Acta Oncologica最新文献

Background and purpose: The COVID-19 pandemic impacted substantially on cancer healthcare, including the temporary suspension of screening activities. We compared cancer incidence rates and stage during 2020-2021 to pre-pandemic rates in the Nordic countries.

Material and methods: Using data from the national cancer registries in Denmark, Finland, Iceland, Norway, and Sweden, we estimated age-, sex-, and period-adjusted incidence rate ratios, expressed as relative percentage change (%) with 95% confidence intervals (CIs), comparing rates in 2020-2021 to those in 2017-2019 (pre-pandemic).

Results: In 2020-2021, 340,675 cancer cases were diagnosed. The incidence rates declined during the first pandemic wave (Q2 2020), ranging from -21.7% [95% CI: -23.3%; -20.2%] (Sweden) to -7.9% [-17.7%; 3.0%] (Iceland). Incidence rates also declined in the second pandemic wave (Q1 2021), ranging from -8.6% [-10.2%; -6.9%] (Sweden) to -2.3% [-4.6%; 0.1%] (Norway), and in Sweden also by -3.1% [-4.8%; -1.3%] in the third pandemic wave (Q4 2021). Stage I breast cancer incidence declined during 2020 in Denmark/Norway/Sweden, with some catch-up in stage II incidence in 2021. Prostate cancer rates declined in Denmark/Finland/Norway/Sweden during 2020-2021, while melanoma rates declined in Finland in 2020. During 2020, colon cancer rates declined in Denmark and Iceland, while rectal cancer rates declined in Denmark, and lung and kidney cancer rates declined in Norway.

Interpretation: During 2020-2021, cancer incidence rates declined across the Nordic countries with the largest declines in Sweden. During the third pandemic wave, the incidence rates were mostly similar to pre-pandemic rates. Changes in cancer stage may reflect reduced screening activities.

Background and purpose: Melanoma is one of the deadliest skin cancers and challenges clinicians worldwide due to rising incidence, potential aggressiveness, and propensity for metastasis, necessitating comprehensive follow-up programs after primary treatment. Circulating tumor DNA (ctDNA) is a promising biomarker that may indicate disease progression earlier than traditional surveillance methods, including 18F-FDG PET-CT, ultrasound, and clinical examination. This study examines ctDNA detection in blood as a minimally invasive method for early identification of progression following primary treatment of melanoma. The aim is to overcome the limitations of current methods, potentially improving prognosis and survival.

Patients/material and methods: Patients with high risk of recurrence following primary treatment of melanoma are offered inclusion. Blood sampling is performed at each follow-up visit. In case of recurrence, patient-specific mutations are identified through next-generation sequencing (NGS) of formalin and paraffin embedded tissue from diagnostic routine. Detection of mutation-specific ctDNA is performed on blood using digital droplet polymerase chain reaction (ddPCR) or NGS. This allows determination of the value and sensitivity of ctDNA for early detection of recurrence.

Results and interpretation: For validation purposes, we conducted a small pilot study using blood samples from 10 patients who had experienced recurrence and had a clinically confirmed BRAF V600E mutation. Detection of BRAF V600E ctDNA using ddPCR varied from 0/5 (0%) in DNA harvested from 4 mL plasma, to 3/5 (60%) in DNA from 8 mL of plasma. These results show promise and highlight the importance of high sensitivity and sampling volumes to ensure accurate detection of low levels of ctDNA.

Background: The treatments of hematological malignancies tend to be intense, and compared with solid tumors, less is known about the health care consumption during end of life (EOL). Therefore, the aim was to study the receipt of specialized palliative care (SPC) and how it affects health care utilization, in relation to sex, age, socioeconomics, and frailty risk (Hospital Frailty Risk Score [HFRS]).

Methods: In a retrospective, observational registry study, all patients who died of a hematological malignancy during the years 2015-2021 in the Stockholm County were included and analyzed with descriptive statistics and logistic regression models.

Results: Of the 2,858 included patients (mean age 76 years, 41% women), 38% had myeloid malignancies, 41% lymphocytic malignancies, and 21% had myeloma. During the last 3 months of life, 56% received SPC, with an overrepresentation of women, aOR 1.35 (1.16-1.58, p < 0.0001), whereas persons with risk of frailty (HFRS) were underrepresented, aOR 0.74 (0.63-0.86, p < 0.0001). Unplanned ER visits were more likely in persons aged over 80 years (p = 0.004) and in persons with frailty risk (p < 0.0001). Patients receiving SPC had a substantially reduced likelihood of ER visits, aOR 0.34 (0.29-0.40, p < 0.0001). Emergency hospitals as place of death was positively associated with frailty risk, aOR 1.50 (1.23-1.83, p < 0.0001) but negatively associated with age over 80 years (p < 0.0001) and especially with receipt of SPC, aOR 0.05 (0.04-0.06, p < 0.0001).

