals of Hematology. ISSN 0939-5555. 102(4), s. 927–935. doi: 10.1007/s00277-023-05149-x. Fulltekst i vitenarkiv Vis sammendrag

  Whether patient-reported outcomes (PROs) can predict overall survival (OS) and non-relapse mortality (NRM) among recipients of allogeneic stem cell transplantation (allo-HSCT), is unclear. We performed an exploratory analysis of the prognostic value of patient-reported outcomes (PROs) among 117 recipients of allogeneic stem cell transplantation (allo-HSCT) who participated in a randomized nutrition intervention trial. Cox proportional hazards models were used to investigate possible associations between PROs collected pre-allo-HSCT (baseline) using scores from the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and 1-year overall survival (OS), whereas logistic regression was used to study associations between these PROs and 1-year non-relapse mortality (NRM). Multivariable analyses indicated that only the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and the European Bone Marrow Transplantation (EBMT) risk score were associated with 1-year OS. In the multivariable model including clinical-sociodemographic factors for 1-year NRM, our analysis showed that living alone (p=0.009), HCT-CI (p=0.016), EBMT risk score (p=0.002), and stem cell source (p=0.046) could be associated with 1-year NRM. Moreover, in the multivariable model, our analysis showed that only appetite loss from the QLQ-C30 was associated with 1-year NRM (p=0.026). In conclusion, in this specific setting, our analysis suggests that the commonly used HCT-CI and EBMT risk scores could be predictive for both 1-year OS and 1-year NRM, whereas baseline PROs in general were not.

• Rootwelt, Rebecca; Skovlund, Eva; Andreassen, Joakim Stray; Arvidsson, Lisa; Halvardson, Jonathan & Solheim, Ole Skeidsvoll [Vis alle 10 forfattere av denne artikkelen] (2023). Preoperative Prognostic Index for Patients with Brain Metastases—A Population-Based Multi-Centre Study. Cancers. 15(12). doi: 10.3390/cancers15123174. Fulltekst i vitenarkiv Vis sammendrag

  Background: Brain metastases (BM) are common in cancer patients and are associated with high morbidity and mortality. Surgery is an option, but the optimal selection of patients for surgery is challenging and controversial. Current prognostication tools are not ideal for preoperative prognostication. By using a reference population (derivation data set) and two external populations (validation data set) of patients who underwent surgery for BM, we aimed to create and validate a preoperative prognostic index. Methods: The derivation data set consists of 590 patients who underwent surgery for BM (2011–2018) at Oslo University Hospital. We identified variables associated with survival and created a preoperative prognostic index with four prognostic groups, which was validated on patients who underwent surgery for BM at Karolinska University Hospital and St. Olavs University Hospital during the same time period. To reduce over-fitting, we adjusted the index in accordance with our findings. Results: 438 patients were included in the validation data set. The preoperative prognostic index correctly divided patients into four true prognostic groups. The two prognostic groups with the poorest survival outcomes overlapped, and these were merged to create the adjusted preoperative prognostic index. Conclusion: We created a prognostic index for patients with BM that predicts overall survival preoperatively. This index might be valuable in supporting informed choice when considering surgery for BM.

• Gulbrandsen, Monica; Nøding, Ane Steen; Smeland, Knut Bjøro; Eikeland, Siri Asheim; Kiserud, Cecilie E. & Hjermstad, Marianne Jensen [Vis alle 7 forfattere av denne artikkelen] (2023). Health-related quality of life, depressive symptoms, and chronic fatigue in long-term survivors of Hodgkin lymphoma. Leukemia and Lymphoma. ISSN 1042-8194. 64(6), s. 1139–1150. doi: 10.1080/10428194.2023.2198053. Fulltekst i vitenarkiv Vis sammendrag

  High-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT) is the preferred treatment option in relapsed or refractory Hodgkin lymphoma (HL). We analyzed the association between treatment intensity and health-related quality of life (HRQoL), depressive symptoms, and chronic fatigue (CF) in long-term survivors of HL (HLS), identified in two population-based national cross-sectional studies on late adverse effects. We included 375 HLS treated between 1987 and 2006, 264 with conventional therapy only, and 111 with HDT-ASCT. Despite similar differences to the matched general population, when controlling for other imbalances between the groups, use of HDT-ASCT was not associated with poorer outcome in multivariable analysis. However, work participation, family income, comorbidities, and lifestyle factors had stronger associations with aspects of HRQoL, depressive symptoms, and CF. Our data suggest that better rehabilitation to work participation and adequate income as well as follow-up for comorbidities may reduce differences in long-term outcome after treatment for HL.

• Åsberg, Ragnhild Emilie; Nilsen, Marianne; Hjermstad, Marianne Jensen; Reinertsen, Kristin Valborg; Karlsen, Jarle & Giskeødegård, Guro F. [Vis alle 7 forfattere av denne artikkelen] (2023). Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45. European Journal of Cancer. ISSN 0959-8049. 190. doi: 10.1016/j.ejca.2023.112943. Fulltekst i vitenarkiv Vis sammendrag

  Objective The aim of this study was to provide sex-, age-, and morbidity-specific Norwegian general population normative values for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires QLQ-C30, the sexual health questionnaire QLQ-SHQ22 and the sexual domains of the breast modules QLQ-BR23 and QLQ-BR45. Methods A random nationwide sample stratified by sex and age groups (18–29, 30–39, 40–49, 50–59, 60–69 and ≥70 years) was drawn from the Norwegian National Population Register. Participants were notified through national online health services (HelseNorge) and postal mail. The survey included sociodemographic background information, health-related quality of life assessed by the EORTC questionnaires, and morbidity assessed by the Self-Administered Comorbidity Questionnaire. Multivariable linear regression was carried out to estimate the associations of age, sex and morbidity with the EORTC scale and item scores. Results Of the 15,627 eligible individuals, 5135 (33%) responded. Women and persons with morbidities reported lower functioning and higher symptom burden than men and persons without morbidities, respectively, on nearly all EORTC scales. Sex differences were most prominent for emotional functioning, pain, fatigue and insomnia (QLQ-C30), body image, sexual functioning (QLQ-BR23/45), importance of sexual activity, libido and fatigue (QLQ-SHQ22). The score differences between persons with and without morbidity were highly significant and largest in the youngest and middle-aged groups. Conclusion This is the first study to provide normative values for the EORTC sexual health questionnaire QLQ-SHQ22 and the sexual subscales of the QLQ-BR23 and QLQ-BR45 for all, separately in age groups by sex and morbidity.

• Smeland, Knut Bjøro; Holte, Harald; Fagerli, Unn-Merete; Bersvendsen, Hanne Skjerven; Hjermstad, Marianne Jensen & Loge, Jon Håvard [Vis alle 13 forfattere av denne artikkelen] (2022). Total late effect burden in long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplant and its effect on health-related quality of life. Haematologica. ISSN 0390-6078. 107(11), s. 2698–2707. doi: 10.3324/haematol.2021.280413. Fulltekst i vitenarkiv Vis sammendrag

  Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at risk of several late effects, which might impair their health-related quality of life (HRQoL). We assessed the total late effect burden in this population, and how it affects HRQoL. All lymphoma survivors treated with HDT-ASCT as adults in Norway between 1987 and 2008 were identified, and 271 (68%) attended both a comprehensive clinical assessment and completed a questionnaire. Severity of 45 conditions in 12 organ-system categories were graded as mild, moderate, severe or life-threatening, according to a modified version of CTCAEv4.03. At a median of 8 years after HDT-ASCT, 98% of survivors had at least one moderate or more severe late effect and 56% had severe or life-threatening late effects. Fourteen percent had low, 39% medium and 47% high late effect burden, defined as having moderate or more severe late effects in 0-1, 2-3 and >3 organsystems, respectively. Female sex, increasing age, B-symptoms at diagnosis and >1 treatment line prior to HDT-ASCT were independently associated with having high late effect burden. The survivors had significantly poorer physical and mental HRQoL assessed by the Short Form-36 compared to age- and sex-matched controls. The prevalence of poor physical and mental HRQoL increased with higher late effect burden (both P<0.001), and the low burden group had better physical HRQoL than controls (P<0.001). In conclusion, lymphoma survivors after HDT-ASCT have impaired HRQoL, seemingly driven by a high late effect burden. This highlights the importance of prevention, regular assessments for early detection and treatment of late effects and modifiable risk factors.

