Testikkelkreftoverlevende kommer tilbake i jobb

Abstract Purpose. As a result of improved prognosis of many kinds of cancer, an increasing number of cancer survivors are able to return to work after their treatment. Previous studies have indicated that cancer does not have a great impact on the survivors’ employment and that cancer survivors usually are able to return to work. However, the research on the effects of testicular cancer on work ability is scarce, and among the few published studies no proper reference group has been used. The purpose of this study was to increase our knowledge of the work ability for long-term testicular cancer survivors (TCSs), compared with an age-matched cancer-free male population sample. Methods. Participants were 1.326 Norwegian TCSs treated between 1980 and 1994. Norm data was obtained from 6.630 age-matched controls. Participants provided information about their work ability, medical, social and familial situation on a questionnaire. Results. There was no significant differences between the employment rate of TCSs (86.5 percent) and the controls (87.8 percent). A significant association was found between TCSs‘ employment rate and post orchiectomy treatment principles. Further, the TCSs reported increased health problems compared to controls, for instance concerning anxiety disorders, gastrointestinal complains and vascular diseases. TCSs were also to a larger degree physically inactive and showed reduced self esteem compared to controls. In multivariate analysis TCSs’ employment skills was associated with high education and treatment surveillance without subsequent relapse (SURV). Disability pension, unemployment benefits, economic difficulties, vascular diseases and anxiety were all correlated with unemployment. Conclusion. This study showed that the majority of TCSs were able to continue working, in line with previous research. As a whole they experienced higher degree of impairment in health due to their illness than male controls from the general population

Extraskeletal Osteosarcoma in Norway, Between 1975 and 2009, and a Brief Review of the Literature

Aim: To evaluate the clinicopathological features of extraskeletal osteosarcoma (ESOS) and its response to multimodal therapy. Patients and Methods: A nationwide cohort comprising all Norwegian histologically verified ESOS patients between 1975 and 2009 supplemented with clinical reports from all hospitals involved in sarcoma management. Results: Thirty-seven patients were classified as ESOS, mostly elderly people. Seventy-six % had an axial tumour, including nine patients with radiation-induced ESOS. The gender balance was equal. The 5-year sarcoma-specific survival (SSS) was 16 %. Adequate surgical remission had a positive impact on SSS, in contrast to chemotherapy and radiotherapy. Primary metastatic disease, elevated tumour size and elevated serum alkaline phosphatase, serum lactate dehydrogenase and Ki67, respectively, all predicted poor outcome. Conclusion: The relatively poor prognosis of ESOS may relate to both primary chemotherapy resistance and different biologic characteristics of these tumours as compared to conventional osteosarcoma. Hence, new predictive molecular markers and therapeutic approaches for treatment of ESOS are needed. http://ar.iiarjournals.org/content/35/4/2129.lon

Vurdering av legemiddelforskrivning av antipsykotika blant eldre bosatt på sykehjem

