Acta Oncologica最新文献

Background and purpose: The prevalence of sequelae following rectal cancer (RC) treatment is high. We investigate the prevalence and temporal change in sexual dysfunction among male RC patient, along with their counselling and treatment needs and associations between sexual dysfunction and clinical factors. Patient/materials and methods: Patient-reported outcome measures were completed 3 and 12 months after RC surgery. We used the five-item International Index of Erectile Function score to measure sexual function in sexually active patients and ad hoc items to explore their sexual activity level, causes of disrupted sexual life, and self-rated sexual function. Clinical data were obtained from the Danish Colorectal Cancer Group database Results: In total, 364 of 490 (74%) eligible male patients were included. Their mean age (standard deviation [SD]) at surgery was 68.3 (11) years. Forty-one percent reported being sexually inactive at the time of diagnosis. Among sexually active men, 44% had resigned from sexual activity at 12 months, mainly due to erectile dysfunction (ED), as reported by 55%. Only 16% experienced improvement; 19% experienced a worsening of their ED category in the 12-month observation time. Stoma was associated with both ED (odds ratio [OR] 5.6; 95% confidence interval [CI] [1.8, 17.4]) and low self-rated sexual function (OR 3.5 95% CI [1.8 , 6.7]). Phone contact to discuss sexual problems was requested by 29%; 19% were referred to professional treatment.

Interpretation: Sexual dysfunction is common following RC, without improvement over time. Systematic screening enables identification of patients needing professional help.

Background and purpose: We previously demonstrated positive effects on quality of life and mental health following breast cancer when comparing a nurse-led follow-up program without scheduled visits (MyHealth) to regular follow-up. This study aims to examine whether MyHealth also positively impacts self-reported work ability.

Patients/material and methods: A total of 288 patients, potentially active on the labour market, were randomized to MyHealth or control follow-up after primary treatment for early-stage breast cancer (2017-2019). MyHealth included individual self-management sessions, electronic symptom monitoring, and assistance with navigating healthcare services. Control follow-up consisted of biannual outpatient visits with a physician. Linear mixed-effect models were applied to evaluate the effect of MyHealth on self-reported work ability at 6, 12, 24, and 36 months after randomization as measured by the Work Ability Score (WAS).

Results: Work ability increased significantly in both groups during the first 6 months (mean WAS increase MyHealth: 1.64, 95% confidence interval [CI]: 1.26; 2.02 and control: 1.57, 95% CI: 1.17; 1.97) and continued to increase slightly but non-significantly (p-values > 0.13) until end of follow-up at 36 months. Improvement was especially pronounced among patients reporting poor work ability at baseline. Differences in mean WAS between patients in MyHealth and control follow-up were non-significant and close to zero at all time points (-0.21 to 0.48).

Interpretation: The MyHealth follow-up program had no additional effect on self-reported work ability compared to regular follow-up. Future interventions should target patients with poor work ability and include components specifically designed to enhance work ability.

Background and purpose: There is limited data on the real-world management of incidental pulmonary nodules (IPN). In this article, we review current practices and adherence to international guidelines in the Nordic countries.

Materials and methods: This non-interventional, observational survey study based on an online survey consisting of 13 questions. In total, 32 hospitals responded to the survey, with 11 from Denmark, 10 from Sweden, 7 from Norway, and 4 from Finland, resulting in an overall response rate of 86% (32/37). These institutions reported following a median of 20 new lung nodules monthly (5-400 IPN cases per month).

Results: In Denmark and Sweden, 100% of respondents indicated the presence of national guidelines. In Norway, this rate was 86%, and in Finland 80%. Among the primary guidelines followed, 70% of respondents reported using national guidelines, 20% used international guidelines, and only 10% reported relying on local/institutional guidelines as their first choice. Most sites used a combination of international and national guidelines (75%, 24/32). Available international guidelines were equally represented, with 35% using the Fleischner Criteria, 30% using British Thoracic Society guidelines, and 35% using others (e.g. European Society for Medical Oncology, National Comprehensive Cancer Network). There was variation in which department held primary responsibility for IPN follow-up. The article also demonstrated differences in suggested follow-up cases from the survey.

Interpretation: The study reveals strong adherence to guidelines among Nordic hospitals, with a notable preference for hybrid approaches that combine different guidelines. We need continued efforts to harmonize and update guidelines.

Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient's Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL.

Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only.

Background and purpose: The gold standard when treating muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), a procedure that holds the potential to affect the function of several pelvic organs, causing an impact on the patient's Quality of Life (QoL). Knowledge of the late effects following bladder cancer and treatment with RC is sparse. The aim is to describe the incidence of late effects and to investigate the impact on QoL.