• Evensen, Helge; Hjermstad, Marianne Jensen; Småstuen, Milada Cvancarova; Kristensen, Vendel Ailin; Larssen, Lene & Skattum, Jorunn Pettersen [Vis alle 9 forfattere av denne artikkelen] (2022). Quality of life in patients with achalasia: Associations with Eckardt score and objective treatment outcomes after peroral endoscopic myotomy. Endoscopy International Open. 10(12). doi: 10.1055/a-1968-7682. Fulltekst i vitenarkiv Vis sammendrag

  Background and study aims Knowledge on self-reported quality of life (QoL) in achalasia and QoL improvements after peroral endoscopic myotomy (POEM) is limited. Furthermore, the clinical role of QoL in achalasia follow-up has not been evaluated. The present study aimed to examine QoL in achalasia patients before and after POEM and assess associations between QoL, Eckardt score (ES) and objective results. Patients and methods This was a single-center prospective study of treatment-naïve achalasia patients with 12-month follow-up after POEM including manometry, upper endoscopy, 24-hour pH registration, and timed barium esophagogram. QoL data were registered using European Organisation for Research and Treatment of Cancer core questionnaire (QLQ-C30) and esophageal module (QLQ-OES18). Comparison with a reference population was performed to assess impact of achalasia on QoL and effect of therapy. Mixed models for repeated measures were applied. Results Fifty patients (26 females) with a median age of 47 years (18-76) were included. Before treatment, all QoL domains were significantly impaired compared with an age- and gender-adjusted reference population ( P < 0.05). No significant QoL-differences were found after POEM, except for fatigue and nausea/vomiting. Clinically relevant QoL improvement was observed in ≥ 50 % of the patients in all QoL domains, except for physical and role functioning. QoL was significantly associated with ES ( P < 0.05) but not with objective results. Conclusions Achalasia is associated with severe QoL impairment. Following POEM, a significant and clinically relevant QoL improvement is observed. QoL is associated with ES, but not with objective results after POEM. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

• Jakobsen, Gunnhild; Gjeilo, Kari Hanne; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers. 14(16), s. 3933–3933. doi: 10.3390/cancers14163933. Fulltekst i vitenarkiv Vis sammendrag

  Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.

• Jakobsen, Gunnhild; Sjue, Karin; Paulsen, Ørnulf; Kaasa, Stein; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Supportive Care in Cancer. ISSN 0941-4355. 31. doi: 10.1007/s00520-022-07537-x. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. Methods: A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). Results: Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). Conclusion: Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer.

• Kosgallana, Shamini; Jayasekara, Prasanna; Abeysinghe, Prasad; Hjermstad, Marianne Jensen & Lalloo, Ratilal (2022). Translation and validation of Sinhala version of modified EORTC QLQ-OH15 in oral cancer patients who receive radiotherapy with or without chemotherapy in Sri Lanka. BMC Oral Health. 22(1). doi: 10.1186/s12903-022-02392-y. Fulltekst i vitenarkiv Vis sammendrag

  Background The recognition of patient-reported outcomes for oral cancer is important in improving patients’ quality of life. The aim of this study was to translate and validate the modified Sinhala version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oral Health Module (EORTC QLQ-OH15). Methods A cross-sectional study was conducted to validate the EORTC QLQ-OH15 that was modified after adding two questions to the original questionnaire. The two questions added were ‘difficulty in opening the mouth wide’ and ‘trouble with talking’ which affect oral health related quality of life (OHRQOL) of oral cancer patients receiving radiotherapy. The Sinhala translated modified EORTC QLQ-OH15 and already validated the core questionnaire EORTC QLQ-C30 were self-completed by 85 adult oral cancer patients who received initial anti-cancer treatment with radiotherapy with or without chemotherapy. Content and face validity were examined by an expert panel. Construct validity was confirmed by using factor analysis, multi-trait scaling analysis, and known group comparison. Reliability was assessed by internal consistency, test–retest reliability by Wilcoxon Signed Ranks Test and intra class correlation coefficient. Responsiveness to change was assessed. Results The majority of participants (58%) were aged 50–69 years and 84% were males. Nearly 32% had cancer of the anterior two thirds of the tongue. Of the sample, 66% received chemo radiotherapy. Thirteen items were included for the factor analysis. They were loaded for four factors. Three scales ‘Eating problem’, ‘Gum and Speech problem’ and ‘Soreness’ loaded with 5, 4 and 3 items respectively and single item ‘teeth’ to a one factor with the total variance explained was 72.74%. Mann–Whitney U tests for all three scales were statistically significant confirming the ability of the modified EORTC QLQ-OH15 to detect expected differences in OHRQOL in clinically different groups. Cronbach’s alpha for all the scales were more than 0.8. Wilcoxon Matched Paired Sign Rank Test showed highly significant results (p < 0.05) for all three scales revealing high responsiveness. Conclusions The modified Sinhala version of the EORTC QLQ-OH15 is a valid, reliable tool that can be used to measure OHRQOL in oral cancer patients who receive radiotherapy with or without chemotherapy.

• Bye, Asta; Bjerkeset, Ellen; Stensheim, Hanne; Loge, Jon Håvard; Hjermstad, Marianne Jensen & Klepstad, Pål [Vis alle 9 forfattere av denne artikkelen] (2022). Benefits of Study Participation for Patients with Advanced Cancer Receiving Radiotherapy: A Prospective Observational Study. Palliative Medicine Reports (PMR). 3(1), s. 264–271. doi: 10.1089/pmr.2022.0044. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with advanced cancer and bone metastases may have unmet palliative care (PC) needs that go unnoticed during clinical oncological practice. This observational study describes interventions that were initiated as the patients participated in the Palliative Radiotherapy and Inflammation Study (PRAIS). It was hypothesized that the patients would benefit from study participation due to PC interventions initiated by the study team. Methods: A retrospective review of patients' electronic records. Patients with advanced cancer and painful bone metastases included in PRAIS were eligible. All patients met with the study team before start of radiotherapy, after completion of Patient Reported Outcome Measures. Interventions initiated by the study team were documented in the patients' electronic records. Results: A total of 133 patients were reviewed: 63% males, mean (standard deviation [SD]) age 65 (9.6) and mean (SD) Karnofsky performance status (KPS) score 73.2 (9.1). Interventions were initiated in 50% (n = 67) of the patients. Changes in opioid management (69%), treatment of constipation (43%), and nausea (24%) and nutritional advice were most frequent (21%). Patients receiving interventions had lower mean KPS (70 vs. 77 p < 0.001), shorter survival time after study inclusion (median 28 vs. 57.5 weeks p = 0.005) and were more often opioid naïve (12% vs. 39% p < 0.001) than those not receiving interventions by the study team. Conclusions: Patients with advanced cancer and painful bone metastasis benefited from study participation due to multiple PC interventions initiated by the study team. The findings call for a systematic integration of PC in patients with advanced cancer.

• Nielsen, Hans Jørgen; Nedrebø, Bjørn Gunnar; Fosså, Alexander; Andersen, John Roger; Assmus, Jörg & Dagsland, Vigdis Halvorsen [Vis alle 15 forfattere av denne artikkelen] (2022). Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy. International Journal of Obesity. ISSN 0307-0565. 46(4), s. 739–749. doi: 10.1038/s41366-021-01028-5. Fulltekst i vitenarkiv Vis sammendrag

  Background/objectives There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.

• Schei, Stine; Solheim, Ole; Salvesen, Øyvind; Hjermstad, Marianne Jensen; Bouget, David Nicolas Jean-Marie & Sagberg, Lisa Millgård (2022). Pretreatment patient-reported cognitive function in patients with diffuse glioma. Acta Neurochirurgica. ISSN 0001-6268. 164, s. 703–711. doi: 10.1007/s00701-022-05126-9. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Cognitive function is frequently assessed with objective neuropsychological tests, but patient-reported cognitive function is less explored. We aimed to investigate the preoperative prevalence of patient-reported cognitive impairment in patients with diffuse glioma compared to a matched reference group and explore associated factors. Methods: We included 237 patients with diffuse glioma and 474 age- and gender-matched controls from the general population. Patient-reported cognitive function was measured using the cognitive function subscale in the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. The transformed scale score (0–100) was dichotomized, with a score of ≤ 75 indicating clinically important patient-reported cognitive impairment. Factors associated with preoperative patient-reported cognitive impairment were explored in a multivariable regression analysis. Results: Cognitive impairment was reported by 49.8% of the diffuse glioma patients and by 23.4% in the age- and gender-matched reference group ( p  < 0.001). Patients with diffuse glioma had 3.2 times higher odds (95% CI 2.29, 4.58, p  < 0.001) for patient-reported cognitive impairment compared to the matched reference group. In the multivariable analysis, large tumor volume, left tumor lateralization, and low Karnofsky Performance Status score were found to be independent predictors for preoperative patient-reported cognitive impairment. Conclusions: Our findings demonstrate that patient-reported cognitive impairment is a common symptom in patients with diffuse glioma pretreatment, especially in patients with large tumor volumes, left tumor lateralization, and low functional levels. Patient-reported cognitive function may provide important information about patients’ subjective cognitive health and disease status and may serve as a complement to or as a screening variable for subsequent objective testing.

