Stein Kaasa

• Borgogni, Federico; Marzorati, Chiara; Voskanyan, Viktorya; Pietrobon, Ricardo; Heide, Iris van der & Caraceni, Augusto Tomasso Giovanni [Vis alle 19 forfattere av denne artikkelen] (2026). The transformative impact of spirituality assessment on the quality of life for end of life cancer patients: a perspective paper. Frontiers in Psychology. 17, s. 1–6. doi: 10.3389/fpsyg.2026.1880381.
• Cilla, Savino; Rossi, Romina; Habberstad, Ragnhild Hansdatter; Klepstad, Pål; Agata, Monia Dall & Kaasa, Stein [Vis alle 11 forfattere av denne artikkelen] (2026). Machine learning decision tree models for multiclass classification of prognosis in patient undergoing palliative radiotherapy for bone metastases. Journal of Applied Clinical Medical Physics. 27(7). doi: 10.1002/acm2.70606. Fulltekst i vitenarkiv
• 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
• 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.

• 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
• Nicklin, Emma; Bedding, Christopher; Alfieri, Sara; Apolone, Giovanni; Arndt, Volker & Bos, Nanne [Vis alle 39 forfattere av denne artikkelen] (2026). The development of the European Toolkit for the self-assessment of quality of life across the cancer care continuum (EUonQoL-Kit). European Journal of Cancer. ISSN 0959-8049. 238. doi: 10.1016/j.ejca.2026.116677. Fulltekst i vitenarkiv
• Svalheim, K. G.; Andresen, Nikolai Kragøe; Bjerre, C.; Gilje, Bjørnar; Jakobsen, E. H. & Falk, Ragnhild Sørum [Vis alle 9 forfattere av denne artikkelen] (2026). Patient-reported outcomes from the randomized ALICE trial evaluating the addition of atezolizumab to anthracycline-based chemotherapy in metastatic triple-negative breast cancer. Breast. ISSN 0960-9776. 86. doi: 10.1016/j.breast.2026.104704. Fulltekst i vitenarkiv Vis sammendrag

  Background The ALICE trial demonstrated that adding atezolizumab to anthracycline-based immunomodulatory chemotherapy improved progression-free survival (PFS) in patients with metastatic triple-negative breast cancer (mTNBC), including those with PD-L1–negative tumors. Here, we report the patient-reported outcome measures (PROMs). Methods Patients were randomized to receive chemotherapy plus atezolizumab (atezo-chemo) or chemotherapy plus placebo (placebo-chemo). PROMs were collected at baseline and weeks 9, 17, 25, and 49 using the EORTC QLQ-C15-PAL, Chalder Fatigue Questionnaire (CFQ), and Numeric Rating Scale (NRS) for pain. Results PROMs were available from 64 of 68 patients. At week 9, mean changes from baseline favored the atezo-chemo arm across all QLQ-C15-PAL domains, CFQ scores, and NRS pain intensity. Time-to-deterioration analyses also favored atezo-chemo, with statistically significant hazard ratios for global quality of life (QoL; HR 0.24), emotional functioning (HR 0.30), and pain (HR 0.20). Pain—a pre-specified cardinal symptom—improved in the atezo-chemo group at all time points. At 12 months, PROMs indicated sustained tolerability. Better baseline PROM scores were associated with improved PFS and overall survival, especially among patients treated with atezolizumab. Patients with >median QoL score at baseline recorded improved PFS when treated with atezolizumab (HR 0.25), while patients with ≤median QoL score did not (HR 1.02). Conclusions Adding atezolizumab to the study-chemotherapy in mTNBC improves both PFS and patient-reported quality of life, emotional well-being and symptom control. These findings support continued development of this combination regimen and suggest that baseline quality of life may serve as a useful predictor of immunotherapy benefit.

• 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.

• Yri, Olav Erich & Kaasa, Stein (2025). A balancing ACT: maximizing the benefits of appropriate brain radiation therapy—authors’ reply. The Lancet Regional Health - Europe. 52, s. 101291–101291. doi: 10.1016/j.lanepe.2025.101291. Fulltekst i vitenarkiv
• Sweegers, Maike G.; Jongh, Esther de; Bedding, Christopher; Nicklin, Emma; Doege, Daniela & Alfieri, Sara [Vis alle 29 forfattere av denne artikkelen] (2025). Development of a unified system for assessing health related quality of life across the cancer care continuum: the EUonQoL Delphi study to identify priorities for quality of life domains. Journal of Patient-Reported Outcomes. 9(1). doi: 10.1186/s41687-025-00907-z. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Cancer and cancer treatment have a major impact on health related quality of life (HRQoL). To improve the assessment of HRQoL in patients with cancer and evaluate the impact of policy interventions, the European Oncology Quality of Life (EUonQoL) project aims at developing a digital, patient centred system to assess HRQoL based on evaluations and preferences of cancer patients and survivors: the EUonQoL-kit. Method Patients across the cancer care continuum, healthcare professionals and researchers from six European countries (Denmark, France, Germany, Italy, The Netherlands and United Kingdom) were asked to rate the importance of 44 pre-selected HRQoL subdomains over a maximum of three Delphi survey rounds. We evaluated the importance of HRQoL subdomains for three target populations: patients undergoing active treatment, cancer survivors and patients receiving palliative care. The results were discussed during a consensus meeting. Results 96 patients and 59 healthcare professionals participated in the Delphi study. After three rounds, consensus was reached for 20 subdomains: ability to work, communication with healthcare professionals, diarrhoea, fatigue, fear of recurrence, global health status, impact of treatment side effects, impact on children/family, insomnia, instrumental activities of daily living, maintaining independence, mobility, nausea, overall quality of life, pain, partner relationship, social activity limitations, social isolation, symptom awareness and uncertain prognosis. The subdomains pain and fear of recurrence were rated as important for all three target populations. Conclusion Subdomains that were considered important for the assessment of HRQoL in patients with cancer can be summarised into: physical symptoms, mobility & activity, future outlook, social roles & activities, family & relationships, social isolation, self-efficacy, overall HRQoL, and healthcare experience. The importance of the subdomains differed for patients in different phases of the cancer care continuum. These findings were used for the creation of the first version of the EUonQoL-Kit, as a base for its further development.

• 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
• Engelaar, Merel; Schelven, Femke van; Bos, Nanne; L'Hote, Marion; Rialland, Clémentine & Couespel, Norbert [Vis alle 25 forfattere av denne artikkelen] (2025). Evaluating the Involvement of People With Cancer and Informal Caregivers in the Development Process of a New Set of Quality of Life Questionnaires. Health Expectations. ISSN 1369-6513. 28(3). doi: 10.1111/hex.70267. Fulltekst i vitenarkiv
• Hustad, Kristin Solheim; Kaasa, Stein & Laird, Barry J. (2025). Integrated nutritional care in cancer; About time? Current opinion in supportive and palliative care. ISSN 1751-4258. 19(3), s. 198–202. doi: 10.1097/SPC.0000000000000765. 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.

