Nina Kathrine Aass

• 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.

• Bye, Asta; Balstad, Trude Rakel; Raaness, Ida Ervik; Solheim, Tora Skeidsvoll; Habberstad, Ragnhild Hansdatter & Klepstad, Pål [Vis alle 11 forfattere av denne artikkelen] (2026). Linking Inflammation to Reduced Food Intake in Advanced Cancer: A Prospective Observational Study. Current Oncology. ISSN 1198-0052. 33(4). doi: 10.3390/curroncol33040209. Fulltekst i vitenarkiv Vis sammendrag

  Background: Undernutrition and cachexia are common in advanced cancer and often linked to systemic inflammation. While inflammation is associated with poorer prognosis, accelerated weight loss, and reduced treatment tolerance, its direct impact on food intake remains insufficiently investigated. Aim: To examine the association between systemic inflammation and energy and protein intake over time in patients with advanced cancer. Methods: A total of 170 patients from the Palliative Radiotherapy and Inflammation Study were included. Nutritional status was assessed using PG-SGA SF. Dietary intake was recorded using repeated 24 h recalls. Systemic inflammation was defined as CRP > 10 mg/L. Mixed linear models were applied to evaluate the association between inflammation energy and protein intake over time. Results: Systemic inflammation (CRP >10 mg/L) was present in 87 (51%) patients and associated with significantly lower energy (−3.6 kcal/kg, p = 0.04) and lower protein intake (−0.25 g/kg, p = 0.003). Patients with inflammation were more often undernourished and had shorter survival. Conclusions: Systemic inflammation is likely associated with clinically relevant reductions in energy and protein intake in advanced cancer. CRP may help identify patients for whom standard nutritional support is insufficient.

• 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.

• 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.

• 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
• 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

• 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.

• 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

• Habberstad, Ragnhild H; Aass, Nina Kathrine; Mollnes, Tom Eirik; Damås, Jan Kristian; Brunelli, Cinzia & Rossi, Romina [Vis alle 9 forfattere av denne artikkelen] (2022). Inflammatory Markers and Radiotherapy Response in Patients With Painful Bone Metastases. Journal of Pain and Symptom Management. ISSN 0885-3924. 64(4), s. 330–339. doi: 10.1016/j.jpainsymman.2022.06.018. Fulltekst i vitenarkiv Vis sammendrag

  Context Inflammation is proposed to influence tumor response in radiotherapy (RT). Clinical studies to investigate the relationship between inflammatory markers and RT response is warranted to understand the variable RT efficacy in patients with painful bone metastases. Objectives To evaluate the association between inflammatory markers and analgesic response to RT in patients with painful bone metastases. Methods Adult patients from 7 European study sites undergoing RT for painful bone metastases were included in this prospective and longitudinal analysis. The association between RT response and 17 inflammatory markers at baseline, as well as the association between RT response and the changes observed in inflammatory markers between baseline and three and eight weeks after RT, was analyzed with univariate regression analyses. Baseline analyses were adjusted for potential clinical predictors of RT response. Results None of the inflammatory markers were significantly associated with an upcoming RT response in the analysis of 448 patients with complete baseline data. In patients available for follow-up, the three-week change in TNF (P 0.017), IL-8 (P 0.028), IP-10 (P 0.032), eotaxin (P 0.043), G-CSF (P 0.033) and MCP-1 (P 0.002) were positively associated with RT response, while the three-week change in CRP (P 0.006) was negatively associated. Conclusion Results from this study show an association between RT response and change in pro-inflammatory mediators and indicate that inflammation may be important to achieve an analgesic RT response in patients with painful bone metastases. None of the investigated inflammatory markers were found to be pre-treatment predictors of RT response.

• 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.

• Aass, Nina Kathrine & Kaasa, Stein (2022). Pasientsentrert behandling – er det mulig? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(3), s. 1–3. doi: 10.4045/tidsskr.22.0072. Fulltekst i vitenarkiv
• 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.

• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Bjerkeset, Ellen; Abramova, Tatiana Mikhailovna & Garcia-Alonso, Elena [Vis alle 13 forfattere av denne artikkelen] (2021). Clinical Predictors for Analgesic Response to Radiotherapy in Patients with Painful Bone Metastases. Journal of Pain and Symptom Management. ISSN 0885-3924. 62(4), s. 681–690. doi: 10.1016/j.jpainsymman.2021.03.022. Fulltekst i vitenarkiv Vis sammendrag