• Rootwelt, Rebecca; Hjermstad, Marianne Jensen; Skovlund, Eva; Aass, Nina Kathrine; Helseth, Eirik & Kaasa, Stein [Vis alle 8 forfattere av denne artikkelen] (2022). Surgery for brain metastases—impact of the extent of resection. Acta Neurochirurgica. ISSN 0001-6268. 164, s. 2773–2780. doi: 10.1007/s00701-021-05104-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Surgical resection of brain metastases improves symptoms and survival in selected patients. The benefit of gross total resection is disputed, as most patients are believed to succumb from their non-CNS tumor burden. We investigated the association between overall survival and residual tumor after surgery for single brain metastases. Methods We reviewed adults who underwent surgery for a single brain metastasis at a regional referral center (2011–2018). Gross total resection was defined as no visible residual tumor on cerebral MRI 12–48 h postoperatively. Results We included 373 patients. The most common primary tumors were lung cancer (36%) and melanoma (24%). We identified gross total resection in 238 patients (64%). Median overall survival was 11.0 months, 8.0 (6.2–9.8) months for patients with subtotal resection and 13.0 (9.7–16.3) months for patients with gross total resection. In a multivariate regression analysis including preoperative prognostic factors, gross total resection was associated with longer overall survival (HR: 0.66, p = 0.003). Postoperative radiotherapy administered within 6 weeks did not significantly alter the hazard ratio estimates for grade of resection. Conclusions Our study suggests improved survival with gross total resection compared to subtotal resection. The importance of extent of resection in surgery for brain metastases should not be discarded.

• Lundeby, Tonje; Finset, Arnstein; Kaasa, Stein; Wester, Torunn Elin; Hjermstad, Marianne Jensen & Dajani, Olav [Vis alle 8 forfattere av denne artikkelen] (2022). A complex communication skills training program for physicians providing advanced cancer care–content development and barriers and solutions for implementation. Journal of Communication in Healthcare. ISSN 1753-8068. doi: 10.1080/17538068.2022.2039468. Fulltekst i vitenarkiv Vis sammendrag

  Background : Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article. Methods : A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer. Results : The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians’ communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training.

• Gullhaug, Anna; Hjermstad, Marianne Jensen; Yri, Olav Erich; Svestad, Jørund Graadal; Aass, Nina Kathrine & Johansen, Safora (2021). Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study. Journal of Medical Imaging and Radiation Sciences. ISSN 1939-8654. 52(2), s. 214–222. doi: 10.1016/j.jmir.2021.01.002. Fulltekst i vitenarkiv Vis sammendrag

  Aim: To analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases. Methods: Breast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital’s RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed. Results: 255 females with WBRT (n 1⁄4 206) or SRS (n 1⁄4 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT frac- tionation regimen was 3 Gy 10. SRS was most often single frac- tions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1–73) relative to 23 (CI 0–78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metas- tases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis. Conclusion: WBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were asso- ciated with superior OS in multivariate analysis.

• Karlsson, Astrid Telhaug; Hjermstad, Marianne Jensen; Omdahl, Therese; Aass, Nina Kathrine; Skovlund, Eva & Hellebust, Taran Paulsen [Vis alle 9 forfattere av denne artikkelen] (2021). Overall survival after initial radiotherapy for brain metastases; a population based study of 2140 patients with non-small cell lung cancer. Acta Oncologica. ISSN 0284-186X. 60(8), s. 1054–1060. doi: 10.1080/0284186X.2021.1924399. Fulltekst i vitenarkiv Vis sammendrag

  Background Brain metastases (BM) occur in about 30% of all patients with non-small cell lung cancer (NSCLC). BM treatment guidelines recommend more frequent use of stereotactic radiotherapy (SRT). Overall, studies report no difference in overall survival (OS) comparing SRT to whole-brain radiotherapy (WBRT). We examined survival after radiotherapy for BM in a population-based sample from the South-Eastern Norway Regional Health Authority treated 2006-2018. Methods We reviewed electronic medical records of 2140 NSCLC patients treated with SRT or WBRT for BM from 2006–2018. Overall survival (OS) was compared to predicted survival according to the prognostic systems DS-GPA and Lung-molGPA. Results Use of SRT increased during the period, from 19% (2006–2014) to 45% (2015–2018). Median OS for all patients was 3.0 months, increasing from 2.0 (2006) to 4.0 (2018). Median OS after SRT was 7.0 months (n = 435) and 3.0 months after WBRT (n = 1705). Twenty-seven percent of SRT patients and 50% of WBRT patients died within 90 days after start of RT. Age ≥70, male sex, KPS ≤70, non-adenocarcinoma histology, ECM present, multiple BM, and WBRT were associated with shorter survival (p < .001). Actual mOS corresponded best with predicted mOS by DS-GPA and Lung-molGPA for the SRT group. Conclusion Overall survival after radiotherapy (RT) for BM improved during the study period, but only for patients treated with SRT. Survival after WBRT remains poor; its use should be questioned. DS-GPA and Lung-molGPA seem most useful in predicting prognosis considered for SRT.

• Rootwelt, Rebecca; Vik-Mo, Einar Osland; Yri, Olav Erich; Aass, Nina Kathrine; Kaasa, Stein & Skovlund, Eva [Vis alle 8 forfattere av denne artikkelen] (2021). Surgery for brain metastases – real-world prognostic factors’ association with survival. Acta Oncologica. ISSN 0284-186X. 60(9), s. 1161–1168. doi: 10.1080/0284186X.2021.1930150. Fulltekst i vitenarkiv Vis sammendrag

  Background Surgical resection of brain metastases (BM) improves overall survival (OS) in selected patients. Selecting those patients likely to benefit from surgery is challenging. The Graded Prognostic Assessment (GPA) and the diagnosis-specific Graded Prognostic Assessment (ds-GPA) were developed to predict survival in patients with BM, but not specifically to guide patient selection for surgery. Our aim was to evaluate the feasibility of preoperative GPA/ds-GPA scores and assess variables associated with OS. Methods We retrospectively reviewed first-time surgical resection of BM from solid tumors at a Norwegian regional referral center from 2011 to 2018. Results Of 590 patients, 51% were female and median age was 63 years. Median OS was 10.3 months and 74 patients (13%) died within three months after surgery. Preoperatively tumor origin was unknown in 20% of patients. A GPA score could be calculated for 92% of the patients preoperatively, but could not correctly predict survival. A ds-GPA score could be calculated for 46% of patients. Multivariable regression analysis revealed shorter OS in patients with higher age, worse functioning status, colorectal primary cancer compared to lung cancer, presence of extracranial metastases, and more than four BM. Patients with preoperative progressive extracranial disease or synchronous BM had shorter OS compared to patients with stable extracranial disease. Conclusion Ds-GPA could be calculated in less than half of patients preoperatively and GPA poorly identified patients which had minimal benefit of surgery. Including status of extracranial disease improve prognostication and therefore selection to surgery for brain metastases.

• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Rosland, Jan Henrik; Aass, Nina Kathrine & Albert, Eva [Vis alle 10 forfattere av denne artikkelen] (2021). 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. 29(4), s. 2047–2055. doi: 10.1007/s00520-020-05693-6. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Hjermstad, Marianne Jensen; Hamfjord, Julian; Aass, Nina Kathrine; Dajani, Olav; Lundeby, Tonje & Wester, Torunn Elin [Vis alle 7 forfattere av denne artikkelen] (2021). Using process indicators to monitor documentation of patient-centred variables in an integrated oncology and palliative care pathway—results from a cluster randomized trial. Cancers. 13(9), s. 1–16. doi: 10.3390/cancers13092194. Fulltekst i vitenarkiv Vis sammendrag

  Background. Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single–centre process evaluation monitors documentation of required patient-centred variables during an RCT. Methods. Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. Results. 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3–100%), relative to 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. Conclusions. The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus.

• Koller, Michael; Shamieh, Omar; Hjermstad, Marianne Jensen; HORNSLIEN, KJERSTI; Young, Teresa & Chalk, Tara [Vis alle 25 forfattere av denne artikkelen] (2020). Psychometric properties of the updated EORTC module for assessing quality of life in patients with lung cancer (QLQ-LC29): an international, observational field study. The Lancet Oncology. ISSN 1470-2045. 21(5), s. 723–732. doi: 10.1016/S1470-2045(20)30093-0. Fulltekst i vitenarkiv Vis sammendrag

  Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) assesses quality of life (QOL) in patients with lung cancer and was the first EORTC module developed for use in international clinical trials. Since its publication in 1994, major treatment advances with possible effects on QOL have occurred. These changes called for an update of the module and its international psychometric validation. We aimed to investigate the scale structure and psychometric properties of the updated lung cancer module, QLQ-LC29, in patients with lung cancer. Methods This international, observational field study was done in 19 hospitals across 12 countries. Patients aged older than 18 years with a confirmed diagnosis of lung cancer and no other previous primary tumour, and who were mentally fit with sufficient language skills to understand and complete the questionnaire were included. Patients were asked during a hospital visit to fill in the paper versions of the core questionnaire EORTC QLQ-C30 plus QLQ-LC29, and investigators selected half of these patients to complete the questionnaire again 2–4 weeks later. Our primary aim was to assess the scale structure and psychometric properties of EORTC QLQ-LC29. We analysed scale structure using confirmatory factor analysis; reliability using Cronbach's α value (internal consistency) and intra-class coefficient (test–retest reliability); sensitivity using independent t tests stratified by Karnofsky performance status; and responsiveness to change over time by ANOVA. This study is registered with ClinicalTrials.gov, NCT02745691. Findings Between April 12, 2016, and Sept 26, 2018, 523 patients with a confirmed diagnosis of either non-small-cell lung cancer (n=442) or small-cell lung cancer (n=81) were recruited. Confirmatory factor analysis provided a solution composed of five multi-item scales (coughing, shortness of breath, fear of progression, hair problems, and surgery-related symptoms) plus 15 single symptom or side-effect items: χ2=370·233, root mean square error of approximation=0·075, and comparative-fit index=0·901. Cronbach's α for internal consistencies of all multi-item scales were above the threshold of 0·70. Intra-class coefficients for test–retest reliabilities ranged between 0·82 and 0·97. Three (shortness of breath, fear of progression, and hair problems) of the five multi-item scales showed responsiveness to change over time (p values <0·05), as did nine of 15 single symptom items. Four (coughing, shortness of breath, fear of progression, and surgery-related symptoms) of the five multi-item scales and ten of the 15 single symptom items were sensitive to known group differences (ie, lower vs higher Karnofsky performance status). Interpretation Results determined the psychometric properties of the updated lung cancer module, which is ready for use in international clinical studies.