1. Sammendrag 1.1 Bakgrunn/emne: Temaet for vår KLoK-oppgave er knyttet til legemiddelbehandlingen av eldre mennesker. Foruten høy alder og langtkomne aldersforandringer er mange eldre preget av multimorbiditet, gjerne med ukarakteristisk symptomatologi. Eldre pasienter er derfor ofte storforbrukere av medikamenter. Slik medikamentell behandling er oftest til stor nytte. Det kan i denne forbindelse være verdt å være oppmerksom på at kompliserte legemiddelregimer kan tenkes å medføre redusert compliance, og tap av slike gunstige effekter. Samtidig kan økt legemiddelbruk og endret farmakokinetikk og -dynamikk blant eldre bidra til flere legemiddelinteraksjoner og økt frekvens av legemiddelbivirkninger. Slike bivirkninger kan i alderdommen forveksles med andre sykdommer eller forårsake situasjoner som for eksempel delirium, synkope, parkinsonisme, anoreksi eller økt falltendens, med økt morbiditet og mortalitet til følge. 1.2 Kunnskapsgrunnlag: Temaet for oppgaven er antipsykotikabruk blant sykehjemspasienter. Søk ble gjort i Cochrane og PubMed med søkeordene "nursing home" og "elderly" og "antipsychotics" i begge databaser. I Cochrane ga søket 7 treff, alle primærstudier. Søket i PubMed ga 31 artikler, hvorav 8 oversiktsartikler. 4 primærstudier var felles treff i begge databaser. Vi la først vekt på de åtte systematiske oversiktene publisert fra 1998 til 2008. Vi har også konsultert Professor Jørund Straand og fått anbefalt ytterligere artikler av ham. Vi mener å ha god dokumentasjon på følgende i vårt kunnskapsgrunnlag: 1. Utstrakt bruk av antipsykotika hos eldre i sykehjem er uheldig 2. Utstrakt bruk av antipsykotika er vanlig hos eldre i sykehjem 3. Det er hensiktsmessig å redusere bruken av antipsykotika 4. Medikamentgjennomgang er et nyttig tiltak. 1.3 Begrunnet tiltak og metode: Etter samtale med dr. Stine Rognstad er det per idag er det ved Lillestrøm bo- og behandlingssenter (LIBOS) og Åråsveien bo- og omsorgssenter ingen standariserte tester eller retningslinjer vedrørende forskrivning av antipsykotika. Dette kan etter gruppens mening utføres ved følgende enkle grep: Ved bruk av datasystemet Gerika, hvor man går igjennom medikamentlistene til beboerne, og ved å motivere sykepleiere og helsepersonell i form av kurs/undervisning. Vi mener også at det er gunstig for prosjektgjennomføringen at de øvrige ansatte ved sykehjemsavdelingen får forståelse av hvilke indikasjoner som bør medføre forskrivning av antipsykotika, bivirkninger av antipsykotika, og hvilke situasjoner der alternative behandlingsformer kan være mer hensiktsmessige 1.4 Organisering: I dette prosjektet vil det primært være tilsynslege som tar selve medikamentgjennomgangen, evt i møter sammen med medikamentansvarlig sykepleier ved avdelingen. En slik gjennomgang må antas å gi best resultater dersom sykehjemmet har en fast tilsynslege. Selve prosessen bør være en PDSA (Plan-Do-Study-Act) -struktur, med et klart mål om å få ned antipsykotikabruken blant beboerne på avdelingen. Det bør videre være månedlige medikamentgjennomganger som tiltak for å nå dette målet, og andel pasienter som bruker antopsykotika målbar indikator på om prosessen har den ønskede effekten. Utfra dette kan man underveis evaluere om prosessen bør videreføres eller ikke. 1.5 Resultater/vurdering: Kostnadene knyttet til uhensiktsmessig antipsykotikabruk er høye, og det er også kjent at det er utbredt bruk av disse preparatene i norske sykehjem38. Månedlig medikamentgjennomgang er et relativt billig tiltak som i seg selv ikke krever store personalressurser, og vi mener at motstanden som kan oppstå hos pleiepersonalet når det gjelder vårt prosjekt ikke vil oppveie de godene vi forventer at prosjektet vårt vil kunne medføre. Vi mener derfor at vårt prosjekt bør gjennomføres

Clinical Epidemiology of Low-Grade and Dedifferentiated Osteosarcoma in Norway during 1975 and 2009

Purpose. To describe epidemiological, clinical characteristics and treatment outcomes of low-grade osteosarcoma (LGOS), including dedifferentiated osteosarcoma (DLGOS). Method. We analysed a nationwide cohort comprised of patients with histologically verified LGOS and DLGOS between 1975 and 2009, based on registry sources supplemented with clinical records from hospitals involved in sarcoma management. Results. Fifty-four patients were identified, 12 of whom had DLGOS. The annual incidence for all patients was 0.3 per million, with the peak incidence in the third decade of the life. Fifteen patients experienced local relapses during follow-up and ten developed metastatic diseases, including three at primary diagnosis. Patients with DLGOS dominated the metastatic relapse group. The five-year sarcoma-specific survival rate was 91%, with no documented improvement over time. Free margin following surgical resection of the primary tumour had a positive impact on survival. As expected, both local relapse and metastasis during follow-up were associated with an unfavourable outcome. Radiotherapy predicted poor survival due to the selection of high-risk patients in need of such treatment. Neither higher age nor axial tumour localisation was adverse prognostic factors. Conclusion. LGOS has an excellent prognosis when surgically resected with a free margin; however, LGOS has the potential to dedifferentiate and metastasize with a poor outcome