  Background Radiotherapy (RT) reduces pain in about 60% of patients with painful bone metastases, leaving many patients without clinical benefit. This study assesses predictors for RT effectiveness in patients with painful bone metastases. Materials and methods We included adult patients receiving RT for painful bone metastases in a multicenter, multinational longitudinal observational study. Pain response within 8 weeks was defined as ≥2-point decrease on a 0−10 pain score scale, without increase in analgesics; or a decrease in analgesics of ≥25% without increase in pain score. Potential predictors were related to patient demographics, RT administration, pain characteristics, tumor characteristics, depression and inflammation (C-reactive protein [CRP]). Multivariate logistic regression analysis with multiple imputation of missing data were applied to identify predictors of RT response. Results Of 513 eligible patients, 460 patients (90 %) were included in the regression model. 224 patients (44%, 95% confidence interval (CI) 39%−48%) responded to RT. Better Karnofsky performance status (Odds ratio (OR) 1.39, CI 1.15−1.68), breast cancer (OR 2.54, CI 1.12−5.73), prostate cancer (OR 2.83, CI 1.27−6.33) and soft tissue expansion (OR 2.00, CI 1.23−3.25) predicted RT response. Corticosteroids were a negative predictor (OR 0.57, CI 0.37−0.88). Single and multiple fraction RT had similar response. The discriminative ability of the model was moderate; C-statistic 0.69. Conclusion This study supports previous findings that better performance status and type of cancer diagnosis predicts analgesic RT response, and new data showing that soft tissue expansion predicts RT response and that corticosteroids is a negative predictor for RT response in patients with painful bone metastases.

• 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.

• 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.

• 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.

• Grotmol, Kjersti Støen; Lie, Hanne Cathrine; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Currow, David & Kaasa, Stein [Vis alle 9 forfattere av denne artikkelen] (2017). Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer. Journal of Pain and Symptom Management. ISSN 0885-3924. 54(6), s. 889–897. doi: 10.1016/j.jpainsymman.2017.04.010. Fulltekst i vitenarkiv Vis sammendrag

  Context Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies. Objectives To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden. Methods A total of 563 patients were included from the European Palliative Care Research Collaborative–Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score—mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models. Results Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 β = −0.12, P = 0.003; mGPS = 2 β = −0.09, P = 0.023), lower physical performance (β = 0.17, P < 0.001), reduced appetite (β = −0.15, P < 0.001), breathlessness (β = −0.11, P = 0.004), pain (β = −0.14, P = 0.002), and higher depression severity (β = −0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance. Conclusion Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.

• Jacobsen, Ellisiv Lærum; Bye, Asta; Aass, Nina Kathrine; Fosså, Sophie Dorothea; Grotmol, Kjersti Støen & Kaasa, Stein [Vis alle 9 forfattere av denne artikkelen] (2017). Norwegian reference values for the Short-Form Health Survey 36: development over time. Quality of Life Research. ISSN 0962-9343. s. 1–12. doi: 10.1007/s11136-017-1684-4. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Reference values for patient-reported outcome measures are useful for interpretation of results from clinical trials. The study aims were to collect Norwegian SF-36 reference values and compare with data from 1996 to 2002. Methods In 2015, SF-36 was sent by mail to a representative sample of the population (N = 6165). Time trends and associations between background variables and SF-36 scale scores were compared by linear regression models. Results The 2015 response rate was 36% (N = 2118) versus 67% (N = 2323) in 1996 and 56% (N = 5241) in 2002. Only 5% of the youngest (18–29 years) and 27% of the oldest (>70 years) responded in 2015. Age and educational level were significantly higher in 2015 relative to 1996/2002 (p < .001). The oldest age group in 2015 reported better scores on five of eight scales (p < 0.01), the exceptions being bodily pain, vitality, and mental health compared to 1996/2002 (NS). Overall, the SF-36 scores were relatively stable across surveys, controlled for background variables. In general, the most pronounced changes in 2015 were better scores on the role limitations emotional scale (7.4 points, p < .001) and lower scores on the bodily pain scale (4.6 points, p < .001) than in the 1996/2002 survey. Conclusions The low response rate in 2015 suggests that the results, especially among the youngest, should be interpreted with caution. The high response rate among the oldest indicates good representativity for those >70 years. Despite societal changes in Norway the past two decades, HRQoL has remained relatively stable.

• Bye, Asta; Sjøblom, Bjørg; Wentzel-Larsen, Tore; Grønberg, Bjørn Henning; Baracos, Vickie E. & Hjermstad, Marianne Jensen [Vis alle 10 forfattere av denne artikkelen] (2017). Muscle mass and association to quality of life in non-small cell lung cancer patients. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 8, s. 759–767. doi: 10.1002/jcsm.12206. Fulltekst i vitenarkiv Vis sammendrag