• Ekström, Magnus P.; Palmqvist, Sebastian; Currow, David C.; Sjøgren, Per; Kurita, Geana Paula & Jakobsen, Gunnhild [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Context Patients with advanced cancer commonly suffer from both distressing symptoms and cognitive impairment, but the effect of cognitive impairment on the reliability and validity of symptom self-report is unknown. Objectives To evaluate the reliability and validity of symptom self-report in cancer outpatients with and without mild to moderate cognitive impairment. Methods This was an analysis of the longitudinal European Palliative Care Cancer Symptom study of adults with incurable cancer in specialized palliative care (30 centers across 12 countries). Patients who could not comply with the study because of severe cognitive impairment were excluded. Cognitive status on the Mini-Mental State Examination short version and nine symptoms (pain, tiredness, drowsiness, nausea, appetite, breathlessness, depression, anxiety, and well-being) using the revised Edmonton Symptom Assessment System were self-reported at baseline and one-month follow-up. Reliability was analyzed using intraclass correlation coefficients and validity using regression of each symptom with health-related quality of life (HrQoL) measured with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care. Results A total of 1047 patients were included: mean age of 62.9 years; 54.4% women; main cancer types were of digestive organs (26.6%), breast (21.6%), and lungs (21.2%). Cognitive impairment was present in 181 (17.3%) at baseline and associated with worse self-reported tiredness, drowsiness, appetite, and depression. Reliability (intraclass correlation coefficient) and validity (associations with HrQoL) were similar between people with/without cognitive impairment across the nine symptoms, except breathlessness, which showed a weaker relation to HrQoL in patients with cognitive impairment. Findings were robust in sensitivity analyses and after controlling for potential confounders. Conclusion In advanced cancer, self-report of nine major symptoms was reliable and valid also in people with mild-to-moderate cognitive impairment.

• Beisland, Elisabeth Grov; Hauge, Elen Martine; Aarstad, Anne Kari Hersvik; Hjermstad, Marianne Jensen; Aarstad, Hans Jørgen & Beisland, Christian (2020). Personality and educational level determine self-reported health-related quality-of-life and distress in patients with renal tumors awaiting radical surgery. Scandinavian Journal of Urology. ISSN 2168-1805. 54(4), s. 304–312. doi: 10.1080/21681805.2020.1773528. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Data on preoperative distress and health-related quality-of-life (HRQoL) is lacking for patients with newly diagnosed renal tumors. This study aims to compare HRQoL within this group with the general population and to study the relationship between distress, HRQoL, personality, coping, and patient/tumor-related factors. Materials and methods: Between January 2011 and June 2014, 153 patients (100 males/53 females), scheduled for surgery were prospectively included. Distress was determined by the General Health Questionnaire (GHQ), HRQoL by EORTC-QLQ-C30 questionnaire, personality by Eysenck Personality Inventory and coping by COPE questionnaire. HRQoL-data from an age and gender matched Norwegian reference population was used for comparison. Results: The study patients had significantly poorer HRQoL than the reference population. GHQ and HRQoL sum scores had a common variance (CV = r2) of 29–35%. In regression models, the measured variables accounted for 33% of the variance for the GHQ score. Significant predictors of the measured variance were neuroticism (18%), education level (3%) and avoidant coping (2%). Similarly, the measured variables accounted for 33–44% of the variance for the HRQoL sum scores. For all HRQoL sum scores, neuroticism predicted 17–28%, while education predicted 4–11% of the measured variance. Large tumor size, comorbidity, performance status and CRP predicted 2–7% of individual sum scores. Conclusions: For both preoperative distress and HRQoL, personality traits such as neuroticism and education level were the most important predictors. Tumor-related factors and other preexisting conditions seemed to be of lesser importance. Thus, preoperatively screening of psychological factors could be helpful to identify those at risk of poor outcomes.

• Koch, Myriam; Hjermstad, Marianne Jensen; Tomaszewski, Krzysztof A.; Tomaszewska, Iwona M.; Hornslien, Kjersti & Harle, Amelie [Vis alle 20 forfattere av denne artikkelen] (2020). Gender effects on quality of life and symptom burden in patients with lung cancer: Results from a prospective, cross-cultural, multi-center study. Journal of Thoracic Disease (JTD). ISSN 2072-1439. 12(8), s. 4253–4261. doi: 10.21037/jtd-20-1054. Fulltekst i vitenarkiv
• Dahl, Alv A; Grotmol, Kjersti Støen; Hjermstad, Marianne Jensen; Kiserud, Cecilie E. & Loge, Jon Håvard (2020). Norwegian reference data on the Fatigue Questionnaire and the Patient Health Questionnaire-9 and their interrelationship. Annals of General Psychiatry. 19:60, s. 1–9. doi: 10.1186/s12991-020-00311-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Population-based reference data on frequently used questionnaires are important for comparative purposes. Due to changes in health and lifestyles, such data should be updated every other decade. The objectives of this study were to establish Norwegian population-based reference data on the Fatigue Questionnaire (FQ) and the Patient Health Questionnaire-9 (PHQ-9) on depression, to compare the FQ-scores with our previous reference data from 1996, and to explore the relationship between the scores on these two instruments. Methods In 2015, a representative sample of 6,012 Norwegians aged 18–80 years was mailed a questionnaire including the FQ and the PHQ-9, and 36% responded. Complete FQ-scores were delivered by 2,041 subjects, and complete PHQ-9 scores by 2,086 subjects. The scores are displayed according to sex and 10-year age groups. Results Few 2015 mean scores of mental, physical, and total fatigue differed significantly from those of 1996, and the same was found for the prevalence rates of chronic fatigue. The exception was a significantly lower prevalence in 2015 of mean fatigue scores and prevalence of chronic fatigue in females ≥ 60 years. The prevalence of major depressive episode (MDE) based on the PHQ-9 sum score cut-off ≥ 10 was 5.9% for males and 9.8% for females, and 2.5% and 3.8% using a DSM-based algorithm with at least five endorsed criteria including either anhedonia or depressed mood. The correlation between the FQ and the PHQ-9 was 0.59, implying 36% shared variance. Conclusions This study showed considerable interrelationship between the FQ and the PHQ-9 constructs. The reference data show that scores on the FQ have only improved significantly in persons aged 60 or more years between 1996 and 2015. Our prevalence findings of MDE based on the PHQ-9 are in accordance with the findings from other countries. The FQ and the PHQ-9 should be used together in epidemiological and clinical studies.

• Krogstad, Hilde; Loge, Jon Håvard; Grotmol, Kjersti S.; Kaasa, Stein; Kiserud, Cecilie E. & Salvesen, Øyvind [Vis alle 7 forfattere av denne artikkelen] (2020). Symptoms in the general Norwegian adult population - prevalence and associated factors. BMC Public Health. 20(988). doi: 10.1186/s12889-020-09109-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Patients´ own perceptions and evaluations of symptoms, functioning and other health-related factors, i.e. Patient Reported Outcomes (PROs), are important elements for providing good patient care. Symptoms are subjective and best elicited by the patient orally or by using PRO measures (PROMs), be it on paper, or as electronic assessment tools. Reference values on frequently used PROMs facilitate the interpretation of scores for use in clinics and research settings, by comparing patient data with relevant samples from the general population. Study objectives were to (1) present reference values for the M.D. Anderson Symptom Inventory (MDASI) (2) examine the occurrence and intensity of symptoms assessed by the MDASI in a general Norwegian adult population sample, and (3) examine factors associated with higher symptom burden defined as the sum score of all symptoms, and factors associated with symptoms` interference on functions. Methods In 2015, MDASI was sent by mail as part of a larger survey, to a representative sample of the general Norwegian adult population (N = 6165). Medical comorbidities were assessed by the Self-Administered Comorbidity Questionnaire. Depression was self-reported on the Patient Health Questionnaire 9 (PHQ-9). Linear multivariable regression analysis was used to examine for factors associated with MDASI sum score and factors associated with symptoms’ interference on functions. Results The response rate was 36%. More women (54%) than men (46%) responded. Mean age was 55 years (SD 14). The most frequent symptoms were fatigue (59.7%), drowsiness (56.2%) and pain (56.1%). Fatigue, pain and disturbed sleep had the highest mean scores. The presence of one or more comorbidities, increasing PHQ-9 score and lower level of education were associated with higher MDASI sum score (p < 0.001). The MDASI sum score and the PHQ-9 score were positively associated with all interference items (p < 0.001) except for walking (p = 0.22). Conclusion This study provides the first Norwegian reference values for MDASI. The presence of one or more comorbidities, higher level of depressive symptoms and lower level of education were significantly associated with higher MDASI sum score. These covariates must be controlled for when using the reference values.