Interpretation: Receipt of SPC could possibly reduce the need for emergency care in the end of life and the Stockholm model might facilitate referral to SPC for hematological patients.

Background and purpose: After reports that complete lymph node dissection (CLND) did not improve melanoma-specific survival of sentinel lymph node (SLN)-positive patients, the use of CLND has diminished but it is still carried out for selected patients. We sought to assess differences in Health-Related Quality of Life (HRQoL) and tertiary care costs among the Finnish Multicenter Selective Lymphadenectomy Trial (MSLT)-II-patients.

Patients/materials and methods: A total of 52 patients randomized to CLND and 55 to nodal observation completed a modified version of the standardized and validated, RAND-36 questionnaire at baseline, 4 months and annually up to 5 years. Tertiary care costs between the groups were also compared.

Results: At 60 months, the mean HRQoL score for the CLND and observation groups for General Health were 77.3 versus 65.0 (p = 0.007, adjusted p = 0.065), for role limitations due to physical health 89.5 versus 72.3 (p = 0.029, adjusted p = 0.203) and for role limitations due to emotional problems 91.4 versus 71.9 (p = 0.006, adjusted p = 0.065) and at 48 months, 92.8 versus 71.3 (p = 0.002, adjusted p = 0.056). Median costs per patient were higher in the CLND group at 4 months but the difference disappeared during follow-up.

Interpretation: This study suggests that undergoing CLND after a positive SLN biopsy is not a predictor of worse HRQoL. CLND generates greater costs initially, but there seem to be no major differences in total cost per patient between the two groups.

Background: Soft tissue undifferentiated sarcomas (STUS) are an ultra-rare and heterogenous group of mesenchymal neoplasms often lacking known genetic abnormalities with a marked vulnerability towards intensive therapy such as invasive surgery and high dose chemotherapy. Despite aggressive treatment, they are usually associated with dismal outcomes.

Case presentation: Here we describe two cases of STUS in 3-week-old and 3-month-old infants localized on the neck and the trunk area.

Discussion: In both cases, the malignancy had a fatal outcome due to the toxicity of intensive therapy in one case and the progression of the disease in the other. The purpose of this report is to discuss the clinical challenges of managing infancy-related STUS such as limited treatment options and poor prognosis.

focused on patients living with metastatic cancer. We examined the feasibility of the SleepNow intervention combining cognitive behavioral therapy for insomnia (CBT-I) with physical exercise in men with metastatic prostate cancer (mPCa).

Patients/material and methods: We conducted a feasibility randomized trial in patients under treatment for castration resistant mPCa with insomnia (Insomnia Severity Index [ISI] score ≥ 8). Patients were randomized 1:1 to either SleepNow or usual care. SleepNow is a manualized 12-week program consisting of bi-weekly sessions of physical exercise and four nurse-led sessions of CBT-I. Patients in usual care received no insomnia treatment. We assessed feasibility and measured objective and patient-reported outcomes at baseline and 3-months follow-up. Changes in both groups were compared using the Wilcoxon test.

Results: We randomized 12 patients (5 intervention and 7 control; age range = 59-81 years, mean Gleason score = 7.75, mean time since diagnosis ≈ 7 years). Intervention patients reported high satisfaction, all attended at least three CBT-I sessions (75%) and four completed at least 20 of the 24 training sessions. The intervention group showed improvements in insomnia, sleep quality, fatigue, anxiety, depression and health-related quality-of-life but between-group differences were not statistically significant.

Interpretation: The SleepNow intervention is the first to combine nurse-delivered CBT-I and physical exercise and was acceptable and potentially efficacious. Our results are important for targeting sleep interventions to the growing population of patients living long term with metastatic cancer.

Background and purpose: Many men with cancer experience that changes created by cancer and its treatment may impair sexual function. However, many studies investigating sexual impairments fail to consider whether such impairments are perceived as distressing, i.e. create sexual distress. We investigated the prevalence of sexual distress, overlap with sexual impairment, and sociodemographic and clinical characteristics and other symptoms associated with sexual distress in a heterogeneous male cancer population.

Patients and methods: Across cancer diagnoses, 2792 men in treatment or follow up at the Department of Oncology, Rigshospitalet, were invited. The Sexual Complaint Screener (SCS) assessed sexual impairments and sexual distress. Regression analyses estimated the association of sexual distress with sociodemographic and tumor-related factors, other symptoms (pain, depression, fatigue, insomnia, fear of recurrence), and health-related quality of life. The number of patients who received help for or were interested in a consultation for sexual problems was calculated.