• Slørdahl, Kathinka Schmidt; Skovlund, Eva; Olsen, Jan Åge; Tvedt, Ragnhild; Thomsen, Maria & Kaasa, Stein [Vis alle 7 forfattere av denne artikkelen] (2025). Patient-reported outcomes after chemoradiotherapy for anal cancer. Acta Oncologica. ISSN 0284-186X. 64, s. 1005–1013. doi: 10.2340/1651-226x.2025.43636. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose: Chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) results in favorable survival. However, treatment intensity must be balanced against late side effects. The aim of this current study was to prospectively investigate patient-reported outcomes (PROs) before CRT and up to 5 years after completed CRT for SCCA. Patient/material and methods: This prospective study included 120 patients with SCCA receiving CRT to total doses of 54–58 Gy with concomitant mitomycin and 5-fluorouracil. Patients completed PRO questionnaires before CRT, and at 3 months, 1-, 3-, and 5 years after completed CRT. The questionnaires were the EORTC QLQ-C30 and QLQ-CR29, St. Marks incontinence score, Fatigue Questionnaire, the Hospital Anxiety and Depression Scale, and a scoring for neuroticism. Results: Patients reported a high burden of symptoms and impaired functional outcomes prior to treatment. Tumor-related symptoms, such as buttock pain, improved (difference 11.1, p = 0.002) at a clinically relevant level 3 months after CRT, consistent with tumor response. Other functional outcomes and symptoms, such as body image (difference 11.5, p < 0.001), worsened. While some outcomes, such as anxiety (difference 10.4, p = 0.001), improved over time, several were persistently impaired, in particular anorectal and sexual function, where symptom burden remained high 5 years after CRT. Chronic fatigue (CF) was reported by 28% of patients at 5-year follow-up. Interpretation: Five years after CRT for SCCA, patients report a persistently high symptom burden regarding anorectal and sexual function, and one-third report CF, demonstrating the long-term impact of treatment.

• 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.

• 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.

• Skåre, Terese Solvoll; Lundeby, Tonje; Lund, Jo-Åsmund; Lundereng, Elias David; Kaasa, Stein & Glas, Nienke de [Vis alle 9 forfattere av denne artikkelen] (2025). Exploring Perspectives of Patients With Cancer on Implementing Electronic Patient-Reported Outcome Measures to Enhance Patient-Centered Care: Qualitative Study. JMIR Cancer. 11, s. 1–15. doi: 10.2196/79144. Fulltekst i vitenarkiv Vis sammendrag

  Background: Systematic symptom management is a crucial component in patient-centred cancer care. Despite advancements in symptom management and the development of numerous electronic patient-reported outcome tools (ePROMs), integrating these tools into clinical practice remains challenging. Engaging key stakeholders, including patients, in the development of ePROM tools is pivotal to fostering the adaption of such tools. As part of an innovation and implementation study aimed at enhancing efficiency and patient-centred care through the development of digital patient-centred care pathways, we explored cancer patients’ perspectives on current clinical practice regarding symptom management and patient-centred care, as well as their needs and preferences related to ePROMs. Objective: To explore cancer patients’ perspectives on PCC and symptom management, including their experience with current clinical practice and their views on how ePROMs might enhance patient-centred follow-up. Methods: A two-stage qualitative design was employed. In Stage 1 semi-structured individual interviews were conducted to gain an in-depth understanding of patients’ experiences with current clinical practice, including perceived challenges and unmet needs. Stage 2 involved structured interviews to further explore patients’ perspectives on the potential role of ePROMs in enhancing patient-centred follow up. Results: A total of ten patients were included in the study, participating in either or both stages. Two main themes were developed through a reflexive thematic analysis process: 1) Symptom management in the shadow of disease-centred care, and 2) ePROMs: Bridging holistic care and disease management. Theme 1 highlighted how patients made sense of symptom management within a healthcare context primarily focused on disease treatment and progression. Their narratives revealed that biomedical concerns often dominated clinical encounters, while patients’ broader lived experiences and symptom-related needs were marginalised. Patients shared an understanding that it was their own responsibility to redirect the focus of clinical consultations toward symptoms. While they generally expressed satisfaction with the care received, they also described a sense of unmet needs that remained unaddressed. The second theme explored how patients made sense of the potential role of an ePROM tool in supporting more patient-centred cancer care. Their accounts revealed both perceived barriers and facilitators to its use, shaped by the expectations and needs that contrasted with current clinical practices. Central to this was a belief, emerging through engagement with the conceptual tool’s functionalities, that it could enable a more holistic approach to care, extending beyond physical symptom to encompass the lived experience of cancer. Conclusions: Patients often felt personally responsible for ensuring their symptoms were addressed, indicating shortcomings in follow-up and communication. ePROMs were identified as a promising tool to strengthen patient-centred care by amplifying patient voices and enabling more holistic and responsive follow-up. Integrating ePROMs into routine care may improve symptom visibility, foster shared understanding between patients and healthcare professionals, and support more equitable care delivery.

• 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.

• Vagnildhaug, Ola Magne; Habberstad, Ragnhild Hansdatter; Salvesen, Øyvind Olav; Balstad, Trude Rakel; Bye, Asta & Dajani, Olav [Vis alle 9 forfattere av denne artikkelen] (2025). A comparison of inflammatory markers’ potential to predict weight loss in advanced cancer: a prospective observational study. Journal of Circulating Biomarkers (JCB). 14(1), s. 20–20. doi: 10.33393/jcb.2025.3510. Fulltekst i vitenarkiv Vis sammendrag

  Background: Systemic inflammation is crucial in cancer cachexia, but the optimal measurement method remainsunclear. This study compares markers of systemic inflammation (MoSI) in predicting weight loss in patients withmetastatic cancer.Methods: This prospective, observational multi-center study involved patients undergoing radiotherapy forbone metastases. Baseline assessments included demographics, clinical characteristics, previous weight loss,and appetite loss. MoSI included: C-reactive protein (CRP), albumin, white blood cells, neutrophil-to-lymphocyteratio, monocyte-to-lymphocyte ratio, interleukin-6 (IL-6), modified Glasgow Prognostic Score (mGPS), andPrognostic Nutritional Index. Body weight was recorded at baseline, 3, and 8 weeks post-radiotherapy. Multiplelinear regression assessed MoSI’s predictive ability for weight loss, adjusting for previous weight loss, appetiteloss, and primary tumour type. Goodness-of-fit was assessed using adjusted R2.Results: Out of 574 recruited patients, 540 and 470 were analyzed at 3 and 8 weeks, respectively. The median age(IQR) was 67 (15), 330 (61%) were male, and 397 (74%) had a Karnofsky performance status ≥70. In a base modelwithout MoSI, significant predictors of weight loss at 3 weeks were appetite loss and urological, lung, and gastrointestinalcancer (adjusted R2 of 0.064), while at 8 weeks, urological and lung cancer were significant (adjusted R2of 0.035). At 3 weeks, all MoSI significantly improved the base model, with adjusted R2 between 0.078 and 0.091.At 8 weeks: CRP, mGPS, albumin and IL-6 improved the model; however only CRP and mGPS retained an adjustedR2 of ~0.09.Conclusions: All MoSI predicted weight loss, but CRP and mGPS were the most optimal.

• Skåre, Terese Solvoll; Lundeby, Tonje; Lund, Jo-Åsmund; Lundereng, Elias David; Kaasa, Stein & Glas, Nienke de [Vis alle 9 forfattere av denne artikkelen] (2025). Exploring perspectives of patients with cancer on implementing electronic patient-reported outcome measures to enhance patient-centred care: qualitative study. JMIR Cancer. 11, s. 1–15. doi: https:/preprints.jmir.org/preprint/79144. Fulltekst i vitenarkiv Vis sammendrag