• Kirkhus, Lene; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2019). Frailty identified by geriatric assessment is associated with poor functioning, high symptom burden and increased risk of physical decline in older cancer patients: Prospective observational study. Palliative Medicine. ISSN 0269-2163. 33(3), s. 312–322. doi: 10.1177/0269216319825972. Fulltekst i vitenarkiv Vis sammendrag

  Background: Maintaining quality of life including physical functioning is highly prioritized among older cancer patients. Geriatric assessment is a recommended approach to identify patients with increased vulnerability to stressors (frailty). How frailty affects quality of life and physical functioning in older cancer patients has scarcely been investigated. Aim: Focusing on physical functioning and global quality of life, we investigated whether frailty identified by a geriatric assessment was associated with higher risk of quality-of-life deterioration during cancer treatment and follow-up. Design: Prospective, observational study. Patients were classified as frail or non-frail by a modified geriatric assessment. Quality of life was measured using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at inclusion, 2, 4, 6 and 12 months. Setting: Eight Norwegian outpatient cancer clinics. Participants: Patients ⩾70 years with solid tumours referred for palliative or curative systemic medical cancer treatment. Results: Among 288 patients included, 140 (49%) were frail and 148 (51%) non-frail. Frail patients consistently reported poorer scores on all functioning and symptom scales. Independent of age, gender and major cancer-related factors, frail patients had significantly poorer physical functioning and global quality of life during follow-up, and opposed to non-frail patients they had both a clinically and statistically significant decline in physical functioning from baseline until 12 months. Conclusions: Geriatric assessment identifies frail patients with increased risk of physical decline, poor functioning and high symptom burden during and following cancer treatment. Frail patients should therefore receive early supportive or palliative care.

• Jakobsen, Gunnhild; Engstrøm, Morten; Thronæs, Morten; Løhre, Erik Torbjørn; Kaasa, Stein & Fayers, Peter [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Although patients with advanced cancer report poor sleep quality, few studies have assessed sleep quality with a combination of subjective and objective measures. We aimed to examine sleep quality in hospitalized patients with advanced cancer by combining patient-reported outcome-measures (PROMs) and polysomnography (PSG) or actigraphy. Methods A one-night prospective observational study of sleep in hospitalized patients with metastatic cancer using WHO step III opioids was conducted. Total sleep time, sleep onset latency, number of awakenings, and wake after sleep onset were assessed by PROMs and actigraphy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) (range; 0–21), where higher scores indicate worse sleep quality. Results Forty patients were monitored. Median age was 70, median oral morphine equivalent dose was 80 mg/24 h (10–1725), median Karnofsky Performance Score was 50 (20–90), and median time to death from inclusion was 38 days (4–319). Mean PSQI score was 6.5 (SD ± 3.4). PROMs and actigraphy of mean (SD) sleep onset latency were 46 (± 64) and 35 min (± 61), respectively, while mean time awake at night was 37 (± 35) and 40 min (± 21). PROMs and actigraphy differed on number of awakenings (mean 2 (± 1) vs. 24 (± 15), p ˂ 0.001). Bland-Altman plots showed large individual differences between PROMs and actigraphy. PSG was not feasible. Conclusions PROMs and actigraphy documented poor sleep quality, but a lack of agreement across methods. The study demonstrates a need to improve assessment of sleep quality and treatment of sleep disturbance in hospitalized patients with advanced cancer near end of life.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  Performance status, a predictor of cancer survival, and ability to maintain independent living deteriorate in advanced disease. Understanding predictors of performance status trajectory could help identify those at risk of functional deterioration, target support for independent living and reduce service costs. The relationship between symptoms, analgesics and performance status is poorly delineated. The aim of this study is to determine whether demographics, analgesics, disease characteristics, quality-of-life domains and C-reactive protein predict the trajectory of Karnofsky Performance Status (KPS) in patients with advanced cancer. The study design is the secondary data analysis of the international prospective, longitudinal European Palliative Care Cancer Symptom study (ClinicalTrials.gov: NCT01362816). A multivariable regression model was built for KPS area under the curve per day (AUC). Setting and participants: This included adults with advanced, incurable cancer receiving palliative care, without severe cognitive impairment and who were not imminently dying ( n = 1739). The mean daily KPS AUC ( n = 1052) was 41.1 (standard deviation = 14.1). Opioids ( p &lt; 0.001), co-analgesics ( p = 0.023), poorer physical functioning ( p &lt; 0.001) and appetite loss ( p = 0.009) at baseline were explanatory factors for lower KPS AUC. A subgroup analysis of participants with C-reactive protein data ( n = 240) showed that only C-reactive protein ( p = 0.040) and physical function ( p &lt; 0.001) were associated with lower KPS AUC. This study is novel in determining explanatory factors for subsequent functional trajectories in an international dataset and identifying systemic inflammation as a candidate therapeutic target to improve functional performance. The effect of interventions targeting physical function, appetite and inflammation, such as those used for cachexia management, on maintaining functional status in patients with advanced cancer needs to be investigated.

• Sigurdardottir, Katrin Rut; Hjermstad, Marianne Jensen; Filbet, Marilene; Tricou, Colombe; McQuillan, Regina & Costantini, Massimo [Vis alle 9 forfattere av denne artikkelen] (2019). Pilot testing of the first version of the European Association for Palliative Care basic dataset: A mixed methods study. Palliative Medicine. ISSN 0269-2163. 33(7), s. 832–849. doi: 10.1177/0269216319844439. Fulltekst i vitenarkiv Vis sammendrag

  Background: Inadequate description of palliative care cancer patients in research studies often leads to results having limited generalizability. To standardize the description of the sample, the European Association for Palliative Care basic data set was developed, with 31 core demographic and disease-related variables. Aim: To pilot test the data set to check acceptability, comprehensibility and feasibility. Design: International, multi-centre pilot study at nine study sites in five European countries, using mixed methods. Setting/participants: Adult cancer patients and staff in palliative care units, hospices and home care. Results: In all, 191 patients (544 screened) and 190 health care personnel were included. Median time to fill in the patient form was 5 min and the health care personnel form was 7 min. Ethnicity was the most challenging item for patients and requires decisions at a national level about whether or how to include. Health care personnel found weight loss, principal diagnosis, additional diagnoses and stage of non-cancer diseases most difficult to respond to. Registration of diagnoses will be changed from International Statistical Classification of Diseases and Related Health Problems, 10th version code to a predefined list, while weight loss and stage of non-cancer diseases will be removed. The pilot study has led to rewording of items, improvement in response options and shortening of the data set to 29 items. Conclusion: Pilot testing of the first version of the European Association for Palliative Care basic data set confirmed that patients and health care personnel understand the questions in a consistent manner and can answer within an acceptable timeframe. The pilot testing has led to improvement, and the new version is now subject to further testing. Keywords Neoplasms, palliative care, patient outcome assessment, questionnaire design, standards, data set, pilot study

• Habberstad, Ragnhild H; Hjermstad, Marianne Jensen; Brunelli, Cinzia; Kaasa, Stein; Bennett, Michael I & Pardon, Koen [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Explore clinical factors associated with higher pain intensity and future pain in patients with bone metastases to identify patients who can benefit from closer follow-up or pain-modifying interventions. Methods This is a secondary analysis of 606 patients with bone metastases included in a multicenter longitudinal study. The dependent variables were “average pain” and “worst pain” in the last 24 h (0–10 NRS). Twenty independent variables with potential association to pain intensity were selected based on previous literature. Cross-sectional analyses were performed with multiple linear regression to explore factors associated with pain intensity at baseline. Longitudinal data were analyzed with a generalized equation models to explore current factors associated with pain intensity at the next visit in 1 month. Results Current pain intensity (p < 0.001), sleep disturbances (p 0.01 and 0.006), drowsiness (p 0.003 and 0.033) and male gender (p 0.045 and 0.001) were associated with higher average and worst pain intensity in 1 month. In addition, breakthrough pain was related to higher worst pain intensity (p 0.003) in 1 month. The same variables were also associated with higher average pain intensity at baseline. Conclusion Higher current pain intensity, sleep disturbances, drowsiness, male gender, and breakthrough pain are factors associated with higher pain intensity in patients with bone metastases at the next follow-up in 1 month. These factors should be assessed in clinical practice and may aid clinicians in identifying patients that can benefit from closer follow-up or interventions to prevent lack of future pain control.

