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Biomedical subjects

E Wist

Publications and source records attributed to E Wist.

At least 37 records · Page 2Linked to original sources
PubMed1997

Why are cancer patients using non-proven complementary therapies? A cross-sectional multicentre study in Norway.

This study addressed the use of alternative medicine, here called non-proven therapies (NPTs), among hospitalized Norwegian cancer patients. A total of 126 (20%) of the assessable 630 patients were users of NPTs. Approximately 43% of all patients and more than 60% of the users of NPTs stated that they would like NPTs to be an option in hospitals belonging to the National Health Service. Most users of NPTs (82%) consulted traditional medicine first, while 15% started treatment with NPTs simultaneously. Users of NPTs reported to have received less hope of a cure (30%) from their physicians than non-users (50%). Users mostly learned about NPTs from friends and relatives. Most users believed that NPTs might give them strength and relieve their symptoms. Very few patients believed in a cure (10%). Nearly 40% were uncertain of any effect of the NPTs or felt there had been no effect. 4 patients reported adverse effects. 15 patients had been treated abroad, most of them in Denmark. Expenses incurred through use of NPTs were mostly moderate, but some patients used large sums of money. Patients' opinions on whether or not the treatment had been expensive were closely linked to their anticipation of the effect of the treatment.

Adolescent↗
PubMed1997

Communicating with and treating cancer patients: how does the use of non-proven therapies and patients' feeling of mental distress influence the interaction between the patient and the hospital staff.

A questionnaire-based study was carried out at the Department of Oncology, University Hospital of Tromsø, during the period July 1990-October 1991. The 252 participating patients received a questionnaire at arrival at the oncology unit and the surviving patients a follow-up questionnaire at home 4 months later. The aim of the study was to assess whether patients' attitudes to information about their malignant disease and satisfaction with the given treatment correlated to their use of non-proven therapies (NPTs) and reported mental distress. Patients under 45 years of age significantly more often preferred comprehensive medical information than older patients (83% versus 52%, P = 0.001). Better educated patients were more satisfied with the information given by their general practitioner (GP) (P = 0.05) and at their local hospital (P = 0.02) than other patients. Of all responders, 81% of the patients treated in the department were completely satisfied with the opportunities to ask questions while 87% reported being given comprehensive information. Only 2% of the patients reported to have received unwanted information. Better educated patients expressed less satisfaction with the information given and the possibility of influencing their own treatment at the Department of Oncology (P = 0.02). Patients expressing mental distress wanted less information (P = 0.05) and expressed less satisfaction with the quality of the perceived information in the oncology unit (P = 0.004). They were also less satisfied with the treatment given (P = 0.05) and their own influence on the treatment decision (P = 0.02). Users of NPT did not feel the received treatment to be the best possible (P = 0.04).

Adolescent↗
PubMed1997

Risk-adapted treatment of clinical stage 1 non-seminoma testis cancer.

250 patients with clinical stage 1 non-seminomatous germ cell tumours of the testis (NSGCT 1) were included into a prospective multicentre protocol during 1990-1994 and treated according to three risk strata: patients without tumour cell invasion of vascular structures in the testis (VASC-) and elevated serum AFP levels (AFP+) at orchiectomy were considered low risk (LR) and only observed closely. VASC- and AFP- or VASC+ and AFP+ patients were presumed intermediate risk (IR) and pathologically staged (PS) by retroperitoneal lymph node dissection (RPLND). VASC+ and AFP-patients were regarded as high risk (HR) and received adjuvant chemotherapy (PEB x 3). At a median observation time of 40 (7-68) months, all patients were alive and without evidence of active germ cell cancer. The actuarial relapse rate in the 106 LR patients was 22%, and 70% (14/20) had elevated serum tumour markers at relapse. One of 32 (3%) HR patients relapsed with a resectable retroperitoneal mature teratoma despite adjuvant chemotherapy. Only 14% of the 99 IR patients who underwent RPLND had PS2 disease, and the actuarial relapse rate in 85 PS1 patients was 18%. This multicentre study demonstrated that excellent therapeutic outcome is possible when 18 comparatively small urological and oncological centres follow a strict and formal cancer care programme. The useful prognostic effect of VASC was once again verified. Pathological staging by RPLND in NSGCT1 is, in our opinion, not necessary, with presumed low-risk patients offered surveillance and high-risk patients offered adjuvant chemotherapy.