  Background: Systematic symptom management is a crucial component in patient-centered cancer care. Despite the development of numerous electronic patient-reported outcome measure (ePROM) tools, integrating these tools into clinical practice remains challenging. Engaging key stakeholders, including patients, in the development of ePROM tools is pivotal to fostering the adoption of such tools. As part of an innovation and implementation study aimed at enhancing efficiency and patient-centered care (PCC) through the development of digital PCC pathways, we explored the perspectives of patients with cancer on current clinical practice regarding symptom management and PCC, as well as their needs and preferences related to ePROMs. Objective: This study aims to explore the perspectives of patients with cancer on PCC and symptom management, including their experience with current clinical practice and their views on how ePROMs might enhance patient-centered follow-up. Methods: A 2-stage qualitative design was used. In stage 1, semistructured individual interviews were conducted to gain an in-depth understanding of patients’ experiences with current clinical practice, including perceived challenges and unmet needs. Stage 2 involved structured interviews to further explore patients’ perspectives on the potential role of ePROMs in enhancing patient-centered follow-up. Results: A total of 10 patients were included in the study, participating in either or both stages. Two main themes were developed through a reflexive thematic analysis process: (1) symptom management in the shadow of disease-centered care, and (2) ePROMs: bridging holistic care and disease management. Theme 1 highlighted how patients made sense of symptom management within a health care context primarily focused on disease treatment and progression. Their narratives revealed that biomedical concerns often dominated clinical encounters, while patients’ broader lived experiences and symptom-related needs were marginalized. Patients shared an understanding that it was their own responsibility to redirect the focus of clinical consultations toward symptoms. While they generally expressed satisfaction with the care received, they also described a sense of unmet needs that remained unaddressed. The second theme explored how patients made sense of the potential role of an ePROM tool in supporting more patient-centered cancer care. Their accounts revealed both perceived barriers and facilitators to its use, shaped by the expectations and needs that contrasted with current clinical practices. Central to this was a belief, emerging through engagement with the conceptual tool’s functionalities, that it could enable a more holistic approach to care, extending beyond physical symptom to encompass the lived experience of cancer. Conclusions: Patients often felt personally responsible for ensuring that their symptoms were addressed, indicating shortcomings in follow-up and communication. ePROMs were identified as a promising tool to strengthen PCC by amplifying patient voices and enabling more holistic and responsive follow-up. Integrating ePROMs into routine care may improve symptom visibility, foster shared understanding between patients and health care professionals, and support more equitable care delivery.

• Marzorati, Chiara; Voskanyan, Viktorya; Sala, Diana; Grasso, Roberto; Borgogni, Federico & Pietrobon, Ricardo [Vis alle 21 forfattere av denne artikkelen] (2025). Psychosocial factors associated with quality of life in cancer patients undergoing treatment: an umbrella review. Health and Quality of Life Outcomes. 23(1). doi: 10.1186/s12955-025-02357-z. Fulltekst i vitenarkiv
• 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.

• Laird, Barry James Anderson; Skipworth, Richard; Bonomi, Philip D.; Fallon, Marie; Kaasa, Stein & Giorgino, Ruben [Vis alle 8 forfattere av denne artikkelen] (2025). Anamorelin Efficacy in Non–Small-Cell Lung Cancer Patients With Cachexia: Insights From ROMANA 1 and ROMANA 2. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. 16(1). doi: 10.1002/jcsm.13732. Fulltekst i vitenarkiv
• 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
• Minnai, Francesca; Shkodra, Morena; Noci, Sara; Esposito, Martina; Brunelli, Cinzia & Pigni, Alessandra [Vis alle 15 forfattere av denne artikkelen] (2025). A genome-wide association study of European advanced cancer patients treated with opioids identifies regulatory variants on chromosome 20 associated with pain intensity. European Journal of Pain. ISSN 1090-3801. 29(1). doi: 10.1002/ejp.4764. Fulltekst i vitenarkiv Vis sammendrag

  Background Opioids in step III of the WHO analgesic ladder are the standard of care for treating cancer pain. However, a significant minority of patients do not benefit from therapy. Genetics might play a role in predisposing patients to a good or poor response to opioids. Here, we investigated this issue by conducting a genome-wide association study (GWAS). Methods We genotyped 2057 European advanced cancer patients treated with morphine, buprenorphine, fentanyl and oxycodone. We carried out a whole-genome regression model (using REGENIE software) between genotypes and the opioid response phenotype, defined as a numerical score measuring patient pain intensity. Results The GWAS identified five non-coding variants on chromosome 20 with a p-value <5.0 × 10−8. For all of them, the minor allele was associated with lower pain intensity. These variants were intronic to the PCMTD2 gene and were 200 kbp downstream of OPRL1, the opioid related nociceptin receptor 1. Notably according to the eQTLGen database, these variants act as expression quantitative trait loci, modulating the expression mainly of PCMTD2 but also of OPRL1. Variants in the same chromosomal region were recently reported to be significantly associated with pain intensity in a GWAS conducted in subjects with different chronic pain conditions. Conclusions Our results support the role of genetics in the opioid response in advanced cancer patients. Further functional analyses are needed to understand the biological mechanism underlying the observed association and lead to the development of individualized pain treatment plans, ultimately improving the quality of life for cancer patients. Significance Statement This genome-wide association study on European advanced cancer patients treated with opioids identifies novel regulatory variants on chromosome 20 (near PCMTD2 and OPRL1 genes) associated with pain intensity. These findings enhance our understanding of the genetic basis of opioid response, suggesting new potential markers for opioid efficacy. The study is a significant advancement in pharmacogenomics, providing a robust dataset and new insights into the genetic factors influencing pain intensity, which could lead to personalized cancer pain management.

• Amat-Fernandez, Clara; Garin, Olatz; Luer-Aguila, Ricardo; Pardo, Yolanda; Briseño, Renata & Lizano-Barrantes, Catalina [Vis alle 77 forfattere av denne artikkelen] (2025). Systematic review of the needs and health-related quality of life domains relevant to people surviving cancer in Europe. Quality of Life Research. ISSN 0962-9343. 34(4), s. 913–936. doi: 10.1007/s11136-024-03884-w. Fulltekst i vitenarkiv
• Cilla, Savino; Rossi, Romina; Donati, Costanza Maria; Habberstad, Ragnhild Hansdatter; Klepstad, Pål & Dall’Agata, Monia [Vis alle 11 forfattere av denne artikkelen] (2025). Pain Management Adequacy in Patients With Bone Metastases: A Secondary Analysis From the Palliative Radiotherapy and Inflammation Study Trial. Clinical Medicine Insights: Oncology. 19. doi: 10.1177/11795549241297054. Fulltekst i vitenarkiv
• Casali, P.G.; Antoine-Poirel, H.; Berrocoso, S.; Blay, J.-Y.; Dubois, T. & Ferrari, A. [Vis alle 19 forfattere av denne artikkelen] (2025). Health networking on cancer in the European Union: a ‘green paper’ by the EU Joint Action on Networks of Expertise (JANE). ESMO Open. 10(2). doi: 10.1016/j.esmoop.2024.104126. Fulltekst i vitenarkiv
• Minnai, Francesca; Shkodra, Morena; Noci, Sara; Brunelli, Cinzia; Pigni, Alessandra & Zecca, Ernesto [Vis alle 14 forfattere av denne artikkelen] (2024). Genomic Study in Opioid-Treated Cancer Patients Identifies Variants Associated With Nausea-Vomiting. Journal of Pain and Symptom Management. ISSN 0885-3924. doi: 10.1016/j.jpainsymman.2024.10.033. Fulltekst i vitenarkiv Vis sammendrag

  Context Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%–20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity. Objectives The aim of this genome-wide association study (GWAS) was to identify genetic markers of opioid toxicity, in terms of nausea-vomiting. Methods Cancer patients receiving morphine, oxycodone, buprenorphine, and fentanyl were recruited from different European countries. Data about toxicity (nausea-vomiting score, NVS) and other relevant clinical information were collected, as well as genotyping data. Regression analysis between genotypes of 2052 patients and NVS was performed, using appropriate covariates, with REGENIE software. Results We found 65 variants associated with NVS (P-value < 1.0×10−5). Of note, 14 intronic variants on chromosome 2 were in NPAS2 gene, encoding a circadian transcription factor reported to play a role in another opioid side effect, the alteration of sleep. Some of these variants were previously identified as splicing quantitative trait loci of the NPAS2 gene. Conclusions This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies.