• Verkissen, Mariëtte N.; Hjermstad, Marianne Jensen; Belle, Simon van; 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. 14:e022988(10), s. 1–16. doi: 10.1371/journal.pone.0222988. Fulltekst i vitenarkiv Vis sammendrag

  Background People with advanced cancer experience multiple symptoms during their illness trajectory, which can fluctuate in intensity. Aim To describe the course of self-reported quality of life, emotional functioning, physical functioning and symptom intensity over time in cancer patients receiving palliative care. Design Longitudinal study with monthly assessments, using the EORTC QLQ-C15-PAL. Data were analysed (1) prospectively, from baseline to ≥8-month follow-up; and (2) retrospectively, by taking death as index date and comparing results from three cross-sectional subsamples at different stages of illness (time to death ≥6, 5–3 and 2–0 months). Linear mixed models were calculated. Setting/participants A total of 1739 patients (mean age 66, 50% male) from 30 palliative care centers in 12 countries were included. Results In prospective analyses, quality of life, functioning and symptoms–except nausea/vomiting–remained generally stable over time. In retrospective analyses, patients 2–0 months before death reported significantly lower quality of life and physical functioning scores than those 5–3 months before death, who in turn scored lower than those ≥6 months before death, suggesting progressive decline. Emotional functioning remained initially unchanged, but decreased in the last months. Pain, fatigue and appetite loss showed a stable increase in intensity towards death. Dyspnea, insomnia and constipation increased from 5–3 to 2–0 months before death. Nausea/vomiting only increased when comparing those ≥6 months before death with those 2–0 months before death. Conclusion While the prospective approach showed predominantly stable patterns for quality of life, functioning and symptom severity throughout study duration, retrospective analyses indicated that deterioration was already apparent before the terminal phase and accelerated close to death. Our findings support the importance of early symptom identification and treatment in this population, and highlight the need for further studies to explore what characterizes those with either lower or higher symptom burden at different time points towards death.

• Kirkhus, Lene; Harneshaug, Magnus; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri & Bergh, Sverre [Vis alle 13 forfattere av denne artikkelen] (2019). Modifiable factors affecting older patients' quality of life and physical function during cancer treatment. Journal of Geriatric Oncology. ISSN 1879-4068. 10(6), s. 904–912. doi: 10.1016/j.jgo.2019.08.001. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment. METHODS: Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated. RESULTS: 288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDS-scores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p < .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group. CONCLUSION: Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes.

• Nordvik, Øyvind; Heggdal, Peder Olaf Laugen; Brännström, Jonas; Hjermstad, Marianne Jensen; Aarstad, Anne Kari Hersvik & Aarstad, Hans Jørgen (2019). Quality of life in persons with hearing loss: a study of patients referred to an audiological service. International Journal of Audiology. ISSN 1499-2027. 58(11), s. 696–703. doi: 10.1080/14992027.2019.1627010. Fulltekst i vitenarkiv
• Boland, Jason W.; Allgar, Victoria; Boland, Elaine G.; Bennett, Mike I; Kaasa, Stein & Hjermstad, Marianne Jensen [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making. Methods Secondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death. Results Date of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6–49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 24% co-analgesics. Opioid-use was associated with decreased survival in the multivariable model (HR = 1.59 (95% CI:1.38–1.84), p < 0.001). An exploratory subgroup analysis of those with C-reactive protein (CRP) measures (n = 219) indicated higher CRP was associated with poorer survival (p = 0.001). In this model, the strength of relationship between survival and opioid-use weakened (p = 0.029). Conclusion Opioid-use and survival were associated; this relationship weakened in a small sensitivity-testing subgroup analysis adjusting for CRP. Thus, the observed relationship between survival and opioid-use may partly be due to tumour-related inflammation. Larger studies, measuring disease activity, are needed to confirm this finding to more accurately judge the benefits and risks of opioids in advanced progressive disease.

• Vagnildhaug, Ola Magne; Brunelli, Cinzia; Hjermstad, Marianne Jensen; Strasser, Florian; Baracos, Vickie & Wilcock, Andrew [Vis alle 10 forfattere av denne artikkelen] (2019). A prospective study examining cachexia predictors in patients with incurable cancer. BMC Palliative Care. 18:46, s. 1–10. doi: 10.1186/s12904-019-0429-2. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Grotmol, Kjersti Støen; Lie, Hanne Cathrine; Loge, Jon Håvard; Aass, Nina Kathrine; Haugen, Dagny Faksvåg & Stone, Patrick C [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Objective Clinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors. Method The sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses. Result Patients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables. Significance of results Depression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.

• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Abramova, Tatiana Mikhailovna; Baas, Theo & Mørkeset, Siri Tessem [Vis alle 24 forfattere av denne artikkelen] (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. 17(110). doi: 10.1186/s12904-018-0362-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Radiation therapy (RT) results in pain relief for about 6 of 10 patients with cancer induced bone pain (CIBP) caused by bone metastases. The high number of non-responders, the long median time from RT to pain response and the risk of adverse effects, makes it important to determine predictors of treatment response. Clinical features such as cancer type, performance status and pain intensity, and biomarkers for osteoclast activity are proposed as predictors of response to RT. However, results are inconsistent and there is a need for better predictors of RT response. A similar argument can be stated for the development of cachexia; there are currently no predictors that can identify patients who will develop cachexia later in the cancer disease trajectory. Experimental and preclinical studies show that pain, depression and cachexia are related to inflammation. However, it is not known if inflammatory biomarkers can predict CIBP, depression or development of cachexia. Methods This multicenter, multinational longitudinal observational study will include 600 adult patients receiving RT for CIBP. Demographic data, clinical variables, osteoclast and inflammatory biomarkers will be assessed before start of RT, and 3, 8, 16, 24 and 52 weeks after last course of RT. The primary aim of the study is to identify potential predictors for pain relief from RT. Secondary aims are to explore potential predictors for development of cachexia, the longitudinal relationship between pain intensity and depression, and if inflammatory biomarkers are associated with changes in pain intensity, cachexia and depression during one-year follow up. Discussion The immediate clinical implication of the PRAIS study is to identify potential predictive factors for a RT response on CIBP, and thereby reduce non-efficacious RT. Patient benefits are fewer hospital visits, reduced risk of adverse effects and more individualized pain treatment. The long-term clinical implication of the PRAIS study is to improve the knowledge about inflammation in relation to CIBP, cachexia and depression and potentially identify associations and mechanisms that can be targeted for treatment. Trial registration ClinicalTrials.gov NCT02107664 , date of registration April 8, 2014 (retrospectively registered). Trial sponsor The European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, NTNU, Faculty of medicine and Health Sciences, Trondheim, N-7491, Norway.

• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein & Loge, Jon Håvard [Vis alle 9 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Eir version 3 (V3) is an electronic tool for administration of patient-reported outcome measures (Eir-Patient) that immediately presents patient scores on the physician’s computer (Eir-Doctor). Perceived usability is an important determinant for successful implementation. The aim of this study was to answer the following research question evaluated at the cancer outpatient clinics, in the patients’ home, and at general practitioners’ (GPs) offices: What are the number, type, and severity of usability issues evaluated by the patient (Eir-Patient module) and by the physician (Eir-Doctor module)? Methods A usability evaluation using observations, think-aloud sessions, individual interviews and focus group interviews in cancer patients and their physicians was conducted. Identified usability issues were graded on a severity scale from 1 (irritant) to 4 (unusable). Results Overall, 73 Eir registrations were performed by 37 patients, and used by 17 physicians in clinical consultations. All patients were able to complete the Eir-Patient symptom registration. Seventy-two usability issues were identified. None of them were graded as unusable. For the Eir-Patient module, 62% of the identified usability issues was graded as irritant (grade 1), 18% as moderate (grade 2), and 20% as severe (grade 3). For the Eir-Doctor module, 46% of the identified usability issues were graded as irritant, 36% as moderate and 18% as severe. Conclusions In the updated Eir version, issues in the severe and moderate categories have been changed, to optimize the usability of using real-time PROMs in clinical practice.

• Jakobsen, Gunnhild; Engstrøm, Morten; Paulsen, Ørnulf; Sjue, Karin; Raj, Sunil Xavier & Thronæs, Morten [Vis alle 10 forfattere av denne artikkelen] (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. 19:707(707), s. 1–9. doi: 10.1186/s13063-018-3088-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Despite the high prevalence of insomnia in patients with advanced cancer, there are no randomized controlled trials on pharmacological interventions for insomnia in this group of patients. A variety of pharmacological agents is recommended to manage sleep disturbance for insomnia in the general population, but their efficacy and safety in adults with advanced cancer are not established. Thus, there is a need to evaluate the effectiveness of medications for insomnia in order to improve the evidence in patients with advanced cancer. One of the most used sleep medications at present in patients with cancer is zopiclone. Methods This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. A total of 100 patients with metastatic cancer who report insomnia will be randomly allocated to zopiclone or placebo. The treatment duration with zopiclone/placebo is 6 consecutive nights. The primary endpoint is patient-reported sleep quality during the final study night (night 6) assessed on a numerical rating scale of 0–10, where 0 = Best sleep and 10 = Worst possible sleep. Secondary endpoints include the mean patient-reported total sleep time and sleep onset latency during the final study night (night 6). Discussion Results from this study on treatment of insomnia in advanced cancer will contribute to clinical decision-making and improve the treatment of sleep disturbance in this patient cohort.