Biomarkers, Tumor↗
PubMed1997

Ifosfamide and continuous infusion etoposide in advanced adult soft tissue sarcoma. A Scandinavian Sarcoma Group Phase II Study.

The purpose of this study was to evaluate tumour response and toxicity to ifosfamide and continuous infusion etoposide in metastatic or locally advanced soft tissue sarcoma, with dose escalations under G-CSF (granulocyte colony-stimulating factor) support. Of 92 eligible patients (median age 51 years), 85% had tumours of high-grade malignancy and 82% had metastatic disease. Chemotherapy, the baseline dose, consisted of etoposide 600 mg/m2 as a 72 h infusion and ifosfamide 1500 mg/ m2/day for 3 days, followed by G-CSF support (VIG regimen). Stepwise 10% dose escalations were performed depending on haematological toxicity. For patients considered operable after induction chemotherapy, surgical resection of all identifiable residual tumour was attempted. Complete and partial response rates were 11% and 31%, for an overall response rate of 42% (95% CI 31-52%). Forty-eight per cent of courses were dose escalated by a median of 20%. Complete responders had significantly higher, and patients with progressive disease had significantly lower, dose levels than other patients. None of 20 patients with liver metastases responded despite high dose levels. Compared to a preceding pilot study, the addition of G-CSF led to significantly higher dose levels, improved schedule adherence and less haematological toxicity, but no apparent increase in response rate. In view of the modest dose of ifosfamide applied in this study, it is possible that the prolonged infusion of etoposide made a significant contribution to the regimen's antitumour activity, although this can only be determined definitively in a randomised study.

Adolescent↗
PubMed1997

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group.

BACKGROUND: The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. METHODS: One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. RESULTS: The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. CONCLUSION: The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Adult↗
PubMed1996

Psychological distress in survivors of Hodgkin's disease.

The object of this study was to reveal the psychological distress among survivors of Hodgkin's disease. Between 1985 and 1993, 55 patients were treated for Hodgkin's disease at our small oncological unit. In December 1994 all 49 survivors were mailed a questionnaire consisting of the Impact-of-Event Scale and a visual-analogue scale measuring quality of life, to which 42 patients responded (86%). Half of the patients reported moderate to high levels of psychological distress. Scores predicting significant stress response syndrome were revealed in 19% of the patients. Women reported statistically significant lower psychological distress on the intrusion (P = 0.025) and avoidance scale (P = 0.047) and a higher quality of life (P = 0.032). In order to improve patients' care and support, cases at risk should be identified. Among patients with Hodgkin's disease, men seems to be at highest risk. This study should be helpful for developing supportive interventions for survivors of Hodgkin's disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Spiritual healing among Norwegian hospitalised cancer patients and patients' religious needs and preferences of pastoral services.

In a national questionnaire-based multicentre study, the use of 'alternative medicine', here called non-proven therapy (NPT), was examined. Five questions about the patients' religious beliefs and their preferences concerning pastoral services in the hospitals were included. Among the 911 invited patients, 642 (70.5%) were included in the analysis. Spiritual healing, defined as faith healing and healing by hand, was the most frequently used NPT among Norwegian cancer patients. Almost 50% of cancer patients using spiritual healing had used NPTs, mainly spiritual healing, prior to the diagnosis of cancer. Women, elderly people and patients using faith healing described themselves more often as religious. 139 (23%) of the responding patients reported a strengthening of their religious belief after the diagnosis of cancer. Patients less than 45 years of age and better educated patients expressed more frequently that all patients should be offered pastoral services during the hospital stay. Older patients, in spite of being more religious, expressed that the patients themselves had to request such services.