• Lund, Jo-Åsmund; Lydersen, Stian; Aksnessæther, Bjørg Yksnøy; Solberg, Arne; Wanderås, Anne Dybdahl & Lervåg, Christoffer [Vis alle 8 forfattere av denne artikkelen] (2024). Image guided radiotherapy in curative treatment for prostate cancer. 5-year results from a randomized controlled trial (RIC-trial). Radiotherapy and Oncology. ISSN 0167-8140. 196, s. 1–7. doi: 10.1016/j.radonc.2024.110309. Fulltekst i vitenarkiv Vis sammendrag

  Background: Between 2012 and 2015 we conducted a randomized controlled trial in prostate cancer patients comparing weekly 2-D portal imaging versus daily 3-D verification. Aim: To evaluate the clinical outcomes of image guided radiotherapy by presenting rectal and urinary side effects, health related quality of life and progression free survival after 5-years follow up of a randomized controlled trial. Methods: We randomized 260 men with intermediate or high-risk prostate cancer to weekly 2-D portal imaging with 15 mm margin from CTV to PTV (Arm A) or daily 3-D cone-beam computer tomography with 7 mm margins (Arm B). Prescribed doses were 78 Gy/39 fractions. All patients received hormonal therapy. Primary end point was patient reported bowel symptoms and secondary outcomes were patient reported urinary symptoms, health- related quality of life and progression free survival. Results: Of the 216 patients available for analyses at 5 years more than 90 % completed patient reported outcome measures. There were no significant differences between study arms for any single items nor scales evaluating bowel symptoms. There were also no differences in self-reported urinary symptoms nor in health-related quality of life. Symptom scores were low in both study arms. Progression free survival was similar in Arm B as compared to arm A (Hazard ratio 1.01; 95 % CI 0.57 to 1.97). Conclusions: Our results support that both 2-D weekly and 3-D daily image guided radiotherapy are safe and efficient treatments for PC and emphasize the need to evaluate technological progress in clinical trials with long follow-up.

• 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

• Brenne, Anne Tove; Løhre, Erik Torbjørn; Knudsen, Anne Kari; Lund, Jo-Åsmund; Thronæs, Morten & Driller, Bardo [Vis alle 8 forfattere av denne artikkelen] (2024). Standardizing Integrated Oncology and Palliative Care Across Service Levels: Challenges in Demonstrating Effects in a Prospective Controlled Intervention Trial. Oncology and Therapy. ISSN 2366-1070. 12(2), s. 345–362. doi: 10.1007/s40487-024-00278-3. Fulltekst i vitenarkiv Vis sammendrag

  Plain Language Summary: Palliative care is an important part of cancer care to improve patients’ quality of life. To be cared for and die in the preferred place are quality markers in palliative care. Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of cancer and palliative care would result in more time spent at home during end-of-life. An intervention that included information, education, and a standardized care pathway was developed and implemented in a region of Mid-Norway (the intervention region, I). A similar region served as comparison region (C). Adult patients with cancer treated with non-curative intent were eligible. Altogether, 129 patients in I and 76 patients in C were included in the study, of whom 82% in I and 78% in C died during follow-up. The mean proportion of time spent at home last 90 days of life was 0.62 in I and 0.72 in C (p = 0.044), and 22.6% and 35.6% (p = 0.073) died at home, respectively. A higher proportion died at home in both groups compared to pre-study national levels (12%). During the study period, C developed and implemented an alternative intervention to the study intervention, with the former placing more focus on end-of-life care compared to the she study intervention that focused on the whole disease trajectory. This may explain why the intervention did not result in more time spent at home during end-of-life as compared to C. “Simpler” interventions directed towards the study’s primary outcome may be relevant for future studies on integration of palliative care into oncology.

• 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.

• Cilla, Savino; Rossi, Romina; Habberstad, Ragnhild Hansdatter; Klepstad, Pål; Dall'Agata, Monia & Kaasa, Stein [Vis alle 10 forfattere av denne artikkelen] (2024). Explainable Machine Learning Model to Predict Overall Survival in Patients Treated With Palliative Radiotherapy for Bone Metastases. JCO Clinical Cancer Informatics. 8, s. e2400027–e2400027. doi: 10.1200/CCI.24.00027. Fulltekst i vitenarkiv
• 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.

• Shkodra, Morena; Mulvey, Matthew; Fallon, Marie; Brunelli, Cinzia; Zecca, Ernesto & Bracchi, Paola [Vis alle 12 forfattere av denne artikkelen] (2024). Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer. Pain Reports. 9(2), s. E1140–E1140. doi: 10.1097/PR9.0000000000001140. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy. Objectives: Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST). Methods: This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0–10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal–Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP. Results: Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2–94.3) and 98.3% (95% CI 90.8–100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia (P = 0.0032), warm hypoesthesia (P = 0.0018), pressure hyperalgesia (P = 0.02), and the presence of allodynia (P = 0.0001). Conclusion: The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.

• 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.

• Barratt, Daniel T.; Klepstad, Pål; Dale, Ola; Kaasa, Stein & Somogyi, Andrew A. (2024). Pharmacokinetic and neuroimmune pharmacogenetic impacts on slow-release morphine cancer pain control and adverse effects. The Pharmacogenomics Journal. ISSN 1470-269X. 24(3). doi: 10.1038/s41397-024-00339-w. Fulltekst i vitenarkiv Vis sammendrag

  The aim was to determine if opioid neuroimmunopharmacology pathway gene polymorphisms alter serum morphine, morphine-3-glucuronide and morphine-6-glucuronide concentration-response relationships in 506 cancer patients receiving controlled-release oral morphine. Morphine-3-glucuronide concentrations (standardised to 11 h post-dose) were higher in patients without pain control (median (interquartile range) 1.2 (0.7–2.3) versus 1.0 (0.5–1.9) μM, P = 0.006), whereas morphine concentrations were higher in patients with cognitive dysfunction (40 (20–81) versus 29 (14–60) nM, P = 0.02). TLR2 rs3804100 variant carriers had reduced odds (adjusted odds ratio (95% confidence interval) 0.42 (0.22–0.82), P = 0.01) of opioid adverse events. IL2 rs2069762 G/G (0.20 (0.06-0.52)), BDNF rs6265 A/A (0.15 (0.02–0.63)) and IL6R rs8192284 carrier (0.55 (0.34–0.90)) genotypes had decreased, and IL6 rs10499563 C/C increased (3.3 (1.2–9.3)), odds of sickness response (P ≤ 0.02). The study has limitations in heterogeneity in doses, sampling times and diagnoses but still suggests that pharmacokinetics and immune genetics co-contribute to morphine pain control and adverse effects in cancer patients.

• 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

• Voskanyan, Viktorya; Marzorati, Chiara; Sala, Diana; Grasso, Roberto; Pietrobon, Ricardo & Heijden, Iris van der [Vis alle 20 forfattere av denne artikkelen] (2024). Psychosocial factors associated with quality of life in cancer survivors: umbrella review. Journal of Cancer Research and Clinical Oncology. ISSN 0171-5216. 150(5). doi: 10.1007/s00432-024-05749-8. Fulltekst i vitenarkiv
• Rossi, Romina; Medici, Federica; Habberstad, Ragnhild Hansdatter; Klepstad, Pål; Cilla, Savino & Dall'Agata, Monia [Vis alle 10 forfattere av denne artikkelen] (2024). Development of a predictive model for patients with bone metastases referred to palliative radiotherapy: Secondary analysis of a multicenter study (the PRAIS trial). Cancer Medicine. 13(19). doi: 10.1002/cam4.70050. Fulltekst i vitenarkiv Vis sammendrag