• Petersen, Morten Aa.; Aaronson, Neil K.; Arraras, Juan I; Chie, Wei-Chu; Conroy, Thierry & Costantini, Anna [Vis alle 29 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  Background To optimise measurement precision, relevance to patients and flexibility, patient-reported outcome measures (PROMs) should ideally be adapted to the individual patient/study while retaining direct comparability of scores across patients/studies. This is achievable using item banks and computerised adaptive tests (CATs). The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) is one of the most widely used PROMs in cancer research and clinical practice. Here we provide an overview of the research program to develop CAT versions of the QLQ-C30's 14 functional and symptom domains. Methods The EORTC Quality of Life Group's strategy for developing CAT item banks consists of: literature search to identify potential candidate items; formulation of new items compatible with the QLQ-C30 item style; expert evaluations and patient interviews; field-testing and psychometric analyses, including factor analysis, item response theory calibration and simulation of measurement properties. In addition, software for setting up, running and scoring CAT has been developed. Results Across eight rounds of data collections, 9782 patients were recruited from 12 countries for the field-testing. The four phases of development resulted in a total of 260 unique items across the 14 domains. Each item bank consists of 7–34 items. Psychometric evaluations indicated higher measurement precision and increased statistical power of the CAT measures compared to the QLQ-C30 scales. Using CAT, sample size requirements may be reduced by approximately 20–35% on average without loss of power. Conclusions The EORTC CAT Core represents a more precise, powerful and flexible measurement system than the QLQ-C30. It is currently being validated in a large independent, international sample of cancer patients.

• Baekelandt, Bart Maria Gilbert; Fagerland, Morten; Hjermstad, Marianne Jensen; Heiberg, Turid; Labori, Knut Jørgen & Buanes, Trond (2018). Survival, Complications and Patient Reported Outcomes after Pancreatic Surgery. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2018.07.023. Fulltekst i vitenarkiv Vis sammendrag

  Background: Long-term effects of complications in pancreatic surgery have not been systematically evaluated. The objectives were to assess potential effects of complications on survival and patient reported outcomes (PROs) as well as feasibility of PRO questionnaires in patients with periampullary and pancreatic tumors. Methods: From October 2008 to December 2011, 208 patients undergoing pancreatic surgery were included in a prospective observational study. ESAS, EORTC QLQ-C30 and QLQ-PAN26 questionnaires were completed at inclusion, then every third month. Complications were recorded according to the Clavien-Dindo (CD) classification and Comprehensive Complication Index (CCI). Results: 148 complications were registered in 100 patients (48%), 36 patients (17%) had CD IIIa or above. 125 patients (60%) completed baseline questionnaires, 80 (39%) responded after three and 54 (28%) after six months. Complications were associated with reduced long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC) (p = 0.049) and other malignant diseases. No significant relationship was found between complications and PROs, except for anxiety, which was significantly increased in patients with complications. Conclusion: Postoperative complications led to increased anxiety at 3 months after surgery and were associated with reduced long-term survival in patients with malignancy. A short, patient derived, disease specific questionnaire is required in the clinical research context.

• Grønberg, Bjørn Henning; Sjøblom, Bjørg; Wentzel-Larsen, Tore; Baracos, Vickie Elaine; Hjermstad, Marianne Jensen & Aass, Nina Kathrine [Vis alle 10 forfattere av denne artikkelen] (2018). A comparison of CT based measures of skeletal muscle mass and density from the Th4 and L3 levels in patients with advanced non-small-cell lung cancer. European Journal of Clinical Nutrition. ISSN 0954-3007. s. 1–8. doi: 10.1038/s41430-018-0325-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Muscle mass and density assessed from CT-images at the L3 level are prognostic for survival and predict toxicity in cancer patients. However, L3 is not always included on routine CT-scans. We aimed to investigate whether images at the Th4 level may be used instead. Methods: Patients from three chemotherapy trials in advanced NSCLC were eligible (n = 1305). Skeletal muscle area (cm2), skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD) at Th4 and L3 levels were assessed from baseline CT-scans. SMI and SMD at the Th4 and L3 level were transformed into z-scores and the agreement between scores was investigated by Bland–Altman plots and estimated by intra-class correlation analyses. Linear regression was used to test if Th4 SMI and SMD z-scores predicted L3 SMI and SMD z-scores. Results: CT-images from 401 patients were analysable at both levels. There was a moderate agreement between Th4 and L3 SMI z-scores with an intra-class correlation of 0.71 (95% CI 0.64–0.77) for men and 0.53 (95% CI 0.41–0.63) for women. Regression models predicting L3 SMI z-scores from Th4 SMI z-scores showed coefficients of 0.71 (95% CI 0.62–0.80) among men and 0.53 (95% CI 0.40–0.66) among women. R-squares were 0.51 and 0.28, respectively, indicating moderate agreement. A similar, moderate agreement between Th4 and L3 SMD z-scores was observed. Conclusion: There was only moderate agreement between muscle measures from Th4 and L3 levels, indicating that missing data from the L3 level cannot be replaced by analysing images at the Th4 level.

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• Lundereng, Elias David; Dajani, Olav; Westgaard, Arne; Hjermstad, Marianne Jensen; Fallon, Marie & Ausen, Dag [Vis alle 10 forfattere av denne artikkelen] (2026). A Mixed-Methods Study on the Co-design and Pilot Testing of a Digital Patient-Centered Follow-up Tool (MyPath) in Pancreatic Cancer. Palliative Medicine. ISSN 0269-2163. 40(5), s. 873–874. doi: 10.1177/02692163261433418. Fulltekst i vitenarkiv Vis sammendrag

  Digital tools using electronic Patient-Reported OutcomeMeasures (ePROMs) have shown promise in making cancer care more patient-centered. Yet, the feasibility of this in real-world settings, in patients with high symptom burden and poor prognosis (e.g. pancreatic cancer or cholangiocarcinoma), are limited. The aim of this pilot study was to design and assess the feasibility of a digital solution integrating ePROMs (termed MyPath), in a real-world, out-patient cancer setting. A four-phased mixed-methods approach was employed to evaluate uptake, sustainability, and support needs using a digital Edmonton Symptom Assessment Score (d-ESAS). Eligible participants with pancreatic cancer or cholangiocarcinoma receiving anti-cancer therapy were consecutively sampled. This pilot study demonstrated that ePROMs implementation is feasible in real-world oncology settings with fragile, symptom-burdened patients. Key considerations for the large-scale MyPath implementation include establishing support-systems to facilitate uptake, integrating ePROMS into clinical workflows, and co-creating strategies for meaningful and sustainable use with patients and clinicians.

• Lundereng, Elias David; Guldhav, Kristin Vassbotn; Lund, Jo-Åsmund; Paulsen, Ørnulf; Dajani, Olav & Hjermstad, Marianne Jensen [Vis alle 8 forfattere av denne artikkelen] (2025). 02. Bridging tumour- and patient-centered cancer care: A qualitative meta-synthesis of stakeholder perspectives in digital implementation. Current opinion in supportive and palliative care. ISSN 1751-4258. 19(4), s. 292–299. doi: 10.1097/SPC.0000000000000775. Fulltekst i vitenarkiv
• Caraceni, Augusto Tomasso Giovanni; Laird, Barry James Anderson; Hjermstad, Marianne Jensen; Koteng, Lisa Heide; Sjøgren, Per & Kaasa, Stein (2024). From Vision to Reality: The Evolution of Palliative Care in European Oncology | Oncopedia. Oncopedia. doi: https:/www.oncopedia.wiki/contributions/from-vision-to-reality-the-evolution-of-palliative-care-in-european-oncology. Fulltekst i vitenarkiv Vis sammendrag

  Palliative care, a patient-centred approach that addresses the physical, emotional, spiritual, and social needs of individuals with life-limiting illnesses, has become an essential component of modern cancer care. By combining cutting-edge research, compassionate care, and effective symptom management, palliative care has demonstrated its ability to significantly improve the quality of life for patients with cancer. Herein a historical exploration of the evolution of palliative care in Europe is described within the context of cancer care. The origins of palliative care are traced, with a particular focus on the development of the first modern hospice and its impact on the field. The challenges and successes of integrating palliative care into the broader oncology landscape is explored, including the development of specialised palliative care teams and the integration of palliative care principles into routine cancer care. Research in the field of palliative care, including advancements in symptom management, pain control, and end-of-life care is appraised and the emerging trends and challenges in palliative care (e.g. adapting to a changing oncology landscape) are discussed. By understanding the evolution of palliative care in European cancer care, we can gain valuable insights into its current state and future potential. Our aim is to provide a comprehensive overview of the field, highlighting its significance in improving the quality of life for patients with cancer and its ongoing contributions to healthcare.

