Biomedical subjects
Publications and source records attributed to J Norum.
A 51 year old man developed chylothorax from a non-Hodgkin lymphoma located in the abdomen. The main causes of chylothorax are trauma and malignant disease. The condition is quite often idiopathic. The treatment is usually a combination of surgical treatment, conservative treatment, high voltage radiation and/or pleurodesis with a sclerosing agent.
BACKGROUND: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. OBJECTIVES: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. METHODS: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. RESULTS: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). CONCLUSIONS: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
BACKGROUND: Significant health care resources are today spent on diagnosing and treatment of early breast cancer. MATERIALS AND METHODS: 98 consecutive patients referred to our oncological unit between January 1997 and June 1998 underwent an evaluation programme including thoracic X-ray, liver and bone scan and blood test. When findings suspected for metastatic disease were revealed, further examinations (CT-scan, MRI) were performed. RESULTS: Whereas the screening programme disclosed four cases (4%) of distant metastasis, several patients had to suffer the psychological distress of false positive results. One in three suspicious thoracic X-rays, two in two liver scans and 18 out of 21 suspected bone scans were concluded false positive in terms of metastatic disease. A screening programme including blood test and thoracic X-ray alone, would have mis-classified one out of 98 patients. CONCLUSION: This study indicated thoracic X-ray and blood test as being sufficient and 110 Pounds per patient screened could be saved.
BACKGROUND: We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives. PATIENTS AND METHODS: 65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed. RESULTS: The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion. CONCLUSION: Orchiectomy is the treatment of choice when life expectancy is more than two years.
Recently, studies have suggested a subclassification of Hodgkin's disease, nodular sclerosis (HDNS). Between 1985-1994, twenty-four patients with HDNS were treated at the University Hospital of Tromsø, Norway. The cases were subclassified according to the histological criteria from the British National Lymphoma Investigation (BNLI) into NS1 (15 patients) and NS2 (9 patients). The relative frequencies of the two subtypes of HDNS in our region were in agreement with other reports. After a median follow up of 33 months, no significant difference between NS1 and NS2 with regard to complete remission rate (87% versus 100%) or predicted 5-year actuarial survival (93% versus 75%) were observed. Although our data are too small to draw specific conclusions, the discrepancy with some of the previous studies could be due to an improved response of the more aggressive type (NS2) to optimal treatment. We hope this study may initiate a raised interest in this field.
BACKGROUND: The aim of the study was to document the delay in diagnosis of Hodgkin's disease (HD) and clarify the impact on clinical stage and survival in our region. MATERIAL AND METHODS: A retrospective study of the records of 50 patients treated for primary HD in northern-Norway in the time period 1985 - 1993 was performed in November 1994. The diagnostic delay related to clinical stage, age, sex, relapse or death were registered. RESULTS: The median delay was 4 months (range 0 - 48 months). The histological subgroup lymphocyte predominance (LP) HD had a significant prolonged delay (p = 0.038). There was no correlation between delay in diagnosis and age, sex, B-symptoms, stage of disease, recurrent disease or death of disease. CONCLUSION: The diagnostic delay in patients with HD does not seem to have any significant influence on stage distribution, relapse rate or short-term survival. The aggressiveness of the tumour may be the important parameter.
From July 1990 to July 1991, 263 consecutive cancer patients admitted to our oncological unit for the first time were invited to participate in a questionnaire based study. 252 patients responded and were included in the final analysis. The aim of the survey was to examine the delays involved in diagnosis and treatment of cancer and the possible psychological distress associated to the different periods of delay. A shorter patient delay was found among patients under the age of 30 years (P < 0.005). Patients with higher education had a significantly shorter delay from the time of contact with the GP to admittance to the local hospital (P <0.005). The diagnostic delay was reported to be significantly more distressing for females compared to males (P <0.05). The reported psychological distress, however, correlated positively to the actual length of total delay (P<0.005) for both sexes. All patients reported that the delay between local hospital referral and admittance to the oncological unit to be the most distressing delay period to cope with.
INTRODUCTION: Next to carcinoma of the bronchus, colorectal cancer (CRC) kills more people than any malignancy. Among the efforts to improve the outcome are studies on multidrug resistance (MDR) modulators combined with doxorubicin. MATERIAL AND METHODS: Between November 1996 and August 1997, 10 patients were included in a study employing the MDR-modulator SDZ PSC 833 (5 mg/kg qid 3d/3rd w) and adriamycin (35-45 mg/m2/3rd w). Quality of life (QoL) was measured (EORTC QLQ-C30) at baseline and every 3rd week until progression or patient refusal. RESULTS: SDZ PSC 833 and doxorubicin worsened the global QoL from 68 to 46.6 (0-100 scale) during 6 weeks. There was no improvement in QoL from cycle 1 to 3. The physical, social, nausea/vomiting and dyspnoea subscales were most affected. Mean performance status (WHO) was only slightly reduced. CONCLUSION: SDZ PSC 833 and doxorubicin did not improve QoL and seemed more toxic than 5-FU containing regimens. If superior data on response and survival are revealed, a cost-utility analysis should be performed.