Results: Six hundred and ninety-six patients, most frequently diagnosed with testicular (26%) or multiple (16%) cancers, completed the SCS. Forty-one per cent experienced sexual distress, 60% sexual impairment, and 34% overlapping sexual distress and impairment. Sexual distress was significantly associated with clinically relevant insomnia (OR:2.15; 95% CI:1.5-3.1) and pain (OR:1.90; 95% CI:1.3-2.9). Two thirds of all patients wished for help, but only one third of these were receiving help.

Interpretation: Sexual distress was widespread in men across different cancer diagnoses and sometimes presented without impairment, demonstrating that assessment of sexual problems must include the personal experience of distress and extend to men across cancer diagnoses.

Background and purpose: There is an urgent need to improve patient-selection to surgical treatment in advanced ovarian cancer as our results showed that cytoreductive surgery was without effect or even detrimental in a yet unknown subgroup of women. With an ageing population, 30% of women with advanced ovarian cancer in Sweden are >75 years. Nevertheless, there are no recommendations on patient-selection, albeit treating an unselected population in a public and centralized health care setting. Little attention has been placed on frailty assessments in oncology, despite their potential to stratify the risk of adverse outcome and mortality. Consequently, we hypothesize that frailty is a predictor of poor survival.

Patients and methods: In this Swedish multi-centre prospective cohort study, where the exposure is frailty, consecutive women with advanced ovarian cancer scheduled for surgery with curative intent are eligible for inclusion. Three different frailty instruments are evaluated preoperatively, blinded to the caregiver. The primary outcome is 2-year overall survival. With a fixed sample size of 450 patients, a two-sided α of 0.05 and β of 0.20, the study is powered to detect a difference in 2-year survival of 12.5% by frailty, assuming a 20% prevalence of frailty. The result of the study will have a direct impact on clinical management and patient-selection as the results are expected to have a high external validity. Total study-time is 5 years, with 3 years of accrual. All participating centres started accrual by September 2024. Presentation of data on primary outcome is expected 2029.

Study registration: ClinicalTrials.gov NCT06298877.

Background: Assessment of cardiac disease before cancer therapy is crucial, as advancements in cancer treatment have led to prolonged survival and an increase in cardiovascular complications. Specifically, esophageal cancer and heart disease share common risk factors, such as smoking and obesity. Radiation therapy (RT) for esophageal cancer is associated with elevated cardiac radiation exposure. This study aimed to assess the prevalence of coronary artery disease (CAD) in patients with esophageal cancer who were eligible for RT.

Methods: We examined the prevalence of coronary artery stenosis, abnormal myocardial perfusion, and late enhancement using pre-RT cardiac computed tomography (CT) data of 41 patients with thoracic esophageal cancer who were referred for RT between January 2017 and June 2023 and had no history of ischemic heart disease.

Results: The median age of the 41 patients was 71 years, with 40 patients being male. Cardiac CT identified significant coronary stenosis (≥50% luminal narrowing) in 18 patients (44%), among whom 9 (50%) had severe stenosis, multivessel disease, or myocardial ischemia. Significant stenosis was most frequently observed in the left anterior descending artery (16/18). Late enhancement, indicating myocardial infarction, was observed in seven patients (17%).

Interpretation: Patients with esophageal cancer without a history of ischemic heart disease had a high prevalence (44%) of CAD, with half of them having severe stenosis, multivessel disease, or myocardial ischemia. Given the high prevalence of coronary stenosis, pre-treatment cardiac evaluation is crucial for patients with esophageal cancer. Incorporating cardiac CT findings into radiotherapy planning is recommended to optimize patient care.

Background and purpose: Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follow-up program.

Patients/materials and methods: A total of 924 patients with CSI seminoma were identified in the prospective Danish Testicular Cancer database. Retrospectively collected clinical data were used for descriptive analyses of patterns in detection methods. Additionally, we explored a risk-adapted surveillance approach based on recently identified risk factors for relapse, classifying patients into low- and non-low-risk groups.

Results: At 60 months, the 5-year cumulative relapse risk was 16%, with 146 relapses during surveillance. Relapses were detected by imaging alone in 71% of cases, imaging combined with elevated serum tumor markers (STMs) in 18%, isolated elevation of STMs in 8%, and by self-referral due to symptoms in 3%. No relapses were detected by abnormal findings at a physical examination. In total, 134 (92%) relapses were localized to retroperitoneal lymph nodes, primarily without additional spread. The 5-year relapse risk in patients with low risk of relapse was 9% compared to 28% in patients in the non-low-risk group.

Interpretation: This study highlights that the surveillance program can detect relapses at an early stage. Reduction of visits and omission of routine physical examinations can safely be considered for patients with a low risk of relapse, while further research is needed to optimize follow-up and treatment for patients at higher risk of relapse.