  Background Cancer wasting is characterized by muscle loss and may contribute to fatigue and poor quality of life (QoL). Our aim was to investigate associations between skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) and selected QoL outcomes in advanced non-small cell lung cancer (NSCLC) at diagnosis. Methods Baseline data from patients with stage IIIB/IV NSCLC and performance status 0–2 enrolled in three randomized trials of first-line chemotherapy (n = 1305) were analysed. Associations between SMI (cm2/m2) and SMD (Hounsfield units) based on computed tomography-images at the third lumbar level and self-reported physical function (PF), role function (RF), global QoL, fatigue, and dyspnoea were investigated by linear regression using flexible non-linear modelling. Results Complete data were available for 734 patients, mean age 65 years. Mean SMI was 47.7 cm2/m2 in men (n = 420) and 39.6 cm2/m2 in women (n = 314). Low SMI values were non-linearly associated with low PF and RF (men P = 0.016/0.020, women P = 0.004/0.012) and with low global QoL (P = 0.001) in men. Low SMI was significantly associated with high fatigue (P = 0.002) and more pain (P = 0.015), in both genders, but not with dyspnoea. All regression analyses showed poorer physical outcomes below an SMI breakpoint of about 42–45 cm2/m2 for men and 37–40 cm2/m2 for women. In both genders, poor PF and more dyspnoea were significantly associated with low SMD. Conclusions Low muscle mass in NSCLC negatively affects the patients' PF, RF, and global QoL, possibly more so in men than in women. However, muscle mass must be below a threshold value before this effect can be detected.

• Sjøblom, Bjørg; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Baracos, Vickie E.; Sawyer, Michael & Fløtten, Øystein [Vis alle 9 forfattere av denne artikkelen] (2017). Drug Dose Per Kilogram Lean Body Mass Predicts Hematologic Toxicity From Carboplatin-Doublet Chemotherapy in Advanced Non-Small-Cell Lung Cancer. Clinical Lung Cancer. ISSN 1525-7304. 18(2), s. e129–e136. doi: 10.1016/j.cllc.2016.09.008. Fulltekst i vitenarkiv Vis sammendrag

  Background Variations in lean body mass (LBM) have been suggested to explain variations in toxicity from systemic cancer treatment. We investigated if drug doses per kilogram of LBM were associated with severe hematologic toxicity (HT) in patients with stage IIIB/IV non–small-cell lung cancer (NSCLC) enrolled onto randomized trials comparing first-line carboplatin-doublets. Patients and Methods Patients received carboplatin (AUC [area under the plasma concentration vs. time curve] = 5) plus either pemetrexed 500 mg/m2, gemcitabine 1000 mg/m2, or vinorelbine 60 mg/m2. LBM was estimated from the cross-sectional muscle area at the third lumbar vertebra on computed tomographic scans. Administered doses on day 1, first cycle, were recalculated as milligram of drug per kilogram of LBM. Primary outcome was Common Terminology Criteria for Adverse Events version 3.0 grade 3/4 HT after cycle 1. Results Data from 424 patients were analyzed. Mean age was 65 years, 57% were men, and 78% had stage IV disease. Despite dose individualization by body surface area for the nonplatinum drugs, mean (range) doses expressed as mg/kg LBM showed ∼3-fold range: gemcitabine 38.0 (22.5-61.7) mg/kg LBM, pemetrexed 19.1 (8.1-27.9) mg/kg LBM, and vinorelbine 2.4 (1.4-3.6) mg/kg LBM. For these drugs, dose per kilogram of LBM was associated with HT in adjusted multivariate models (P = .004). Taking mean dose per kilogram LBM for each drug as reference, a 1% increase (odds ratio [OR] = 1.03; 95% confidence interval [CI], 1.01-1.06) or 1% decrease (OR = 0.97; 95% CI, 0.95-0.99) was associated with altered risk of grade 3/4 HT. For doses > 20% above and below mean (14% and 15% of patients, respectively) the risk of grade 3/4 HT was almost doubled (OR = 1.93, 95% CI, 1.21-3.10) and halved (OR = 0.52; 95% CI, 0.32-0.83), respectively. Conclusion Dose per kilogram of LBM varied considerably and was an independent predictor of HT. Computed tomography–defined LBM may provide a future basis for better dose individualization. Keywords Body composition; Chemotherapy dosing; Chemotherapy toxicity; Muscle wasting; Skeletal muscle

• Paulsen, Ørnulf; Laird, Barry J; Aass, Nina Kathrine; Lea, Tor Erling; Fayers, Peter & Kaasa, Stein [Vis alle 7 forfattere av denne artikkelen] (2017). The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer. PLOS ONE. 12(5). doi: 10.1371/journal.pone.0177620. Fulltekst i vitenarkiv Vis sammendrag

  Background Systemic inflammation is associated with reduced quality of life and increased symptoms in patients with advanced cancer. The aims of this study were to examine the relationships between inflammatory biomarkers and the Patient Reported Outcome Measures (PROMs) of pain, appetite and fatigue; and to explore whether levels of baseline biomarkers were associated with changes in these PROMs following treatment with corticosteroids. Material and methods An exploratory analysis was done on a trial examining the analgesic properties of corticosteroids in patients with advanced cancer. Inclusion criteria were: >18 years, taking opioids for moderate or severe cancer pain; pain ≥4 (numerical rating scale 0–10). Serum was extracted and levels of inflammatory biomarkers were assessed. PROMs of pain, appetite and fatigue were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The relationships between PROMs and inflammatory biomarkers were examined using Spearman Rho-Rank and multiple regression analysis. Results Data were available on 49 patients. Levels of sTNF-r1, IL-6, IL-18, MIF, MCP-1, TGF-β1, IL-1ra, and C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were elevated; IL-1β, IL-2, IL-4, IL-8, IL-10, IL-12(p70), interferon-γ, MIP-1α, and TNF-α were below the level of detection. The following correlations were observed: appetite and IL-6 and CRP; fatigue and IL-1ra (rs: 0.38–0.41, p< .01). There was no association between pretreatment biomarkers and effect from corticosteroid treatment. Conclusion In patients with advanced cancer and pain, some pro-inflammatory cytokines were related to appetite and fatigue. Inflammatory biomarkers were not associated with pain or with the efficacy of corticosteroid therapy. Further research examining the attenuation of the systemic inflammatory response and possible effects on symptoms would be of interest.

