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J Norum

Publications and source records attributed to J Norum.

At least 19 recordsLinked to original sources
PubMed1999

[Should the community pay for hospitalized patients waiting for transfer to nursing homes?].

Many hospital patients are on waiting lists for transferral to nursing homes. In a retrospective study, all patients (n = 75) hospitalised at the Department of Oncology, University Hospital of Tromsø until their death and all patients (n = 20) transferred to nursing homes from the same department during a 23-month period were registered. The duration of hospitalisation was 1-111 days (median 10 days) for the first group and 1-39 days (median 8 days) for the second group. 23 out of 32 patients (72%) hospitalised more than 14 days were from the city of Tromsø. This city and other municipalities should be required by law to pay the hospital for patients on waiting list for nursing homes. Today, 4 out of 16 major Norwegian hospitals have such arrangements.

Community Health Services↗
PubMed1999

[Euthanasia and cancer].

Euthanasia is clinical practice in several countries world-wide. Cancer patients' attitude in this field was focused through a review of case reports and questionnaire-based studies on Medline (1992-97). A total of nine publications including 459 cancer patients from USA, Canada and Holland were found. The majority of patients had poor performance status and advanced disease. At least one third reported themselves positive to euthanasia. Patients below 50 years of age, having superior performance status and not considering themselves religious, more frequently supported euthanasia. Psychological factors seem to be more significant than physical factors for support of euthanasia. Loss of control, being a burden on one's family and loss of dignity are the psychological factors most frequently reported. A "help to live" approach aimed at avoiding patient requests for help to die will mean that health care workers must allocate more of their time to these patients. Overcrowded hospitals with several patients in corridors and lack of nursing-homebeds do not make this situation easier to handle.

Adult↗
PubMed1999

Intracavity fractionated balloon brachytherapy in glioblastoma.

In order to reduce hospitalisation time for patients receiving postoperative radiotherapy a phase I-II study of intracavity balloon brachytherapy was instituted. An indwelling balloon catheter was implanted during the closing phase of the initial operation. Starting on the second or third postoperative day the catheter was afterloaded with a high dose rate isotope via a remotely controlled afterloading system. The treatment consisted of 10-12 fractions over a period of 5-6 days, with each treatment session requiring approximately 15 minutes. No external beam radiation was given. Forty-four newly diagnosed patients were treated. A total dose of either 60 Gy (33 patients) or 72 Gy (11 patients) was given. The overall median survival was 11.7 months, (range 2.7-50.9). The treatment was well tolerated and none of the applicators were removed prematurely. The total median hospital stay for this group of patients was significantly reduced compared to more conventional protocols. This study indicates that intracavity high dose rate balloon brachytherapy can achieve survival rates equivalent to those of conventional radiotherapy and is both cost and time efficient.

Adult↗
PubMed1999

Breast cancer screening by mammography in Norway. Is it cost-effective?

BACKGROUND: Mammography screening is a promising method for improving prognosis in breast cancer. PATIENTS AND METHODS: In this economic analysis, data from the Norwegian Mammography Project (NMP), the National Health Administration (NMA) and the Norwegian Medical Association (NMA) were employed in a model for cost-effectiveness analysis. According to the annual report of the NMP for 1996, 60,147 women aged 50-69 years had been invited to a two-yearly mammographic screening programme 46,329 (77%) had been screened and 337 (0.7%) breast cancers had been revealed. The use of breast conserving surgery (BCS) was in this study estimated raised by 17% due to screening, the breast cancer mortality decreased by 30% and the number of life years saved per prevented breast cancer death was calculated 15 years. RESULTS: The cost per woman screened was calculated 75.4 Pounds, the cost per cancer detected 10.365 Pounds and the cost per life year (LY) saved 8.561 Pounds. A raised frequency of BCS, diagnosis and adjuvant chemotherapy brought two years forward, follow-up costs and costs/savings due to prevented breast cancer deaths were all included in the analysis. A sensitivity analysis documented mammography screening cost-effective in Norway when four to nine years are gained per prevented breast cancer death. CONCLUSION: Mammography screening in Norway looks cost-effective. Time has come to encourage national screening programmes.