  Background: The decision to administer palliative radiotherapy (RT) to patients with bone metastases (BMs), as well as the selection of treatment protocols (dose, fractionation), requires an accurate assessment of survival expectancy. In this study, we aimed to develop three predictive models (PMs) to estimate short-, intermediate-, and long-term overall survival (OS) for patients in this clinical setting. Materials and Methods: This study constitutes a sub-analysis of the PRAIS trial, a longitudinal observational study collecting data from patients referred to participating centers to receive palliative RT for cancer-induced bone pain. Our analysis encompassed 567 patients from the PRAIS trial database. The primary objectives were to ascertain the correlation between clinical and laboratory parameters with the OS rates at three distinct time points (short: 3 weeks; intermediate: 24 weeks; prolonged: 52 weeks) and to construct PMs for prognosis. We employed machine learning techniques, comprising the following steps: (i) identification of reliable prognostic variables and training; (ii) validation and testing of the model using the selected variables. The selection of variables was accomplished using the LASSO method (Least Absolute Shrinkage and Selection Operator). The model performance was assessed using receiver operator characteristic curves (ROC) and the area under the curve (AUC). Results: Our analysis demonstrated a significant impact of clinical parameters (primary tumor site, presence of non-bone metastases, steroids and opioid intake, food intake, and body mass index) and laboratory parameters (interleukin 8 [IL-8], chloride levels, C-reactive protein, white blood cell count, and lymphocyte count) on OS. Notably, different factors were associated with the different times for OS with only IL-8 included both in the PMs for short- and long-term OS. The AUC values for ROC curves for 3-week, 24-week, and 52-week OS were 0.901, 0.767, and 0.806, respectively. Conclusions: We successfully developed three PMs for OS based on easily accessible clinical and laboratory parameters for patients referred to palliative RT for painful BMs. While our findings are promising, it is important to recognize that this was an exploratory trial. The implementation of these tools into clinical practice warrants further investigation and confirmation through subsequent studies with separate databases.

• 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.

• Dingemans, Anne-Marie; Walree, Nico van; Schramel, Franz; Soud, Magdolen Youssef-El; Baltruškevičienė, Edita & Lybaert, Willem [Vis alle 9 forfattere av denne artikkelen] (2023). High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients. 15(24). doi: 10.3390/nu15245030. Fulltekst i vitenarkiv
• 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.

• Diernberger, Katharina; Clausen, Eleanor; Murray, Gordon; Wee, Bee; Kaasa, Stein & Hall, Peter [Vis alle 7 forfattere av denne artikkelen] (2023). Cancer pain assessment and management: does an institutional approach individualise and reduce cost of care? BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2022-003547. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To understand individual prescribing and associated costs in patients managed with the Edinburgh Pain Assessment and management Tool (EPAT). Methods The EPAT study was a two-arm parallel group cluster randomised (1:1) trial, including 19 UK cancer centres. Study outcome assessments, including pain levels, analgesia and non-pharmacological and anaesthetic interventions, collected at baseline, 3–5 days and, if applicable, 7–10 days after admission. Costs calculated for inpatient length of stay (LoS), medications and complex pain interventions. Analysis accounted for the clustered nature of the trial design. In this post-hoc analysis, healthcare utilisation and costs are presented descriptively. Participants 10 centres randomised to EPAT (487 patients) and 9 (449 patients) to usual care (UC). Main outcome measures Pharmacological and non-pharmacological management, complex pain interventions, length of hospital stay and costs related to these outcomes. Results The mean per patient hospital cost was £3866 with EPAT and £4194 with UC, reflecting a mean LoS of 2.9 days and 3.1 days, respectively. Costs were lower for non-opioids, Non-steroidal anti-inflammatories (NSAIDs) and opioids but slightly higher for adjuvants with EPAT than with UC. The mean per-patient opioid costs were £17.90 (EPAT) and £25.80 (UC). Mean per patient costs of all medication were £36 (EPAT) and £40 (UC). Complex pain intervention costs were £117 with EPAT per patient and £90 with UC. Overall mean cost per patient was £4018.3 (95% CI 3698.9 to 4337.8) with EPAT and £4323.8 (95% CI 4060.0 to 4587.7) with UC. Conclusions EPAT facilitated personalised medicine and may result in less opioids, more specific treatments, improved pain outcomes and cost savings.

• Miranda, Rose; Raemdonck, Eveline; Deliens, Luc; Kaasa, Stein; Zimmermann, Camilla & Rodin, Gary [Vis alle 10 forfattere av denne artikkelen] (2023). Do cancer centres and palliative care wards routinely measure patients’ quality of life? An international cross-sectional survey study. Supportive Care in Cancer. ISSN 0941-4355. 31(8). doi: 10.1007/s00520-023-07964-4. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Routinely assessing quality of life (QoL) of patients with cancer is crucial for improving patient-centred cancer care. However, little is known about whether or how cancer centres assess QoL for clinical practice or for research purposes. Therefore, our study aimed to investigate if QoL data is collected and if so, how and for what purposes. Method We conducted a cross-sectional survey study among 32 cancer centres in Europe and Canada. Centre representatives identified persons who they judged to have sufficient insight into QoL data collections in their wards to complete the survey. Descriptive statistics were used to summarise the information on QoL assessment and documentation. Results There were 20 (62.5%) responding cancer centres. In total, 30 questionnaires were completed, of which 13 were completed for cancer wards and 17 for palliative care wards. We found that 23.1% and 38.5% of the cancer wards routinely assessed QoL among inpatients and outpatients with cancer, respectively, whereas, in palliative care wards, 52.9% assessed QoL for outpatients with cancer and 70.6% for the inpatients. Wide variabilities were observed between the cancer centres in how, how often, when and which instruments they used to assess QoL. Conclusion A sizable proportion of the cancer wards, especially, and palliative care wards apparently does not routinely assess patients’ QoL, and we found wide variabilities between the cancer centres in how they do it. To promote routine assessment of patients’ QoL, we proposed several actions, such as addressing barriers to implementing patient-reported outcome measures through innovative e-health platforms.

• 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.

• Kreye, G.; Lundeby, Tonje; Latino, N.; Galotti, M. & Kaasa, Stein (2022). ESMO Designated Centres of Integrated Oncology and Palliative Care (ESMO DCs): education, research and programme development survey. ESMO Open. 7(6). doi: 10.1016/j.esmoop.2022.100622. Fulltekst i vitenarkiv Vis sammendrag

  Background The European Society for Medical Oncology (ESMO) Designated Centres (DCs) of Integrated Oncology and Palliative Care is an incentive programme established in 2003 aiming to improve the integration of oncology and palliative care services provided by oncologists and oncology centres worldwide. Currently, the ESMO DCs programme has over 250 centres accredited from 54 countries worldwide, in all six world regions. Materials and methods To evaluate how ESMO can support centres to improve programme development, education and research and vice versa what each single centre can do to improve in these areas, we developed a survey which was shared with all active centres. Two hundred and seven ESMO DCs representing 44 countries were invited to participate. We used content analysis to identify response categories using a stepwise approach. After reviewing and coding all responses to each question separately, they were placed into categories, counted and labelled. Results Of the 207 centres that were invited to participate, 146 centres started the survey, representing 43 countries. Five overarching topics were identified. They included (i) joint events and educational activities; (ii) sharing of materials and defining common standards; (iii) sharing of experiences, scientific knowledge and expertise; (iv) research collaboration; and (v) ESMO support. Respondents were willing to support the ESMO DC community group in all topics and were also asking ESMO to support their centres in these issues in the future. Conclusion The study showed that the ESMO DCs are willing to provide support to improve education, research and programme development. They are also eager to contribute and collaborate amongst each other, but also request ESMO to offer advice and help to improve these issues in the DCs. In the future, facilitation of joint research projects and development of arenas to share experiences, educational and programme developments, and other resources are to be explored and could be offered to the DCs worldwide.

• 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.