Adolescent↗
PubMed1996

Treatment costs in Hodgkin's disease: a cost-utility analysis.

The aim of this study was to estimate costs of treatment for Hodgkin's disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Adolescent↗
PubMed1996

Treatment intention in hospitalized cancer patients in oncological wards in Norway: a national survey.

Clinicians often do not agree whether a treatment is given with a palliative or curative intent. A common clear definition does not exist. This study has assessed the usefulness of dividing the goal of treatment into three distinct categories: curative treatment; palliative, symptom preventive treatment; and palliative, symptom relieving treatment. In a cross-sectional study among all cancer centres in Norway, a total of 629 patients were included into the study. Of these patients, 60% received palliative treatment, with an equal distribution between symptom preventive and symptom relieving. The definitions were found easy to use by the physicians. It gave important information of differences between cancer diagnosis with respect to the number of patients receiving palliative treatment. In order to refine the classification system, the authors will, in future studies, include a fourth category, life prolonging treatment, which is located between curative and palliative treatment with respect to treatment intensity.

Cross-Sectional Studies↗
PubMed1996

ChlVPP is as effective as alternating ChlVPP/ABOD in advanced stage Hodgkin's disease.

The purpose of the study was to evaluate and compare the efficacy and tolerability of two cytostatic regimens-chlorambucil, vinblastine, procarbazine and prednisone (ChlVPP) vs. ChlVPP alternating with doxorubicin, bleomycin, vincristine and dacarbazine (ABOD). One hundred eligible patients with stage IIIA-IVB Hodgkin's disease were randomized to either ChlVPP or ChlVPP alternating with ABOD. The complete response rate (CR) was 80% in both treatment groups. After a median follow-up time of 59 months, 42 (84%) of the patients in the ChlVPP-treated group were in CR compared with 39 (78%) treated with ChlVPP/ABOD. The estimated five-year overall and relapse-free survival rates were 87% and 74%, respectively, for the ChlVPP-treated patients and 76% and 73% for the ChlVPP/ABOD-treated patients. The ChlVPP regimen showed a slightly better subjective tolerance than the ChlVPP/ABOD regimen. The given dose intensity was very close to optimal, and equal for the two regimens.

Adult↗
PubMed1995

[Testicular cancer treated at the regional hospital in Tromsø 1985-1993].

The case histories of 98 patients (47 seminomas and 51 non-seminomas) treated at the Department of Oncology, University Hospital of Tromsø between January 1985 and March 1993 were retrospectively analysed in August 1994. The analysis was undertaken to ascertain whether a small centre can achieve state of the art results. Complete remission was achieved in all cases. During a four year median follow-up period (range 1-10 years), three seminomas and eight non-seminomas relapsed. Only one retroperitoneally located relapse was revealed after retroperitoneal lymph node dissection. Two patients (one seminoma, one non-seminoma) died of progressive disease. A statistically significant correlation was found between stage of disease and human chorionic gonadotropin, lactate dehydrogenate and alpha-fetoprotein in non-seminoma. Our results are similar to those of the major oncological centres. Hence our unit is able to achieve state of the art results in the treatment of testicular carcinomas.

Adolescent↗
PubMed1995

Testicular cancer treated in a minor general oncology department.

The question of where to treat testicular cancer and by whom has been debated in several medical journals over the last few year. Here we present data from 98 patients (47 seminomas, 51 non-seminomas) treated between January 1985 and March 1993 at the Department of Oncology, University Hospital of Tromsø, Norway. During a 4-year median follow-up period 2 patients died of progressive disease. Our results are similar to those of major specialised oncology centres. We argue that within the context of multicentre cooperative studies or treatment protocols, patients with testicular cancer can be treated in a small general oncology centre with the same expectations of cure and treatment-related mortality and morbidity as achieved in major centres.