• Lillekroken, Daniela; Bye, Asta; Halvorsrud, Liv Torill; Yri, Olav Erich; Wester, Torunn Elin & Hjermstad, Marianne Jensen [Vis alle 9 forfattere av denne artikkelen] (2024). Living with brain metastases - A qualitative study about patient-and family members' coping strategies. Fulltekst i vitenarkiv
• Åsberg, Ragnhild Emilie; Giskeødegård, Guro F.; Hjermstad, Marianne Jensen; Reinertsen, Kristin Valborg; Karlsen, Jarle & Nilsen, Marianne [Vis alle 7 forfattere av denne artikkelen] (2023). Sexual health in female and male cancer survivors – compared with age matched cancer-free controls. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Pirnat, Aleksandra; Aass, Nina Kathrine; Andersen, Sigve; Astrup, Guro Lindviksmoen & Dajani, Olav [Vis alle 19 forfattere av denne artikkelen] (2023). 1592MO Anticancer therapy at the end-of-life: A cluster-randomized trial. Annals of Oncology. ISSN 0923-7534. 34, s. S886–S886. doi: 10.1016/j.annonc.2023.09.789. Fulltekst i vitenarkiv
• Lundeby, Tonje; Aass, Nina Kathrine; Andersen, Sigve; Hanssen, Sjur Bjørnar; Hjermstad, Marianne Jensen & Kaasa, Stein [Vis alle 9 forfattere av denne artikkelen] (2023). Family carers' experiences with brain metastases: A longitudinal study. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Gravli, Trine H.; Smeland, Sigbjørn & Kaasa, Stein (2023). Pasientsentrert kreftbehandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(1). doi: 10.4045/tidsskr.22.0668. Fulltekst i vitenarkiv
• Jakobsen, Gunnhild; Sjue, Karin; Paulsen, Ørnulf; Kaasa, Stein; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). Medikamentell behandling av insomni hos kreftpasienter. Fulltekst i vitenarkiv
• Lundeby, Tonje; Wester, Torunn Elin; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Yri, Olav Erich & Bye, Asta [Vis alle 7 forfattere av denne artikkelen] (2022). Living with brain metastases: A longitudinal qualitative study of patient experiences from time of diagnosis. Fulltekst i vitenarkiv
• Yri, Olav Erich; Astrup, Guro Lindviksmoen; Karlsson, Astrid Telhaug; Paulsen, Ørnulf; Helvoirt, Rene van & Lund, Jo-Åsmund [Vis alle 12 forfattere av denne artikkelen] (2022). Brain metastases: Real-life treatment patterns, survival and patient-reported outcomes – Results from a population-based, prospective study in 914 patients. Annals of Oncology. ISSN 0923-7534. 33, s. S668–S668. doi: 10.1016/j.annonc.2022.07.416. Fulltekst i vitenarkiv
• Lundereng, Elias David; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Lundeby, Tonje; Fallon, Marie & Velikova, Galina [Vis alle 9 forfattere av denne artikkelen] (2022). Developing Innovative Digital Patient Centered Care Pathways for Cancer Patients using Agile Design: A pre pilot study. Fulltekst i vitenarkiv
• Urrizola, Amaia; Dajani, Olav; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Kaasa, Stein & Klepstad, Pål [Vis alle 9 forfattere av denne artikkelen] (2022). Nutrition Impact Symptoms in Oncology –Why should we address them? Fulltekst i vitenarkiv
• Astrup, Guro Lindviksmoen; Kaasa, Stein; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Lundeby, Tonje & Helvoirt, Rene van [Vis alle 9 forfattere av denne artikkelen] (2021). Patient-reported outcomes in cancer patients newly diagnosed with brain metastases. Annals of Oncology. ISSN 0923-7534. 32, s. S1076–S1076. doi: 10.1016/j.annonc.2021.08.206. Fulltekst i vitenarkiv
• Yri, Olav Erich; Astrup, Guro Lindviksmoen; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Lund, Jo-Åsmund & Helvoirt, Rene van [Vis alle 8 forfattere av denne artikkelen] (2021). Brain metastases: Extracranial disease status as a prognostic factor after whole brain radiotherapy. Results from a prospective, population-based study. Annals of Oncology. ISSN 0923-7534. 32, s. S526–S526. doi: 10.1016/j.annonc.2021.08.037. Fulltekst i vitenarkiv
• Jakobsen, Gunnhild; Kaasa, Stein; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Klepstad, Pål & Paulsen, Ørnulf (2021). Kortikosteroider påvirker ikke søvn hos alvorlig syke kreftpasienter med smerte. Fulltekst i vitenarkiv
• Kirkhus, Lene; Saltyte-Benth, Jurate; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2020). Reply to the letter to the editor ‘Geriatric-oncology and palliative care: cautionary on using geriatric assessment as a sole basis to limit care’. Palliative Medicine. ISSN 0269-2163. 34(2), s. 255–256. doi: 10.1177/0269216319888987. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Andersen, Sigve; Brunelli, Cinzia; Dajani, Olav & Ahmed, Herish [Vis alle 20 forfattere av denne artikkelen] (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. 21:303, s. 1–17. doi: 10.1186/s13063-020-4224-4. Fulltekst i vitenarkiv Vis sammendrag

  Background - Several publications have addressed the need for a systematic integration of oncological care focused on the tumor and palliative care (PC) focused on the patient with cancer. The exponential increase in anticancer treatments and the high number of patients living longer with advanced disease have accentuated this. Internationally, there is now a persuasive argument that introducing PC early during anticancer treatment in patients with advanced disease has beneficial effects on symptoms, psychological distress, and survival. Methods - This is a national cluster-randomized trial (C-RCT) in 12 Norwegian hospitals. The trial investigates effects of early, systematic integration of oncology and specialized PC in patients with advanced cancer in six intervention hospitals compared with conventional care in six. Hospitals are stratified on the size of local catchment areas before randomization. In the intervention hospitals, a three-part complex intervention will be implemented. The backbone of the intervention is the development and implementation of patient-centered care pathways that contain early, compulsory referral to PC and regular and systematic registrations of symptoms. An educational program must be completed before patient inclusion. A total of 680 patients with advanced cancer and one caregiver per patient are included when patients come for start of last line of chemotherapy, defined according to national treatment guidelines. Data registration, clinical variables, and patient- and caregiver-reported outcomes take place every 2 months for 1 year or until death. The primary outcome is use of chemotherapy in the last 3 months of life by comparing the proportion of patients who receive this in the intervention and control groups. Primary outcome is use of chemotherapy in the last 3 months before death, i.e. number of patients. Secondary outcomes are initiation, discontinuation and number of cycles, last 3 months of life, administration of other medical interventions in the last month of life, symptom burden, quality of life (QoL), satisfaction with information and follow-up, and caregiver health, QoL, and satisfaction with care. Discussion - Results from this C-RCT will be used to raise the awareness about the positive outcomes of early provision of specialized palliative care using pathways for patients with advanced cancer receiving medical anticancer treatment. The long-term clinical objective is to integrate these patient-centered pathways in Norwegian cancer care. The specific focus on the patient and family and the organization of a predictable care trajectory is consistent with current Norwegian strategies for cancer care.

• Kirkhus, Lene; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Hjermstad, Marianne Jensen; Rostoft, Siri & Harneshaug, Magnus [Vis alle 9 forfattere av denne artikkelen] (2019). Reply to the letter to the editor 'Geriatric-oncology and palliative care: cautionary on using geriatric assessment as a sole basis to limit care'. Palliative Medicine. ISSN 0269-2163. doi: 10.1177/0269216319888987. Fulltekst i vitenarkiv
• Sigurdardottir, Katrin Rut; Hjermstad, Marianne Jensen; Filbet, Marilene; Tricou, Colombe; McQuillan, Regina & Costantini, Massimo [Vis alle 9 forfattere av denne artikkelen] (2019). Pilot Testing of the First Version of the European Association for Palliative Care (EAPC) Basic Dataset. Fulltekst i vitenarkiv
• Sigurdardottir, Katrin Rut; Hjermstad, Marianne Jensen; Filbet, Marilene; Tricou, Colombe; McQuillan, Regina & Costantini, Massimo [Vis alle 9 forfattere av denne artikkelen] (2019). Pilot Testing of the First Version of the European Association for Palliative Care (EAPC) Basic Dataset. Palliative Medicine. ISSN 0269-2163. 33, s. 319–320. Fulltekst i vitenarkiv
• Bjerkeset, Ellen; Aass, Nina Kathrine; Bye, Asta; Hamfjord, Julian; Hjermstad, Marianne Jensen & Loge, Jon Håvard [Vis alle 8 forfattere av denne artikkelen] (2018). Identified palliative care needs at start of radiotherapy for painful bone metastases. Fulltekst i vitenarkiv
• Bye, Asta; Seljelid, Berit; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Wester, Torunn & Loge, Jon Håvard (2018). Can we rely on reports on preferences for place of death? Fulltekst i vitenarkiv
• Vagnildhaug, Ola Magne; Brunelli, Cinzia; Hjermstad, Marianne Jensen; Strasser, Florian; Baracos, Vickie E. & Wilcock, Andrew [Vis alle 10 forfattere av denne artikkelen] (2018). A prospective study examining cachexia predictors in patients with incurable cancer. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Løhre, Erik Torbjørn; Fayers, Peter & Thronæs, Morten [Vis alle 8 forfattere av denne artikkelen] (2018). Sleep Quality in advanced cancer. Fulltekst i vitenarkiv
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein & Loge, Jon Håvard [Vis alle 9 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv

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