• Shkodra, Morena; Brunelli, Cinzia; Zecca, Ernesto; Infante, Gabriele; Miceli, Rosalba & Caputo, Mariangela [Vis alle 10 forfattere av denne artikkelen] (2022). Cancer pain: Results of a prospective study on prognostic indicators of pain intensity including pain syndromes assessment. Palliative Medicine. ISSN 0269-2163. 36(9), s. 1396–1407. doi: 10.1177/02692163221122354. Fulltekst i vitenarkiv Vis sammendrag

  Background: Pain is a prevalent symptom in patients with advanced cancer. Recognition of prognostic factors associated with pain intensity, could help provide better assessment, leading to better pain management. Aim: identifying prognostic factors which could guide improvements on cancer pain classification. Design: a prospective observational study on chronic cancer pain, exploring the association between average mean pain intensity during a 28 days study follow-up and patients’ clinical and pain-related characteristics, including pain syndromes. To evaluate these associations, a mixed model was built. Setting/participants: Patients attending a Palliative Care and Pain Outpatient Clinic from May 2015 to June 2019 were screened. Patients with moderate to severe cancer pain who were already receiving or needed treatment with third step WHO ladder opioids were enrolled in the study. Data from 342 patients with at least one follow-up visit were analyzed. Results: Pain intensity decreased significantly for all patients during time ( p &lt; 0.001). Age, sex, emotional distress, pain duration and neuropathic pain presence evaluated by the Douleur Neuropathique 4 Questions (DN4) questionnaire were not significantly associated to pain intensity. Breakthrough/episodic pain was associated with higher pain intensity during follow-up ( p &lt; 0.001). The diagnosis of pain syndrome was overall significantly associated with mean pain intensity during follow-up ( p = 0.016). Particularly, the concurrent presence of visceral and soft ( p = 0.026) or soft and nervous tissue pain ( p = 0.043) were significantly related to worse outcome, whereas pain due to only soft tissue damage with better outcome ( p = 0.032). Conclusions: The recognition of specific pain syndromes may help to better classify cancer pain.

• 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.

• Fallon, M.; Dierberger, K.; Leng, M.; Hall, P.S.; Allende, S. & Sabar, R. [Vis alle 18 forfattere av denne artikkelen] (2022). An international, open-label, randomised trial comparing a two-step approach versus the standard three-step approach of the WHO analgesic ladder in patients with cancer. Annals of Oncology. ISSN 0923-7534. 33(12), s. 1296–1303. doi: 10.1016/j.annonc.2022.08.083. Fulltekst i vitenarkiv Vis sammendrag

  Background Worldwide, cancer pain management follows the World Health Organization (WHO) three-step analgesic ladder. Using weak opioids (e.g. codeine) at step 2 is debatable with low-dose strong opioids being potentially better, particularly in low- and middle-income countries where weak opioids are expensive. We wanted to assess the efficiency, safety and cost of omitting step 2 of the WHO ladder. Patients and methods We carried out an international, open-label, randomised (1 : 1) parallel group trial. Eligible patients had cancer, pain ≥4/10 on a 0-10 numerical rating scale, required at least step 1 (paracetamol) of the WHO ladder and were randomised to the control arm (weak opioid, step 2 of the WHO ladder) or the experimental arm (strong opioid, step 3). Primary outcome was time to stable pain control (3 consecutive days with pain ≤3). Secondary outcomes included distress, opioid-related side-effects and costs. The primary outcome analysis was by intention to treat and the follow-up was for 20 days. Results One hundred and fifty-three patients were randomised (76 control, 77 experimental). There was no statistically significant difference in time to stable pain control between the arms, P = 0.667 (log-rank test). The adjusted hazard ratio for the control arm was 1.03 (95% confidence interval 0.72-1.49). In the control arm, 38 patients (53%) needed to change to a strong opioid due to ineffective analgesia. The median time to change was day 6 (interquartile range 4-11). Compared to the control arm, patients in the experimental arm had less nausea (P = 0.009) and costs were less. Conclusion This trial provides some evidence that the two-step approach is an alternative option for cancer pain management.

• Skåre, Terese Solvoll; Midtbust, May Helen; Lund, Jo-Åsmund; Kaasa, Stein & Dreyer, Anne (2022). Barriers and Facilitators When Implementing Electronic Patient-Reported Outcome Measures at a Municipal Cancer Care Unit: A Qualitative Study. Cancer Nursing. ISSN 0162-220X. 46(4), s. E268–E275. doi: 10.1097/NCC.0000000000001120. Fulltekst i vitenarkiv Vis sammendrag

  Background Few qualitative studies of barriers and facilitators when implementing electronic patient-reported outcome measure (ePROM) in municipal cancer care exist within the large body of symptom assessment research. Such data, gathered from healthcare professionals’ (HCPs) perspective, are central to the development and design of sustainable interventions aiming for a systematic and patient-centered symptom assessment to patients with cancer. Objective The aim of this study was to identify and explore barriers and facilitators, as described by HCPs, in the implementation of the ePROM application “Eir” at a municipal cancer care unit in Norway. Methods The study applies a qualitative method, conducting an inductive data inquiry of semistructured individual interviews and focus groups with 14 Norwegian HCPs. Analysis was inspired by thematic analysis as described by Braun and Clarke. Results The analysis revealed 3 main themes affecting the implementation of ePROM in municipal cancer care: “achieving patient-centered care,” “crucial management and training,” and “technological barriers.” Conclusion The results from this study suggest that HCPs’ motivation plays a significant role when implementing ePROM. Motivation of HCPs was strongly influenced by whether the application added value to previously used symptom assessment. Hands-on management and a multiprofessional approach enabled the implementation by facilitating adaptations, training, and resources. Implications for Practice The findings show that adapting the implementation of ePROMs to patient population could be of major importance. Early integration of ePROMs in cancer care could facilitate use throughout the disease trajectory.

• 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
• Aamdal, Elin; Skovlund, Eva; Jacobsen, Kari Dolven; Straume, Oddbjørn; Kersten, Christian & Herlofsen, Oluf [Vis alle 17 forfattere av denne artikkelen] (2022). Health-related quality of life in patients with advanced melanoma treated with ipilimumab: prognostic implications and changes during treatment. ESMO Open. 7(5), s. 1–10. doi: 10.1016/j.esmoop.2022.100588. Fulltekst i vitenarkiv Vis sammendrag

  Background: We have previously reported that the safety and efficacy of ipilimumab in real-world patients with metastatic melanoma were comparable to clinical trials. Few studies have explored health-related quality of life (HRQL) in real-world populations receiving checkpoint inhibitors. This study reports HRQL in real-world patients receiving ipilimumab and assesses the prognostic value of patient-reported outcome measures. Patients and methods: Ipi4 (NCT02068196) was a prospective, multicentre, interventional phase IV trial. Real-world patients (N = 151) with metastatic melanoma were treated with ipilimumab 3 mg/kg intravenously as labelled. HRQL was assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire at baseline and after 10-12 weeks. Results: The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire was completed by 93% (141/151 patients) at baseline, and by 82% at 10-12 weeks. Poor performance status and elevated C-reactive protein (CRP) were associated with worse baseline HRQL. Clinically relevant and statistically significant deteriorations in HRQL from baseline to weeks 10-12 were reported (P <0.05). Baseline physical functioning [hazard ratio (HR) 1.96, P = 0.016], role functioning (HR 2.15, P <0.001), fatigue (HR 1.60, P = 0.030), and appetite loss (HR 1.76, P = 0.012) were associated with poorer overall survival independent of performance status, lactate dehydrogenase (LDH), and CRP. We further developed a prognostic model, combining HRQL outcomes with performance status, LDH, and CRP. This model identified three groups with large and statistically significant differences in survival. Conclusions: Systemic inflammation is associated with impaired HRQL. During treatment with ipilimumab, HRQL deteriorated significantly. Combining HRQL outcomes with objective risk factors provided additional prognostic information that may aid clinical decision making.