• Fredheim, Olav Magnus Søndenå; Brelin, Siri; Hjermstad, Marianne Jensen; Loge, Jon Håvard; Aass, Nina Kathrine & Johannessen, Tom Børge [Vis alle 7 forfattere av denne artikkelen] (2017). Prescriptions of analgesics during complete disease trajectories in patients who are diagnosed with and die from cancer within the five-year period 2005-2009. European Journal of Pain. ISSN 1090-3801. 21(3), s. 530–540. doi: 10.1002/ejp.956. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Kaasa, Stein; Caraceni, Augusto; Loge, Jon Håvard; Pedersen, Tore & Haugen, Dagny Faksvåg [Vis alle 7 forfattere av denne artikkelen] (2016). Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer. BMJ Supportive & Palliative Care. ISSN 2045-435X. 6(3), s. 344–352. doi: 10.1136/bmjspcare-2015-000887. Fulltekst i vitenarkiv Vis sammendrag

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

• Sjøblom, Bjørg; Grønberg, Bjørn Henning; Wentzel-Larsen, Tore; Baracos, Vickie E.; Hjermstad, Marianne Jensen & Aass, Nina Kathrine [Vis alle 10 forfattere av denne artikkelen] (2016). Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer. Clinical Nutrition. ISSN 0261-5614. 35(6), s. 1386–1393. doi: 10.1016/j.clnu.2016.03.010. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Aielli, F; Bennett, Michael I.; Brunelli, Cinzia & Caraceni, Augusto [Vis alle 26 forfattere av denne artikkelen] (2016). Characteristics of the case mix, organization and delivery in cancer palliative care: a challenge for good-quality research. BMJ Supportive & Palliative Care. ISSN 2045-435X. 8(4), s. 456–467. doi: 10.1136/bmjspcare-2015-000997. Fulltekst i vitenarkiv
• Brelin, Siri; Fredheim, Olav Magnus; Loge, Jon Håvard; Skurtveit, Svetlana; Johannesen, Tom Børge & Aass, Nina Kathrine [Vis alle 8 forfattere av denne artikkelen] (2016). Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study. Journal of Opioid Management. ISSN 1551-7489. 12(1), s. 25–36. doi: 10.5055/jom.2016.0309. Fulltekst i vitenarkiv
• Sjøblom, Bjørg; Grønberg, Bjørn Henning; Benth, Jurate Saltyte; Baracos, Vickie E.; Fløtten, Øystein & Hjermstad, Marianne Jensen [Vis alle 8 forfattere av denne artikkelen] (2015). Low muscle mass is associated with chemotherapy-induced haematological toxicity in advanced non-small cell lung cancer. Lung Cancer. ISSN 0169-5002. 90(1), s. 85–91. doi: 10.1016/j.lungcan.2015.07.001. Fulltekst i vitenarkiv
• Paulsen, Ørnulf; Klepstad, Pål; Rosland, Jan Henrik; Aass, Nina Kathrine; Albert, Eva & Fayers, Peter [Vis alle 7 forfattere av denne artikkelen] (2014). Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: A randomized, placebo-controlled, double-blind trial. Journal of Clinical Oncology. ISSN 0732-183X. 32(29), s. 3221–3228. doi: 10.1200/JCO.2013.54.3926. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Corticosteroids are frequently used in cancer pain management despite limited evidence. This study compares the analgesic efficacy of corticosteroid therapy with placebo. Patients and Methods Adult patients with cancer receiving opioids with average pain intensity ≥ 4 (numeric rating scale [NRS], 0 to 10) in the last 24 hours were eligible. Patients were randomly assigned to methylprednisolone (MP) 16 mg twice daily or placebo (PL) for 7 days. Primary outcome was average pain intensity measured at day 7 (NRS, 0 to 10); secondary outcomes were analgesic consumption (oral morphine equivalents), fatigue and appetite loss (European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire C30, 0 to 100), and patient satisfaction (NRS, 0 to 10). Results A total of 592 patients were screened; 50 were randomly assigned, and 47 were analyzed. Baseline opioid level was 269.9 mg in the MP arm and 160.4 mg in the PL arm. At day-7 evaluation, there was no difference between the groups in pain intensity (MP, 3.60 v PL, 3.68; P = .88) or relative analgesic consumption (MP, 1.19 v PL, 1.20; P = .95). Clinically and statistically significant improvements were found in fatigue (−17 v 3 points; P .003), appetite loss (−24 v 2 points; P = .003), and patient satisfaction (5.4 v 2.0 points; P = .001) in favor of the MP compared with the PL group, respectively. There were no differences in adverse effects between the groups. Conclusion MP 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study.