Aged↗
PubMed1998

[Cancer patients' perception of the examination period prior to treatment].

From July 1990 to July 1991 252 cancer patients admitted consecutively to the Department of Oncology, University Hospital of Tromsø, were included in a questionnaire-based study. The aim of the study was to examine the delays involved in the diagnosis and treatment of cancer. The study also focused on the psychological distress related to these periods of delay. A significant correlation between psychological distress and the actual length of delay (weeks) was revealed (p < 0.01). psychological distress was also correlated positively to the degree of depression (p < 0.01). Women found delays more distressing than men (p < 0.01). Patients from the northern areas (Troms and Finnmark counties) considered a cancer unit in Northern Norway to be of greater importance than those living in the southern area (Nordland county).

Adult↗
PubMed1998

Prevention of colorectal cancer: a cost-effectiveness approach to a screening model employing sigmoidoscopy.

BACKGROUND: Today, only carcinoma of the bronchus kills more people than colorectal cancer (CRC). However, CRC is both preventable and curable. In Norway, projects aiming to detect adenomas and early cancers by the screening of a population aged about 60 years employing sigmoidoscopy have been discussed. MATERIALS AND METHODS: In this study, a mathematical model was used to estimate the cost-effectiveness of a screening programme for colorectal polyps followed by polypectomy. A once-only sigmoidoscopy at age 60 followed by coloscopy in selected risk groups was suggested. Data from the English-language literature, the National Cancer Registry of Norway, and Statistics Norway were included. Norwegian cost data from the National Health Administration were also used. Costs of screening and those related to earlier diagnosis, and savings on health care and averted loss in production due to prevented CRCs were calculated. RESULTS: The basic cost per patient invited and screened (70% compliance) in the suggested programme was estimated at 81.7 Pounds and 116.7 Pounds, respectively. When gains due to prevented CRCs were included, the figures became 34.5 Pounds and 49.2 Pounds. The cost per life-year saved was calculated as 2,889 Pounds. This strongly indicates that screening for the early detection and prevention of CRC is one of the most cost-effective programmes in cancer. CONCLUSIONS: CRC screening according to the suggested programme appears to be cost-effective. Clear evidence that screening can reduce mortality from CRC should convince health-care policy makers that the time has come to encourage screening for colorectal cancer.

Adenocarcinoma↗
PubMed1998

Mitoxantrone in malignant pericardial effusion.

When occurring, malignant pericardial effusion (MPE) is usually a late phenomenon in most malignancies. Several treatment modalities, including chemotherapy, radiotherapy, pericardial window operation, pericardiotomy, catheter pericardiocentesis and local cytotoxic or sclerotherapy, have been employed. Mitoxantrone is reported as having potential in malignant pleural effusion. Between 1992-97, 5 patients (breast cancer-4 pts, ovarian cancer-1 pt) were admitted to the University Hospital of Tromsø due to a life-threatening MPE. They were all treated with ultrasound-guided pericardiocentesis followed by instillation of mitoxantrone (10 mg). Evaluation at a median follow-up of 59 days (range 28-294 days), 2 patients achieved CR, 1 PR and 2 patients have PD. Two patients are alive 213 and 294 days following therapy. Intrapericardial mitoxantrone instillation is a safe and simple way of handling MPE in malignancies sensitive to mitoxantrone.

Adult↗
PubMed1997

[Breast cancer treated at the oncologic department, University Hospital in Tromsø 1986-94].

In the period 1986 to 94, 173 women who had had a lumpectomy or a mastectomy were treated with radiotherapy at the University Hospital of Tromsø. The median diagnostic delay was 2.4 months (range 0-98.6 months). Three out of four patients were operated on within two weeks of the diagnosis being made. About two thirds experienced a delay of more than six weeks from the operation to the start of radiotherapy treatment. The five-year overall survival rate in the mastectomy and postoperative radiotherapy group was 67%. Patients with estrogen receptor positive tumours had a better prognosis. Only 5% and 7% of all patients in our region in stages I and II had breast conserving surgery (BCS) during the study period (66 patients). The five-year overall survival rate in the BCS group was 77%. BCS raised the cost per patient by about 3,000 GBP compared to modified radical mastectomy (MRM). The cost per QALY using BCS as against MRM was about 12,000 GBP. We conclude that MRM should not be used instead of BCS merely for economical reasons.