Methods: A cross-sectional study using register data in combination with a questionnaire, measuring pelvic organ specific symptoms to treatment and QoL. MIBC patients diagnosed between 2015 and 2020 and able to receive digital mail was invited. For each MIBC patient, 6 age- and gender matched controls were invited. QoL was measured using EORTC-QLQ-C30. The MIBC specific EORTC-QLQ-BLM30 was administered to cases only.

Results: A total of 628 (54.3%) MIBC patients and their 1,204 (37.3%) matched controls responded. Median age was 73. Mean time since RC was 4.9 (SD 2.1) years. Scoring of the functional items on EORTC-QLQ-C30 and overall QoL were similar for cases and controls. Regarding late effects, similar responses were seen on questionnaire data when comparing cases and controls. On registry data, a higher risk of infections and hydronephrosis were seen for cases. A strong correlation between fatigue and impaired QoL was identified.

Interpretation: MIBC patients were more often diagnosed with late effects such as infections and hydronephrosis, compared to controls. In spite of this, MIBC patients overall QoL was equal to that of the controls.

Background and purpose: The similarities in biology, treatment regimens and outcome between the different human papillomavirus (HPV) associated squamous cell carcinomas (SCCs) allow for extrapolation of results generated from one SC tumor type to another. In HPV associated cancers, HPV is integrated into the tumor genome and can consequently be detected in the circulating fragments of the tumor DNA. Thus, measurement of HPV in the plasma is a surrogate for circulating tumor DNA (ctDNA) and holds promise as a clinically relevant biomarker in HPV associated cancers. With the present overview we aim to present the status of circulating HPV studies in SCCs, the clinical potential and the gaps of knowledge, with the overall aim to facilitate the next steps into clinically relevant prospective trials.

Material and methods: We reviewed the literature and presented the data for each tumor type as well as analyses of the clinical utility across the SCC.

Results and interpretation: A total of 41 studies were identified in cervical, head and neck and anal SCC and we discuss the common signals from the results across the different tumor sites. Our results not only confirm the strong clinical potential but also emphasize an urgent need to coordinate studies to allow for relevant sample sizes and statistical validations.

Background and purpose: Recommended treatment of urothelial muscle-invasive bladder cancer (MIBC) is cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy, but there are challenges with low utilization of NAC. We aimed to evaluate the utilization of NAC, perioperative complications and oncological efficacy in a real-world setting.

Patients and methods: All patients operated with radical cystectomy at the University Hospital of North Norway during 2011-2021 for MIBC were included. NAC consisted of three cycles of dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (ddMVAC) every second week. Complications after cystectomy (Clavien-Dindo ≥ grade 3 within 30 days), histopathologic NAC response, cancer recurrence, relapse-free survival (RFS), overall survival (OS) and cause of death were reported.

Results: We included 124 patients, median observation time of 4 years. Fifty-nine patients (48%) received NAC. Most common causes for not receiving NAC were age ≥ 75 years (n = 38; 31%), cardiovascular disease (n = 7; 5.6%), and reduced kidney function (n = 6; 4.8%). Overall 34 patients (27%) had a ≥ grade 3 complication. The 5-year actuarial OS rate was higher among patients treated with NAC than those without NAC (67% vs. 45%, p = 0.02). Among NAC-treated patients, 29 (49%) were downstaged to non-muscle invasive stage (≤pT1), and the 5-year actuarial RFS and OS were higher among patients with ≤pT1 in the post-cystectomy specimen than those with ≥ pT2 (92% vs. 35%, and 94% vs. 39%, both p < 0.001).

Interpretation: The utilization of NAC was high in this real-world setting. Treatment with ddMVAC with achieved downstaging to ≤pT1 was associated with considerably improved RFS and OS.

Background and purpose: Lung cancer is the leading cause of cancer-related mortality in Greenland. Since 2004, medical treatment of lung cancer has been available in Greenland. However, both diagnostic work-up and treatment logistics are hampered by the lack of medical services in smaller settlements, the infrastructure, and extreme arctic weather conditions. Clinico-pathological data and assessment of treatment outcome in lung cancer in Greenland have not been carried out since 2015. This study aims to provide an analysis of Greenlandic patients with non-small cell lung cancer (NSCLC) from 2015 to 2020, compared to the cohort from the 2015 study. We focus on diagnostics, patient and treatment characteristics, and survival rates. Additionally, we include new data on treatment-related factors and diagnostic delays. Patients/material: Clinical-, pathological-, genomic data, tuberculosis status and survival were retrieved from the medical journal.

Results: A total of 163 patients were identified. Survival had improved in stage I, III, and IV, and early-stage disease was more often diagnosed as compared to the 2015 cohort. Molecular alterations and PD-L1 expressing tumors were comparable between Greenlandic and Danish patients. Diagnostic delay was a major concern.