• Paulsen, Ørnulf; Aass, Nina Kathrine; Kaasa, Stein & Dale, Ola (2013). Do coricosteroids provide anlgesic effects in cancer patients? A systeamtic literature review. Journal of Pain and Symptom Management. ISSN 0885-3924. 46(1), s. 96–105. doi: 10.1016/j.jpainsymman.2012.06.019. Fulltekst i vitenarkiv
• Brelin, Siri; Loge, Jon Håvard; Skurtveit, Svetlana; Johannesen, Tom Børge; Aass, Nina Kathrine & Ottesen, Stig [Vis alle 7 forfattere av denne artikkelen] (2013). Antidepressants to cancer patients during the last year of life - a population-based study. Psycho-Oncology. ISSN 1057-9249. 22(3), s. 506–514. doi: 10.1002/pon.3059. Fulltekst i vitenarkiv
• Paulsen, Ørnulf; Aass, Nina Kathrine; Kaasa, Stein & Dale, Ola (2013). Do Corticosteroids Provide Analgesic Effects in Cancer Patients? A Systematic Literature Review. Journal of Pain and Symptom Management. ISSN 0885-3924. 46(1), s. 96–105. doi: 10.1016/j.jpainsymman.2012.06.019. Fulltekst i vitenarkiv
• Nekolaichuk, Cheryl; Fainsinger, Robin; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Knudsen, Anne Kari & Klepstad, Pål [Vis alle 8 forfattere av denne artikkelen] (2013). The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity Across Diverse Palliative Care Settings in Eight Countries. Journal of Palliative Medicine. ISSN 1096-6218. 16(5), s. 516–523. doi: 10.1089/jpm.2012.0390. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Kolflaath, Jan; Løkken, Aud Oddny; Hanssen, Sjur Bjørnar; Normann, Are Peder & Aass, Nina Kathrine (2013). Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open. 3(5). doi: 10.1136/bmjopen-2012-002515. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Patients with advanced cancer are often admitted to hospital as emergency cases. This may not always be medically indicated. Study objectives were to register the reasons for the emergency admissions, to examine interventions performed during hospitalisation and self-reported symptom intensity at admission and discharge, and to assess patients’ opinions about the admission. Design: This was a descriptive before-and-after study. Participating patients completed the Edmonton Symptom Assessment System (ESAS) twice, upon hospital admission and prior to discharge. All patients underwent a structured interview assessing their opinion about the emergency admission. Medical data were obtained from the hospital records. Setting: The study was performed in two Norwegian acute care secondary hospitals with urban catchment areas. Participants: 44 patients with cancer (men 27 and women 17; mean age 69.2, SD 9.2) representing 50 emergency admissions were included. Results: Median length of stay was 7 days (95% CI 7.4 to 11.4). Median survival was 50 days (95% CI 51 to 115). 90% were admitted from home, and 46% had been hospitalised less than 1 month earlier. Lung and gastrointestinal symptoms and pain were the most frequent reasons for admissions. Mean pain scores on ESAS were reduced by 50% from admission to discharge (p<0.01). Simple interventions such as hydration, bladder catheterisation and oxygen therapy were most frequent. Nearly one-third would have preferred treatment at another site, provided that the quality of care was similar. Home visits by the family doctor and specialised care teams were perceived by patients as important to prevent hospitalisation. Conclusions: In most emergency admissions, relatively simple medical interventions are necessary. Specialised care teams with palliative care physicians, easier access to the family doctor and better lines of cooperation between hospitals and the primary care sector may make it possible to perform more of these procedures at home, thereby reducing the need for emergency admissions.