Adolescent↗
PubMed1995

The EORTC core quality of life questionnaire (QLQ-C30): validity and reliability when analysed with patients treated with palliative radiotherapy.

The EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) is designed to measure cancer patients' physical, psychological and social functions. The questionnaire is composed of multi-item scales and single items. 247 patients completed the EORTC QLQ-C30 before palliative radiotherapy and 181 after palliative radiotherapy. The questionnaire was well accepted with a high completion rate in the present patient population consisting of advanced cancer patients with short life expectancy. In addition, the questionnaire was found to be useful to detect the effect of palliative radiotherapy over time. The scale reliability was excellent for all scales except the role functioning scale. Excellent criterion validity was found for the emotional functioning scale where it was correlated with GHQ-20. Performance of the questionnaire was improved after the second evaluation as compared with the first. The present study shows that the EORTC QLQ-C30 is found to be practical and valid in measuring quality of life in patients with advanced disease.

Adult↗
PubMed1995

The use of non-proven therapy among patients treated in Norwegian oncological departments. A cross-sectional national multicentre study.

A national multicentre study was performed to investigate the prevalent use of "alternative medicine", here called "non-proven therapies (NPT)", applied among Norwegian cancer patients. Of 911 patients invited to take part in the study, 642 were included in the analysis. Demographic characteristics were collected for all patients. The participating physicians gave information about the patients' clinical characteristics. Among 630 evaluable patients, 20% had been or were present users of NPTs for their oncological disease. The preferred methods were healing by hand and faith healing. Herbs, vitamins, diets and Iscador were other popular methods. As many as 40% of the users of NPTs had used NPTs earlier for non-malignant diseases. Elderly patients were less likely to use NPTs. Use was high in the northern part of Norway.

Adolescent↗
PubMed1995

Use of non-proven therapies. Differences in attitudes between Norwegian patients with non-malignant disease and patients suffering from cancer.

A comparative study was conducted between a group of patients with non-malignant diseases in general practice and a group of cancer patients seen in the Department of Oncology at the University Hospital of Tromsø. The aim of the study was to investigate the prevalent use of 'alternative medicine', here called non-proven therapies (NPTs), among cancer patients and general practice patients, and to investigate whether there are any differences in opinion between the two groups regarding the beneficial effects of NPTs as treatment modalities for cancer. A total of 305 general practice patients and 252 cancer patients were included in the final analysis. In both groups close on 20% had been or were present users of NPTs. Among cancer patients the most preferred NPTs methods were healing by laying on of hands and faith healing. The patients with non-malignant disease expressed a more positive view on the possible benefits of NPTs in the fight against cancer than that expressed by the cancer patients. A total of 63.4% of patients from general practice stated that NPTs ought to be an option for cancer patients within Norwegian hospitals.

Adolescent↗
PubMed1994

Weekly doxorubicin with or without high-dose medroxyprogesterone acetate in hormone-resistant advanced breast cancer. A randomised study. The Norwegian Breast Cancer Group.

In a randomised study, 218 patients with advanced breast cancer, resistant to hormone therapy, received either doxorubicin 20 mg every week (Awkly) alone or Awkly combined with high doses (1000 mg daily) of oral medroxyprogesterone acetate (HD-MPA). Of the 210 evaluable patients, the response rates were 26% [95% confidence interval (CI) 18-34%] for Awkly and 38% (95% CI 29-47%) for Awkly + HD-MPA (P = 0.08). There was no significant difference with regard to duration of response. Median survival was 11 months in both groups. Considerable toxicity was seen from HD-MPA, particularly weight gain and fluid retention. The present study provides evidence that, in concordance with preclinical studies and a previous randomised study, interaction between chemotherapy and HD-MPA may exist in breast cancer normally resistant to hormone therapy. For further studies, other gestagens and/or a dose reduction could be investigated.

Antineoplastic Combined Chemotherapy Protocols↗