• Kristensen, Are Korsnes; Grønberg, Bjørn Henning; Fløtten, Øystein; Kaasa, Stein & Solheim, Tora S (2022). Trajectory of health-related quality of life during the last year of life in patients with advanced non-small–cell lung cancer. Supportive Care in Cancer. ISSN 0941-4355. 30, s. 9351–9358. doi: 10.1007/s00520-022-07359-x. Fulltekst i vitenarkiv Vis sammendrag

  Background The aims of this study were to assess the trajectory of health-related quality of life (HRQOL) during the last year of life in patients with advanced non-small–cell lung cancer (NSCLC) and to explore when and to what degree deterioration of symptoms and physical functioning accelerate towards the end of life. Methods Data from two RCTs of first-line chemotherapy in advanced NSCLC was analyzed. HRQOL was assessed repeatedly using the EORTC QLQ-C30 and LC13. Changes in HRQOL scores were investigated relative to the time of death. Results The study sample included 730 patients, with a median of four HRQOL assessments per patient (range 1–9). Fatigue, dyspnea, appetite loss, and cough were the most pronounced symptoms in all phases of the disease trajectory. The deterioration rates of global quality of life, physical function, and key symptoms were relatively slow until 4 months before death. Then, the decline accelerated, and for physical function, fatigue, and dyspnea, there was a very rapid decline in the last 2 months. Conclusions Patients with advanced NSCLC experience a high symptom burden that worsens over time, especially in the last 4 months. Regular symptom monitoring may help identify where patients are in the disease trajectory, serve as a trigger for changes in anticancer and symptomatic treatment, and facilitate discussions about end-of-life care.

• 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.

• Røen, Ingebrigt; Brenne, Anne-Tove; Brunelli, Cinzia; Stifoss-Hanssen, Hans; Grande, Gunn & Solheim, Tora Skeidsvoll [Vis alle 8 forfattere av denne artikkelen] (2021). Spiritual quality of life in family carers of patients with advanced cancer—a cross-sectional study. Supportive Care in Cancer. ISSN 0941-4355. 29, s. 5329–5339. doi: 10.1007/s00520-021-06080-5. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer. Methods Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models. Results In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R2) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age. Conclusion The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.

• Shkodra, Morena; Brunelli, Cinzia; Zecca, Ernesto; Formaglio, Fabio; Bracchi, Paola & Dico, Silvia Lo [Vis alle 9 forfattere av denne artikkelen] (2021). Neuropathic pain: clinical classification and assessment in patients with pain due to cancer. Pain. ISSN 0304-3959. 162(3), s. 1–9. doi: 10.1097/j.pain.0000000000002076. Fulltekst i vitenarkiv Vis sammendrag

  Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.

• Korwisi, Beatrice; Hay, Ginea; Attal, Nadine; Aziz, Qasim; Bennett, Michael I. & Benoliel, Rafael [Vis alle 22 forfattere av denne artikkelen] (2021). Classification algorithm for the International Classification of Diseases-11 chronic pain classification: development and results from a preliminary pilot evaluation. Pain. ISSN 0304-3959. 162(7), s. 2087–2096. doi: 10.1097/j.pain.0000000000002208. Fulltekst i vitenarkiv Vis sammendrag

  The International Classification of Diseases-11 (ICD-11) chronic pain classification includes about 100 chronic pain diagnoses on different diagnostic levels. Each of these diagnoses requires specific operationalized diagnostic criteria to be present. The classification comprises more than 200 diagnostic criteria. The aim of the Classification Algorithm for Chronic Pain in ICD-11 (CAL-CP) is to facilitate the use of the classification by guiding users through these diagnostic criteria. The diagnostic criteria were ordered hierarchically and visualized in accordance with the standards defined by the Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. The resulting linear decision tree underwent several rounds of iterative checks and feedback by its developers, as well as other pain experts. A preliminary pilot evaluation was conducted in the context of an ecological implementation field study of the classification itself. The resulting algorithm consists of a linear decision tree, an introduction form, and an appendix. The initial decision trunk can be used as a standalone algorithm in primary care. Each diagnostic criterion is represented in a decision box. The user needs to decide for each criterion whether it is present or not, and then follow the respective yes or no arrows to arrive at the corresponding ICD-11 diagnosis. The results of the pilot evaluation showed good clinical utility of the algorithm. The CAL-CP can contribute to reliable diagnoses by structuring a way through the classification and by increasing adherence to the criteria. Future studies need to evaluate its utility further and analyze its impact on the accuracy of the assigned diagnoses.

• Muscaritoli, Maurizio; Arends, Jann; Bachmann, Patrick; Baracos, Vickie E.; Barthelemy, Nicole & Bertz, Hartmut [Vis alle 22 forfattere av denne artikkelen] (2021). ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition. ISSN 0261-5614. 40(5), s. 2898–2913. doi: 10.1016/j.clnu.2021.02.005. Fulltekst i vitenarkiv Vis sammendrag

  Background This practical guideline is based on the current scientific ESPEN guidelines on nutrition in cancer patients. Methods ESPEN guidelines have been shortened and transformed into flow charts for easier use in clinical practice. The practical guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with cancer. Results A total of 43 recommendations are presented with short commentaries for the nutritional and metabolic management of patients with neoplastic diseases. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in cancer patients. Conclusion This practical guideline gives guidance to health care providers involved in the management of cancer patients to offer optimal nutritional 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] (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.

• Bugge, Christoffer; Kaasa, Stein; Sæther, Erik Magnus; Melberg, Hans Olav & Kristiansen, Ivar Sønbø (2021). What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study. BMJ Open. 11(9), s. 1–7. doi: 10.1136/bmjopen-2021-050564. Fulltekst i vitenarkiv
• Borchgrevink, Petter Chr.; Glette, Mari; Woodhouse, Astrid; Butler, Stephen; Landmark, Tormod & Romundstad, Pål [Vis alle 12 forfattere av denne artikkelen] (2021). A Clinical Description of Chronic Pain in a General Population Using ICD-10 and ICD-11 (The HUNT Pain Examination Study). Journal of Pain. ISSN 1526-5900. 23(2), s. 337–348. doi: 10.1016/j.jpain.2021.08.007. Fulltekst i vitenarkiv Vis sammendrag

  The purpose was to present a total description, distribution, and ranking of chronic pain conditions in the general population. This was based on structured clinical examinations of a random sample from a population-based survey (HUNT3) with a calculated oversampling of participants with chronic pain. Supplemented with access to hospital reports, the examination was performed by experienced physicians and psychologists using a consistent definition of chronic pain as well as ICD-10- and the new ICD-11-classification. The main findings were that a higher proportion of the 551 participants had chronic pain assessed by clinical examination (399) than by self-report in a survey the same day (337). Among those with examination-verified chronic pain estimated from HUNT3 to represent 27.9% of the general population, 63% had chronic primary pain, 81% musculoskeletal pain, and 77% more than one chronic pain condition. When separating chronic primary from chronic secondary pain according to ICD-11, the weighted prevalence was 17.7% for chronic pain conditions of unknown and 10.2% of known cause. When all the participants’ conditions were accounted for, the most prevalent was nonspecific low back (10.8%) and neck pain (7.6%). Participants with chronic primary pain did not have significantly more psychopathology than those with chronic secondary pain: 14.5% versus 12.5%. Perspective: Since this study confirms the high prevalence in self-report surveys and indicates that two thirds of chronic pain conditions cannot be explained by underlying diseases, this huge health and societal problem should be solved primarily on a public health level directed toward prevention and rehabilitation.

Se alle arbeider i NVA

• 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.