Interpretation: While NSCLC survival in Greenland has improved over the past decade, significant challenges remain. The trend towards diagnosing more stage IA-IIIA patients and the recent improvements in diagnostic and therapeutic options in Greenland are expected to translate into a better prognosis in the coming years. Addressing diagnostic delays and enhancing treatment options are crucial steps toward improving outcomes for NSCLC patients in Greenland.

Background and purpose: Norway has one of the highest rates of cutaneous melanoma (CM) incidence and mortality globally. Immune checkpoint inhibitor (ICI) therapy for CM was introduced between 2014 and 2017 to improve treatment and patient prognosis, but knowledge about its clinical usage is limited. This study investigates patient's characteristics and treatment patterns in real-world practice compared to clinical trial results.

Material and methods: All adult (≥18) CM patients treated with ICI therapy in Norway from 2014 to 2021 were included, utilizing high-coverage data from multiple national registries to describe patients' health, socioeconomic factors, and treatment management, stratified by first ICI therapy. We compared patient and tumour characteristics with findings from five randomized controlled trials (RCTs).

Results: Among 2,083 patients receiving ICI therapy, 975 (47%) received nivolumab as their first treatment in the metastatic setting. Patients on combination therapy were younger and had higher education and income levels compared to those on monotherapy. Overall, real-world patients were older and had a higher incidence of brain metastases than those in RCTs. Approximately, 1 in 5 patients would have been excluded from RCTs due to pre-existing autoimmune diseases. Targeted therapy was the most common secondary systemic treatment after first-line PD-1 inhibitors.

Interpretation: This study details ICI therapy in Norway, highlighting differences between real-world ICI users and clinical trial participants, raising questions about the effectiveness of this treatment for patients not eligible for trials.

Background: A significant proportion of newly diagnosed patients with hypopharyngeal carcinoma (HC) are at risk of early death and may not benefit from cancer treatments. Our objective was to assess whether an image-based evaluation of muscle mass could identify patients at risk of impaired survival.

Materials and methods: This retrospective study consisted of male patients diagnosed with HC treated at Helsinki University Hospital between 2005 and 2014 (N = 66). Cross-sectional areas of skeletal muscles at the level of the third cervical vertebra (C3) and at the level of the thoracic aortic apex were analyzed using magnetic resonance images and/or computed tomography images. Survival-based cutoff values for low muscle index values were determined using the receiver operating characteristics curves. Kaplan-Meier analyses and Cox proportional hazard models were used to evaluate the associations between the muscle indexes and survival rates.

Results: Several muscle indexes were associated with 6-month and 5-year survival. The 6-month survival rate of males with a low sternocleidomastoid muscle index (cutoff 1.73 cm2/m2) was 66%, as opposed to the 97% survival rate for those with an above-the-cutoff muscle index (hazard ratio 13.0 [95% CI 1.5, 116.6]). In a multivariate Cox model adjusted for age, sex, tumor stage, and grade, lower sternocleidomastoid muscle index was significantly associated with decreased 6-month survival.

Interpretation: C3-level muscle indexes, particularly the sternocleidomastoid muscle index, are a promising marker in the identification of patients at risk of early mortality and could add confidence in decision-making when choosing between active and palliative care.

Background and purpose: European Society for Hyperthermic Oncology (ESHO) 2-85 is a multicenter randomized trial investigating hyperthermia (HT) as an adjuvant to radiotherapy (RT) in treatment of locally advanced neck nodes. The trial never fulfilled recruitment and was stopped prematurely, and has not previously been published.

Patients and methods: Between January 1987 and February 1993, 64 evaluable neck nodes in 54 patients were included. Tumors were stratified according to institution and nodal size and randomly assigned to receive RT alone (2 Gy/fx, 5 fx/wk) to a total dose of 60-70 Gy, including boost, or the same RT followed once weekly by HT (aimed for 43°C for 60 min). The primary endpoint was persistent complete response (local control).

Results and interpretation: Sixty-four tumors in 54 patients were evaluable, with a median observation of 17 months. Thirty-four tumors were randomized to RT alone and 30 to RT+HT. Compliance with RT was good. HT was associated with moderate to severe pain and discomfort in 38% of the treatments. In 57% of the heated patients at least one treatment achieved the target temperature. HT did not significantly increase radiation morbidity. The complete response rate was 53% in the RT versus 80% in the RT+HT group, and 3-year persistent local control rate was 32% for RT alone versus 53% for RT+HT; HR: 0.48 [0.23-0.98]. The ESHO 2-85 study demonstrated that addition of a weekly HT treatment to RT of advanced neck nodes significantly enhanced the persistent tumor control. The results substantiate the potential clinical benefit of hyperthermic oncology.