• Wit, Ronald de; Skoneczna, Iwona; Daugaard, Gedske; Santis, Maria de; Garin, August & Aass, Nina Kathrine [Vis alle 12 forfattere av denne artikkelen] (2012). Randomized Phase III Study Comparing Paclitaxel-Bleomycin, Etoposide, and Cisplatin (BEP) to Standard BEP in Intermediate-Prognosis Germ-Cell Cancer: Intergroup Study EORTC 30983. Journal of Clinical Oncology. ISSN 0732-183X. 30(8), s. 792–799. doi: 10.1200/JCO.2011.37.0171. Fulltekst i vitenarkiv
• Bennett, Michael I; Rayment, Clare; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Caraceni, Augusto & Kaasa, Stein (2012). Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain. ISSN 0304-3959. 153(2), s. 359–365. doi: 10.1016/j.pain.2011.10.028. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Aass, Nina Kathrine; Heitzer, Ellen; Klepstad, Pål; Hjermstad, Marianne Jensen & Schippinger, Walter [Vis alle 9 forfattere av denne artikkelen] (2012). Interviews with patients with advanced cancer-another step towards an international cancer pain classification system. Supportive Care in Cancer. ISSN 0941-4355. 20(10), s. 2491–2500. doi: 10.1007/s00520-011-1361-z. Fulltekst i vitenarkiv
• Rayment, Clare; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Kaasa, Stein; Caraceni, Augusto & Strasser, Florian [Vis alle 9 forfattere av denne artikkelen] (2012). Neuropathic cancer pain: Prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative-Computerised Symptom Assessment study. Palliative Medicine. ISSN 0269-2163. 27(8), s. 714–721. doi: 10.1177/0269216312464408. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Brunelli, C; Klepstad, Pål; Aass, Nina Kathrine; Apolone, Giovanni & Corli, Oscar [Vis alle 9 forfattere av denne artikkelen] (2012). Which domains should be included in a cancer pain classification system? Analyses of longitudinal data. Pain. ISSN 0304-3959. 153(3), s. 696–703. doi: 10.1016/j.pain.2011.12.005. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Brunelli, C; Kaasa, Stein; Apolone, G.; Corli, O & Montanari, M [Vis alle 11 forfattere av denne artikkelen] (2011). Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain. European Journal of Pain. ISSN 1090-3801. 15(3), s. 320–327. doi: 10.1016/j.ejpain.2010.08.001. Fulltekst i vitenarkiv
• Bergh, Irmelin; Kvalem, Ingela Lundin; Aass, Nina Kathrine & Hjermstad, Marianne Jensen (2011). What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System. Palliative Medicine. ISSN 0269-2163. 25(7), s. 716–724. doi: 10.1177/0269216310395985. Fulltekst i vitenarkiv
• Dausgaard, Gedske; Skoneczna, Iwona; Aass, Nina Kathrine; Wit, Ronald de; Santis, Maria de & Dumez, Herlinde [Vis alle 11 forfattere av denne artikkelen] (2011). A randomized phase III study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamide (VIP) plus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo Germinal (EORTC 30974). Annals of Oncology. ISSN 0923-7534. 22(5), s. 1054–1061. doi: 10.1093/annonc/mdq575. Fulltekst i vitenarkiv
• Oliver, R. Timothy D.; Mead, Graham M.; Rustin, Gordon J.S.; Joffe, Johnathan K.; Aass, Nina & Coleman, Robert [Vis alle 9 forfattere av denne artikkelen] (2011). Randomized Trial of Carboplatin Versus Radiotherapy for Stage I Seminoma: Mature Results on Relapse and Contralateral Testis Cancer Rates in MRC TE19/EORTC 30982 Study (ISRCTN27163214). Journal of Clinical Oncology. ISSN 0732-183X. 29(8), s. 957–962. doi: 10.1200/JCO.2009.26.4655. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Fayers, Peter; Haugen, Dagny R Faksvåg; Caraceni, Augusto; Hanks, Geoffrey & Loge, Jon Håvard [Vis alle 9 forfattere av denne artikkelen] (2011). Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review. Journal of Pain and Symptom Management. ISSN 0885-3924. 41(6), s. 1073–1093. doi: 10.1016/j.jpainsymman.2010.08.016. Fulltekst i vitenarkiv
• Haugnes, Hege Sagstuen; Wethal, Torgeir; Aass, Nina Kathrine; Dahl, Olav; Klepp, Olbjørn & Langberg, Carl W. [Vis alle 9 forfattere av denne artikkelen] (2010). Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. Journal of Clinical Oncology. ISSN 0732-183X. 28(30), s. 4649–4657. doi: 10.1200/JCO.2010.29.9362. Fulltekst i vitenarkiv Vis sammendrag

  Adressene er knyttet opp i samarbeid med korresponderende forfatter (tidsskriftet oppgir forfatterne og adressene hver for seg), og godkjent på grunnlag av dette./tøf