• Balstad, Trude Rakel; Raanes, Ida Ervik; Vagnildhaug, Ola Magne; Solheim, Tora S; Habberstad, Ragnhild Hansdatter & Klepstad, Pål [Vis alle 9 forfattere av denne artikkelen] (2025). The Impact of Systemic Inflammation on Energy and Protein Intake in Patients with Advanced Cancer. Fulltekst i vitenarkiv Vis sammendrag

  Undernutrition and cancer cachexia are common in advanced cancer. While undernutrition stems from inadequate energy and protein intake, cachexia involves systemic inflammation that promotes muscle and fat loss, even with adequate intake. C-reactive protein (CRP), a marker of inflammation, has been linked to weight loss in cancer patients. To which the extent inflammation contributes to reduced food intake remains unclear. Therefore, this study explores the impact of systemic inflammation on energy and protein intake in patients with advanced cancer. Methods: This study used data from the Palliative Radiotherapy and Inflammation Study (PRAIS) (ClinicalTrials.gov: NCT02107664), a multicenter longitudinal observational study. Dietary records for 180 patients with advanced cancer referred for palliative radiotherapy for painful bone metastases at Oslo University Hospital (2015 – 2017) were analyzed. Energy and protein intake were assessed using 24-hour recall interviews at baseline, three weeks, and eight weeks after radiotherapy. Systemic inflammation was defined as CRP >10 mg/L. Mixed linear modeling was used to estimate the effect of systemic inflammation at baseline on energy and protein intake while adjusting for possible confounders. Results: The mean age was 66 (SD 9.8) years and 59% were men. The most common cancers were gastrointestinal (26.7%), prostate (22.2%) and breast (20%). Baseline mean energy and protein intake were 25.5 kcal/kg (SD 11.5) and 1.0 g/kg (SD 0.54). Patients with systemic inflammation had lower energy (-3.6 kcal/kg, SE 1.7, p=0.04) and protein (-0.25 g/kg, SE 0.083, p=0.003) intake after adjusting for covariates (age, sex, performance status, primary tumor type, systemic anti-cancer treatment). There was no change in energy and protein intake during follow-up, irrespective of CRP-level. Conclusion: Systemic inflammation is significantly associated with reduced energy and protein intake in advanced cancer patients, even after adjusting for key covariates. Regardless of inflammation status at baseline the energy and protein intake remained stable over time. Addressing inflammation could be a key strategy in improving nutritional status and outcomes in this vulnerable population.

• 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
• Skipar, Kjersti Øvrum; Ørvik, Maren Synnøve; Evers, Christoph; Balteskard, Lise; Ekanger, Christian & Giske, Liv Ellen [Vis alle 14 forfattere av denne artikkelen] (2025). Palliative radiotherapy in symptomatic pelvic soft tissue tumors (PallSoft)– protocol for a national, randomized, non-inferiority study. doi: 10.1186/s12885-025-14424-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Palliative radiotherapy is essential in the management of patients with symptomatic pelvic soft tissue tumors, often providing rapid and efficient symptom relief. No standard treatment recommendations currently exist, yielding large differences in patient management across cancer types and institutions. PallSoft is a national, phase III, non-inferiority study aiming to compare two short-course radiotherapy approaches for these patients. Methods 200 patients will be recruited from 11 institutions over 2–4 years. Patients with either gastrointestinal, urological or gynecological cancers, referred to palliative radiotherapy due to a symptomatic pelvic soft tissue tumor, are eligible for study inclusion. Patients will define their target symptom and be randomly assigned to treatment with either 1 fraction of 8 Gy (Gy) (arm A) or 5 fractions of 5 Gy (arm B). An additional fraction of 8 Gy may be offered to patients in arm A if unsatisfactory symptomatic effect occurs, evaluated according to predefined criteria. The primary objective is to investigate whether the patient-reported target symptom relief in arm A is non-inferior to arm B, assessed on a Numeric Rating Scale (NRS). Secondary objectives are physician-assessed bowel and bladder toxicities and overall survival. Explorative objectives include evaluations of health-related quality of life, general patient satisfaction and health economic aspects. Prognostic models for survival prediction and predictive biomarkers for radiotherapy response will be explored. Statistical analyses using linear regression models and survival analyses will be employed. Discussion We aim to provide evidence of the most optimal palliative radiotherapy regimen for patients with symptomatic pelvic soft tissue tumors, and thereby contribute to establish a standard-of care for these patients. The participation of all radiotherapy units in Norway may ease national implementation of study results.

• 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.

• Apolone, G.; Costantini, M.; Caselli, L.; Bos, N.; Caraceni, Augusto Tomasso Giovanni & Ciliberto, G. [Vis alle 29 forfattere av denne artikkelen] (2024). Validation of the European Oncology toolkit for the self-assessment of Quality of Life (EUonQoL-Kit) in cancer patients and survivors: study protocol of a pan European survey. BMC Public Health. 24(1). doi: 10.1186/s12889-024-21008-4. Fulltekst i vitenarkiv
• Solheim, Tora S; Laird, Barry; Balstad, Trude Rakel; Stene, Guro Birgitte; Baracos, Vickie & Bye, Asta [Vis alle 20 forfattere av denne artikkelen] (2024). Results from a randomised, open-label trial of a multimodal intervention (exercise, nutrition and anti-inflammatory medication) plus standard care versus standard care alone to attenuate cachexia in patients with advanced cancer undergoing chemotherapy. Fulltekst i vitenarkiv
• Engelaar, Merel; Bos, Nanne; Schelven, Femke van; Sunyer, Nora Lorenzo i; Couespel, Norbert & Apolone, Giovanni [Vis alle 19 forfattere av denne artikkelen] (2024). Collaborating with cancer patients and informal caregivers in a European study on quality of life: protocol to embed patient and public involvement within the EUonQoL project. Research Involvement and Engagement. 10(1). doi: 10.1186/s40900-024-00597-9. 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
• Voskanyan, Viktorya; Marzorati, Chiara; Sala, Diana; Grasso, Roberto; Pietrobon, Ricardo & Heide, Iris van der [Vis alle 20 forfattere av denne artikkelen] (2024). Correction to: Psychosocial factors associated with quality of life in cancer survivors: umbrella review (Journal of Cancer Research and Clinical Oncology, (2024), 150, 5, (249), 10.1007/s00432-024-05749-8). Journal of Cancer Research and Clinical Oncology. ISSN 0171-5216. 150(9). doi: 10.1007/s00432-024-05929-6. Fulltekst i vitenarkiv
• Henmo, Ola; Kaasa, Stein & Dajani, Olav (2023). Setter personen, ikke pasienten i sentrum. [Internet]. Kreftforeningen. 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
• Fallon, M.T.; Caraceni, Augusto Tomasso Giovanni; Laird, Barry J & Kaasa, Stein (2023). Reply to the Letter to the Editor “A simple way of doing the complex but utmost important things: cancer pain management” by S. Singhal, M. Verma and D. Kukreja. Annals of Oncology. ISSN 0923-7534. 34(5), s. 496–497. doi: 10.1016/j.annonc.2023.02.005. 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
• Kristiansen, Hege; Kaasa, Stein & Sagabråten, Ståle Onsgård (2022). Reagerer på behandling av døende barn. 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
• Brkic, Alen; Lundeby, Tonje; Guren, Marianne; Kaasa, Stein; Delmas, Dominique & Brunelli, Cinzia [Vis alle 8 forfattere av denne artikkelen] (2024). Collaborative Network Report. European Commission. doi: https:/ec.europa.eu/research/participants/documents/downloadPublic?documentIds=080166e50738a363&appId=PPGMS. Fulltekst i vitenarkiv
• Brkic, Alen; Lundeby, Tonje; Foss, Line; Guren, Marianne; Kaasa, Stein & Delmas, Dominique [Vis alle 10 forfattere av denne artikkelen] (2024). Iterative scoping rounds and Implementation guidelines. European Commission. doi: https:/ec.europa.eu/research/participants/documents/downloadPublic?documentIds=080166e516b07e39&appId=PPGMS. Fulltekst i vitenarkiv

Se alle arbeider i NVA