Clinical epidemiology and treatment outcomes of spindle cell non-osteogenic bone sarcomas – A nationwide population-based study

Purpose: To describe epidemiological and clinical characteristics, as well as long-term treatment outcomes of spindle cell non-osteogenic bone sarcomas (SCS), comprising leiomyosarcoma, fibrosarcoma and undifferentiated pleomorphic sarcoma in bone. Method: We have analysed a nationwide cohort of 104 patients with histologically verified SCS diagnosed between 1975 and 2009, based on registry sources supplemented with clinical records from Norwegian hospitals involved in sarcoma management. Results: In this unselected cohort, a stable annual incidence for SCS patients of slightly below 0.6 per million was observed, with a dominant peak among elderly patients. SCS is mostly a high-grade malignancy (92%) with a male to female ratio of 1.6 for all patients. The axial to appendicular ratio was 0.7, seemingly independent of age. More than one fourth of the patients (29%) had primary metastatic disease. Another 32 patients (46%) developed metastases during follow-up and 12 (17%) experienced local relapses. The five-year sarcoma-specific survival rate was 37%, with no documented improvement over time. Primary metastatic disease was an adverse prognostic factor for survival. Predisposing factors were documented in 19 patients (18%). Negative prognostic factors for overall survival were tumour size >9 cm, age > 40 years, axial tumour localization, FS as subtype and pathologic fracture at time of diagnoses. As expected, patients who received both surgery and chemotherapy as their primary treatment for high-grade SCS (25%) significantly had best sarcoma specific five years survival (62%). Conclusion: We confirm SCS as a rare high-grade bone sarcoma entity, mostly among elderly patients and with a poor overall outcome. The combined treatment of surgery and chemotherapy is essential to achieve optimal long-term survival of SCS. Keywords: Spindle cell, Nationwide, Treatment, Overall surviva

Prognostic Factors and Treatment Results of High-Grade Osteosarcoma in Norway: A Scope Beyond the “Classical” Patient

Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specific survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. This could only partly explain the differences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confirm a dramatic difference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter

Multi-parametric MRI without artificial erection for preoperative assessment of primary penile carcinoma: A pilot study on the correlation between imaging and histopathological findings

Purpose: We aimed to evaluate the diagnostic potential of non-erectile multi-parametric magnetic resonance imaging (mpMRI) for preoperative assessment of primary penile squamous cell carcinoma (SCC). Method: Twenty-five patients who underwent surgery for penile SCC were included. Preoperative mpMRI without artificial erection was performed in all patients. The preoperative MRI protocol consisted of high-resolution morphological and functional sequences (diffusion-weighted imaging and dynamic contrast-enhanced MRI perfusion) covering the penis and lower pelvis. T and N staging, according to the 8th edition of the Union for International Cancer Control TNM classification, as well as the largest diameter and thickness/infiltration depth of the primary lesions were determined in all patients. Imaging data were retrospectively collected and compared with the final histopathology reports. Results: Very good agreement was observed between MRI and histopathology for the involvement of corpus spongiosum (p = 0.002) and good agreement was observed for the involvement of penile urethra and tunica albuginea/corpus cavernosum (p < 0.001 and p = 0.007, respectively). Good agreement was observed between MRI and histopathology for overall T staging and weaker, but still good agreement was observed for N staging (p < 0.001 and p = 0.002, respectively). A strong and significant correlation was observed between MRI and histopathology for the largest diameter and thickness/infiltration depth of the primary lesions (p < 0.001). Conclusions: Good concordance was observed between MRI and histopathological findings. Our initial findings indicate that non-erectile mpMRI is useful in preoperative assessment of primary penile SCC