Adult↗
PubMed1997

[Follow up after potential curative surgery of colorectal cancer. Guidelines from the Norwegian Gastrointestinal Cancer Group].

In Norway, about 2,800 cases of colorectal cancer are diagnosed every year. Two-thirds of the patients undergo potentially curative surgery and almost half of them develop local or distant metastases. The follow-up of colorectal cancer patients involves four strategies: Educating the patients about the disease, symptoms of relapse, and risk of hereditariness; Early diagnosis of relapse, to make curative re-surgery possible; Diagnosis of metachronous/synchronous cancer(s); Recording the results of current surgical techniques. The Norwegian Gastrointestinal Cancer Group recommend a four-year follow-up programme (every third month for two years and then twice a year) of colorectal cancer patients. It is suggested that patients treated with low anterior resection are followed regularly by means of rectoscopy and local examination (digital or by ultrasound) undertaken by specialist (surgeon or gastroenterologist). The others should be followed up mainly by general practitioners. Carcinoembryonic antigen (CEA)-monitoring is suggested every third month for two years, and then every sixth month. Colonoscopy is recommended at one and four year follow-up. Patients with normal CEA levels prior to surgery should be evaluated by ultrasound of the liver every sixth month for four years.

Colonic Neoplasms↗
PubMed1997

[Hodgkin disease treated at the Tromsø regional hospital 1985-93. Diagnosis, treatment, prognosis, quality of life and costs of a decentralized treatment].

Between 1985-93, 55 patients were treated for Hodgkin's disease at the University Hospital of Tromsø. The median diagnostic delay was four months and a significant prolonged delay was connected with the lymphocyte predominance subgroup. The ChlVPP regimen was shown to be a risk factor for herpes zoster virus infection. The 5-year overall survival was 90%. The survivors experienced a low frequency of symptoms and a high level of functioning. The females reported a significant superior global quality of life and had a lower psychological distress and fatigue score than the males. The cost of one quality-adjusted life year (QALY) (production gains included and using a 10% discount rate) was estimated to be 1,651 pounds. This makes Hodgkin's disease one of the most cost-effective malignancies to treat.

Adolescent↗
PubMed1997

Adjuvant chemotherapy in Dukes' B and C colorectal cancer has only a minor influence on psychological distress.

The object of this cross-sectional study on psychological distress was to reveal such distress among patients treated for colorectal cancer (CRC). Between 1993 and 1996, 95 patients in northern Norway were included in the national study randomising Dukes' B and C CRC patients between adjuvant chemotherapy (ACT: 5-fluorouracil and levamisole) or follow-up following radical surgery. In April 1996, all 82 survivors were mailed the Impact-of-Event Scale (IES), to which 64 patients responded (78%). Less than one-third of the patients reported a moderate to high level of psychological distress. Scores predicting significant stress response syndrome were revealed in 14% of the patients. The mean score on the intrusion and avoidance scales were 6.1 and 7.7, respectively. Such variables as age, sex, tumour location (rectum/colon), Dukes' stage B/C and time of follow up did not significantly influence the scores. Patients receiving ACT reported only a slightly raised level on the intrusion (6.97 vs 5.17) and avoidance (8.48 vs 6.80) scales. This study indicates that ACT in CRC Dukes' B and C is not a stressful happening. All advantages in survival achieved by ACT have to be weighed against the "cost" in terms of physical and psychological side effects. This study indicates the weighting in terms of psychological distress may be minimal.

Adult↗
PubMed1997

Lumpectomy or mastectomy? Is breast conserving surgery too expensive?

