Diagnostic pathway efficacy for urinary tract cancer : population-based outcome of standardized evaluation for macroscopic haematuria

Objective: This study assessed a national healthcare intervention launched in Sweden in 2015 to reduce the time between macroscopic haematuria, diagnosis and treatment of urinary tract cancer. Methods: The outcome of the first 11 months was evaluated in 1697 individuals referred to a standardized care pathway for urinary tract cancer compared with 174 patients with conventionally diagnosed urothelial carcinoma. Results: Among the referred individuals, 317 (19%) were diagnosed with cancer, 1034 (61%) had a benign diagnosis and 345 (20%) had a negative evaluation. Bladder cancer was the most common malignant diagnosis [262/317 (83%)]. Cancers were diagnosed in 23% of males and 13% of females, and showed a strong correlation with age: cancer diagnosis in 2% aged <50 years and in 44% aged ≥90 years. Results were affected by bacteriuria but not by anticoagulant medication, with 12%/22% and 19%/19% cancer detection, respectively. The standardized care pathway shortened the diagnostic delay to a median of 25 days compared to 35 days for regular referral (p =.01). However, median time to treatment was unchanged: 39 days from referral to transurethral resection, 42 days from primary resection to re-resection for stage TaG3/T1 disease and 100 days from referral to curative treatment for muscle-invasive disease. Conclusions: Macroscopic haematuria had a cancer capture rate of 19%, with higher predictive values in men and at older age, whereas anticoagulant therapy did not influence the diagnostic yield. The demonstrated lack of effect on time to treatment underscores the need to consider the entire patient process when initiating healthcare reforms to improve outcome

Radiotherapy techniques in current use in Sweden.

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included a review of radiotherapy techniques in current use in Sweden. The following conclusions were drawn: Radiotherapy demands adequate knowledge of diagnostic methods, anatomy, cancer biology and of the physical and biological properties of ionizing radiation. Well-functioning teamwork on the part of the oncologist, medical physicist and oncology nurse is important.Radiotherapy has a high degree of technical sophistication, including the use of computers, which necessitates expert technical support.Technical development is rapid, and since the previous report, multileaf collimators and electronic portal imaging have been introduced in the clinical routine.The use of brachytherapy for treatment of non-gynaecological malignancies is rapidly increasing.The need for quality assurance in all steps of the radiotherapy procedure is stressed. A critical review of the literature on intraoperative radiotherapy is also included as an Appendix

Radiotherapy and tamoxifen after mastectomy in postmenopausal women - 20 year follow-up of the South Sweden Breast Cancer group randomised trial SSBCG II : I

Aims: To evaluate long-term effects of radiotherapy and tamoxifen after mastectomy on recurrence and survival in stage II breast cancer. Methods: A randomised phase III study with three treatment alternatives. (1) Radiotherapy 50 Gy/2S fractions to chest wall and regional lymph nodes (RT). (2) Radiotherapy and tamoxifen 30 mg/day for one year (RT + tam) and 3. Tamoxifen (tam). Results: 724 postmenopausal women were included between 1978 and 1985 and the trial was close to population based. Follow-up for survival was 23 years. Locoregional recurrences were reduced from 18.5% in the tam arm to 5.3% in the RT + tam arm. Overall mortality at 20 years was 71% in the RT arm, 68% in the RT + tam arm and 62% in the tam arm. The difference between RT + tam and tam was not significant except in the receptor positive subgroup in favour of non-irradiated patients (p = 0.047). The cumulative incidence of systemic disease at 20 years was lower in the RT + Tam arm than in the RT arm, 40% versus 50% (p = 0.047). Conclusion: Postmastectomy radiotherapy significantly reduced loco-regional recurrences, but overall survival was not improved. At 20 years, a lower mortality was recorded for non-irradiated patients treated with tam. (C) 2007 Published by Elsevier Ltd

The European postmarketing adult Osteosarcoma Surveillance Study: characteristics of patients A preliminary report

The Scandinavian Sarcoma Group (SSG) registry participates in a multinational postmarketing drug surveillance study evaluating potential medication exposures (including teriparatide) in a population-based series of adult osteosarcoma cases. We present preliminary data from this study. The SSG registry systematically identifies eligible cases in collaboration with regional and national cancer registries in Sweden, Norway, Denmark, Finland, and Iceland. All cases aged ?: 40 years initially diagnosed in January 2004 or later with histologically confirmed osteosarcoma or 5 other prespecified types of bone sarcomas are eligible. Data were collected from the medical records. This review includes all information abstracted to date from patient records of 49 of 85 cases diagnosed between January 2004 and September 2008 (estimated to be all reported adult cases). All patients were Caucasian, mean age 59 (41-88 years), the majority were men. The most prevalent morphology subtypes were osteosarcoma NOS and chondroblastic osteosarcoma. Leg bones were the most frequent tumor site. Potential risk factors for osteosarcoma included prior history of cancer (27%), radiation treatment (24%), or prior injury or infection at the site of the tumor (14%). Site of prior radiation treatment and osteosarcoma tumor matched for 7/9 cases. One prior history of Paget's disease was reported. Treatment with teriparatide before diagnosis had not been reported. Data collected in this study present population based demographic and risk-factor data and are consistent with prior research reporting a link between radiation site and tumor site, and a possible association between osteosarcoma and prior history of cancer, and prior injury or infection at the site of the tumor