• Knudsen, Anne Kari; Aass, Nina; Fainsinger, Robin; Caraceni, Augusto; Klepstad, Pål & Jordhøy, Marit S [Vis alle 7 forfattere av denne artikkelen] (2009). Classification of pain in cancer patients - a systematic literature review. Palliative Medicine. ISSN 0269-2163. 23(4), s. 295–308. doi: 10.1177/0269216309103125. Fulltekst i vitenarkiv
• Haugen, Dagny Faksvåg; Kaasa, Stein & Aass, Nina (2009). Palliativ forskning i Norge i dag. Omsorg: Nordisk tidsskrift for Palliativ Medisin. ISSN 0800-7489. s. 3–7. Fulltekst i vitenarkiv
• Sagstuen, Hege; Aass, Nina Kathrine; Fosså, Sophie Dorothea; Klepp, Olbjørn; Wist, Erik & Dahl, Olav [Vis alle 8 forfattere av denne artikkelen] (2004). Blood pressure and body mass index (BMI) in testicular cancer survivors. Annals of Oncology. ISSN 0923-7534. 15, s. 112–112. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Aass, Nina Kathrine & Kristensen, Are Korsnes (2016). Medikamentell tumorrettet behandling. Gyldendal Akademisk. ISBN 9788205488403. -293304 s. Fulltekst i vitenarkiv
• Halvorsen, Tarje Onsøien & Aass, Nina Kathrine (2016). Kvalme og oppkast. Gyldendal Akademisk. ISBN 9788205488403. -549560 s. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Yri, Olav Erich; Loge, Jon Håvard; Aass, Nina Kathrine; Hamfjord, Julian; Moland, Hege & Hansen, Sjur Bjørnar (2025). Systematisk symptomkartlegging. doi: https:/www.youtube.com/watch?v=rCSfO_QLER4. Fulltekst i vitenarkiv
• Kaasa, Stein; Haugen, Dagny Renata Faksvåg; Andersen, Sigve; Aass, Nina Kathrine; Brenne, Anne Tove & Gravdahl, Eva-Kristin Norum [Vis alle 13 forfattere av denne artikkelen] (2024). Regjeringen gir dødshjelp til palliativ medisin. Fulltekst i vitenarkiv Vis sammendrag

  Mens Europa styrker kompetansen innen lindrende behandling, vil vår regjering svekke tilbudet til alvorlig syke og døende ved å fjerne en formalisert legeutdanning i palliativ medisin.

• 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
• 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
• 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; Aass, Nina Kathrine & Kaasa, Stein (2022). Helhjernebestråling bør begrenses. 142(17). doi: 10.4045/tidsskr.22.0696. 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
• Raanes, Ida Ervik; Balstad, Trude Rakel; Martinez, Amaia; Rosendahl-Riis, Hanne; Dajani, Olav & Solheim, Tora S [Vis alle 12 forfattere av denne artikkelen] (2022). The role of inflammation in development of malnutrition in advanced cancer. 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
• 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.

• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Bjerkeset, Ellen; Abramova, Tatiana Mikhailovna & Garcia-Alonso, Elena [Vis alle 13 forfattere av denne artikkelen] (2019). Clinical predictors for analgesic response to radiotherapy in patients with painful bone metastases. Annals of Oncology. ISSN 0923-7534. 30, s. v662–v662. doi: 10.1093/annonc/mdz261.003. 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
• Jacobsen, Ellisiv Lærum; Bye, Asta; Aass, Nina Kathrine; Fosså, Sophie Dorothea; Grotmol, Kjersti Støen & Kaasa, Stein [Vis alle 9 forfattere av denne artikkelen] (2017). Correction to: Norwegian reference values for the Short-Form Health Survey 36: development over time. Quality of Life Research. ISSN 0962-9343. s. 1–3. doi: 10.1007/s11136-017-1708-0. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Grotmol, Kjersti Støen; Kaasa, Stein; Lundeby, Tonje & Seljelid, Berit [Vis alle 8 forfattere av denne artikkelen] (2017). Integration of oncology and palliative care - findings from the PALLiON pre-study survey. Fulltekst i vitenarkiv
• Haugen, Dagny Faksvåg & Aass, Nina Kathrine (2016). Organisering av palliative tilbud. I Kaasa, Stein & Loge, Jon Håvard (Red.), Palliasjon. Nordisk lærebok. 3. utgave. Gyldendal Akademisk. ISSN 9788205488403. s. 112–125. Fulltekst i vitenarkiv
• Paulsen, Ørnulf; Aass, Nina Kathrine; Klepstad, Pål & Kaasa, Stein (2015). Reply to A. Molfino et al. Journal of Clinical Oncology. ISSN 0732-183X. 33(13), s. 1513–1513. doi: 10.1200/JCO.2014.60.6475. Fulltekst i vitenarkiv
• Kirkhus, Lene; Kristjansson, Siri Rostoft; Selbæk, Geir; Hjermstad, Marianne Jensen; Aass, Nina Kathrine & Bye, Asta [Vis alle 8 forfattere av denne artikkelen] (2013). Cancer in the elderly: prevalence and impact of age related symptoms on quality of life, treatment tolerance and survival. Fulltekst i vitenarkiv
• Bergh, Irmelin; Aass, Nina Kathrine; Haugen, Dagny Faksvåg; Kaasa, Stein & Hjermstad, Marianne Jensen (2012). Symptomkartlegging i palliativ medisin. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 132, s. 18–19. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Klepstad, Pål; Caraceni, Augusto; Kaasa, Stein; Brunelli, C & Aass, Nina Kathrine [Vis alle 9 forfattere av denne artikkelen] (2012). Cancer pain undertreatment and prognostic factors Response. Pain. ISSN 0304-3959. 153(8), s. 1771–1772. doi: 10.1016/j.pain.2012.03.033. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Klepstad, Pål; Aass, Nina Kathrine; Brunelli, C; Caraceni, Augusto & Kaasa, Stein (2012). Classification and assessment of cancer pain. IASP Refresher Course Book. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Klepstad, Pål; Brunelli, C; Aass, Nina Kathrine; Caraceni, Augusto & Kaasa, Stein (2012). Cancer Pain Update: From Mechanisms to Treatment: Assessment & Classification. Fulltekst i vitenarkiv
• Rayment, Clare; Bennett, Michael I; Aass, Nina Kathrine; Hjermstad, Marianne Jensen & Kaasa, Stein (2011). Performance of PainDetect for identifying cancer neuropathic pain in the European Palliative Care Research Collaborative computerized symptom assessment study. European Journal of Palliative Care. ISSN 1352-2779. s. 166–166. Fulltekst i vitenarkiv
• Bergh, Irmelin; Kvalem, Ingela Lundin; Aass, Nina Kathrine & Hjermstad, Marianne Jensen (2011). What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System (ESAS). European Journal of Palliative Care. ISSN 1352-2779. s. 78–78. Fulltekst i vitenarkiv
• Nekolaichuk, Cheryl; Fainsinger, Robin; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Knudsen, Anne Kari & Klepstad, Pål [Vis alle 8 forfattere av denne artikkelen] (2011). The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features Across Diverse Palliative Care Settings in Eight Countries. European Journal of Palliative Care. ISSN 1352-2779. s. 228–228. Fulltekst i vitenarkiv
• Rayment, Clare; Bennett, Michael; Aass, Nina Kathrine; Hjermstad, Marianne Jensen & Kaasa, Stein (2011). Cancer Neuropathic pain: prevalence and associated factors in the European Palliative Care Research Collaborative computerized symptom assessment study. European Journal of Palliative Care. ISSN 1352-2779. s. 230–230. Fulltekst i vitenarkiv
• Kolflaath, Jan; Løkken, A; Normann, Are Peder; Sætre, Liv; Hanssen, Sjur & Aass, Nina Kathrine [Vis alle 7 forfattere av denne artikkelen] (2011). Emergency admissions in palliative care may not always be appropriate. European Journal of Palliative Care. ISSN 1352-2779. s. 131–131. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Aass, Nina Kathrine; Klepstad, Pål; Heitzer, Ellen; Hjermstad, Marianne Jensen & Schippinger, Walter [Vis alle 9 forfattere av denne artikkelen] (2010). Advanced cancer patients' opinion on classification for cancer pain. Palliative Medicine. ISSN 0269-2163. 24(4). Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Aass, Nina Kathrine; Klepstad, Pål; Heitzer, Ellen; Hjermstad, Marianne Jensen & Schippinger, Walter [Vis alle 9 forfattere av denne artikkelen] (2010). Advanced cancer patients' opinion on classification for cancer pain. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Brunelli, C; Apolone, G.; Corli, O; Montanari, M & Fainsinger, Robin [Vis alle 11 forfattere av denne artikkelen] (2010). Content of a future classification system for cancer pain. Palliative Medicine. ISSN 0269-2163. 24(4), s. 22–23. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Brunelli, C; Apolone, G.; Corli, O; Montanari, M & Fainsinger, Robin [Vis alle 11 forfattere av denne artikkelen] (2010). Content of a future classification system for cancer pain. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Brunelli, C; Apolone, G.; Corli, O; Montanari, M & Fayers, Peter [Vis alle 10 forfattere av denne artikkelen] (2010). Content of a future classification for pain. Fulltekst i vitenarkiv
• Hjermstad, Marianne Jensen; Fayers, Peter; Haugen, Dagny Faksvåg; Loge, Jon Håvard; Fainsinger, Robin & Hanks, Geoffrey [Vis alle 9 forfattere av denne artikkelen] (2010). Comparisons of Numerical Rating Scales (NRS), Verbal Rating Scales (VRS) and Visual Analogue Scales (VAS) for assessment of pain intensity - which is the preferred scale? Palliative Medicine. ISSN 0269-2163. 24(4), s. S43–S43. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Aass, Nina; Fainsinger, Robin; Caraceni, Augusto; Klepstad, Pål & Jordhøy, Marit [Vis alle 8 forfattere av denne artikkelen] (2009). ”Improving assessment and classification of cancer pain - How can we improve?”. Fulltekst i vitenarkiv
• Knudsen, Anne Kari; Aass, Nina; Klepstad, Pål; Heitzer, Ellen; Hjermstad, Marianne Jensen & Schippinger, Walter [Vis alle 9 forfattere av denne artikkelen] (2009). Advanced cancer patients’ opinion on classification of cancer pain. Fulltekst i vitenarkiv
• Sagstuen, Hege; Aass, Nina; Aass, Nina Kathrine; Fosså, Sophie D; Dahl, O & Klepp, Olbjørn [Vis alle 10 forfattere av denne artikkelen] (2005). Metabolic syndrome in long-term testicular cancer survivors. Journal of Clinical Oncology. ISSN 0732-183X. 23. Fulltekst i vitenarkiv

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