In the last decade, breast cancer patients have enjoyed an increase in breast conserving surgery (BCS). At present, modified radical mastectomy (MRM) and BCS offers equal expectations of survival. During the last few years, however, a drop in the frequency of BCS has been reported by several authors. Is this new trend due to economic concerns? To clarify the costs of breast cancer therapy (stage I and II), we review the literature and include a cost-utility and a cost-minimisation analysis comparing MRM and BCS. The treatment cost (per patient) of BCS and MRM in Norway was calculated at $9,564 and $5,596, respectively. Employing a quality of life gain in BCS of 0.03 (0-1 scale) and a 5% discount rate, the cost per QALY in BCS compared to MRM was $20,508. In cost-minimising analysis, BCS and mastectomy followed by reconstructive surgery had a cost of $10,748 and $8,538, respectively. This indicates that BCS remains within reasonable cost and should not be displaced by mastectomy on economic grounds.

Breast Neoplasms↗
PubMed1997

A cost-effectiveness approach to the Norwegian follow-up programme in colorectal cancer.

BACKGROUND: Today, continued periodic follow-up of patients treated for colorectal cancer (CRC) seems often to be routine because of tradition, rather than its demonstrated value. Recently, the Norwegian Gastrointestinal Cancer Group (NGICG) has recommended a standard surveillance programme in this malignancy. In this protocol patients are suggested followed for four years with CEA monitoring, ultrasound of the liver, chest radiograph and colonoscopy at regular intervals. MATERIALS AND METHODS: In this study, the cost-effectiveness of this programme was addressed employing Norwegian cost data and data from the Cancer Registry of Norway. Clinical data from the existing English language literature was used in the analysis. RESULTS: The basic cost of the NGICG recommended programme was 1,232 Pounds per patient. Including extended investigation due to suspected relapse in 45% of cases, the figure raised to 1,943 Pounds per patient. The cost per life year saved was indicated to 9,525 Pounds-16,192 Pounds. The corresponding cost per quality adjusted life year (QALY) was indicated to 11,476 Pounds-19,508 Pounds. CONCLUSION: We conclude the NGICG recommended follow-up programme in CRC cost-effective. Excluding CEA monitoring may improve the cost-effectiveness.

Carcinoembryonic Antigen↗
PubMed1997

Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis.

BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.

Adult↗
PubMed1997

Intrapleurally instilled mitoxantrone in metastatic pleural effusions: a phase II study.

Thirty cases (breast cancer-20 cases, malignant lymphoma-4 cases, different malignancies-6 cases) of histologically/cytologically verified malignant pleural effusion (MPE) in 29 patients were treated with intrapleurally instilled mitoxantrone (30 mg). The therapy was well tolerated. At evaluation, 25 patients had died of progressive disease. The median survival was 3 months (range 0.3-21.3 months). There were 26 responders (12 complete responses (CR), 14 partial responses (PR)), whereas 4 patients relapsed and 3 of these had an early relapse (within 3 months). Patients achieving PR or CR had a low risk (15%) of treatment failure. Five patients were subjected to a pharmacokinetic evaluation. This demonstrated rapidly declining plasma and pleural exudate levels of mitoxantrone within the first 6 hours. At 24 hours after instillation, mitoxantrone was only detected in circulating mononuclear cells. This study shows that mitoxantrone is efficacious in the treatment of MPE, and may represent a cost-effective alternative.

Adolescent↗
PubMed1996

Quality of life in survivors of Hodgkin's disease.

The great majority of patients with Hodgkin's disease (HD) are successfully treated. However, several reports on treatment sequela have been published. The object of this study was to examine the quality of life (QOL) among survivors of HD focusing on gender and treatment modalities. All patients treated for HD at our oncological unit between 1985 and 1993 (n = 55) were registered. In December 1994, 49 survivors were mailed a questionnaire consisting of the EORTC QLQ-C30. Forty-two patients responded (86%). They reported a low frequency of symptoms and a high level of functioning. There was a significant correlation between mantle field irradiation and dyspnoea (p = 0.023). Females reported a significantly superior global quality of life (p = 0.016) and a lower fatigue score (p = 0.040) compared to males. Almost half of the patients reported financial difficulties. To improve QOL among survivors of HD, groups at risk have to be identified. Patients treated with mantle field irradiation and males seems to be at a higher risk. Should the treatment of HD be altered towards less radiotherapy and more chemotherapy?

Activities of Daily Living↗