Ørnulf Paulsen

• Festvåg, Line Elida; Sverre, Beate Lie; Paulsen, Ørnulf & Eilertsen, Grethe (2024). Advance care planning with older Norwegian adults in their homes: a narrative ethnographic study. BMC Palliative Care. ISSN 1472-684X. 23(1). doi: 10.1186/s12904-024-01378-7. Show summary

  Background: The aim of advance care planning (ACP) is to enable patients to define and discuss their values and preferences to ensure that the care they receive is consistent with their needs and wishes. Most studies of ACP with older adults focus on conversations conducted in institutions. This study aimed to explore how ACP with older patients is carried out and experienced by healthcare professionals when the conversations occur in their private homes. Methods: The data were obtained from participant observations of ACP conversations in the homes of eight older patients with advanced cancer, which also involved relatives and healthcare professionals. Additionally, ethnographic interviews were conducted with the healthcare professionals. We undertook a narrative analysis of what was said, and how the individuals acted and interacted. Results: The home influenced both the substance and form of the ACP conversations. The patients and relatives welcomed the healthcare professionals as guests and were encouraged to share their perceptions of their current situation, joys and worries. Their values were often implicit in their stories about past experiences. The planning mainly focused on life-prolonging treatment and the preferred future place of care. Several patients were not ready to discuss one or more ACP issues. The palliative-care-team physician addressed the patients' readiness for ACP by asking for permission to move on to a different topic, shifting between serious and lighter topics, and using elements from the home as 'door openers' to continue conversations. ACP conversations were an essential basis for future palliative care and cooperation, giving important additional information about the patient and their relatives. Conclusion: Conducting the ACP conversations in the patients' homes ensured a homely atmosphere that facilitated a caring approach when sensitive issues were discussed, and in turn supported the identification of important personal values. The healthcare professionals expressed that the ACP conversations represented an essential common reference point and provided a shared awareness of the expected disease trajectory and the values, preferences and needs of the patient. These findings are particularly important given that many older patients struggle to verbalize or form an opinion on issues affecting their future.

• Hjermstad, Marianne Jensen; Pirnat, Aleksandra; Aass, Nina Kathrine; Andersen, Sigve; Astrup, Guro Lindviksmoen & Dajani, Olav [Show all 19 contributors for this article] (2024). PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life. Palliative Medicine. ISSN 0269-2163. 38(2), p. 229–239. doi: 10.1177/02692163231222391. Show summary

  Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. Setting: A total of 12 Norwegian hospitals (03/2017-02/2021). Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. Results: A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3-14) and 7 months (IQR 3-12), and days between anticancer therapy start and death were 204 (90-378) and 168 (69-351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes. Conclusion: We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.

• Jakobsen, Gunnhild; Sjue, Karin; Paulsen, Ørnulf; Kaasa, Stein; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Supportive Care in Cancer. ISSN 0941-4355. 31. doi: 10.1007/s00520-022-07537-x. Full text in Research Archive Show summary

  Purpose: Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. Methods: A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). Results: Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). Conclusion: Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer.

• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Rosland, Jan Henrik; Aass, Nina Kathrine & Albert, Eva [Show all 10 contributors for this article] (2021). The short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer in a randomized, placebo-controlled, double-blind trial. Supportive Care in Cancer. ISSN 0941-4355. 29(4), p. 2047–2055. doi: 10.1007/s00520-020-05693-6. Full text in Research Archive Show summary

  Purpose: Although corticosteroids are frequently used in patients with advanced cancer, few studies have examined the impact of these drugs on patient-reported sleep. We aimed to examine the short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer. Methods: Patient-reported sleep was a predefined secondary outcome in a prospective, randomized, placebo-controlled, double-blind trial that evaluated the analgesic efficacy of corticosteroids in advanced cancer patients (18+), using opioids, and having pain ≥ 4 past 24 h (NRS 0-10). Patients were randomized to the methylprednisolone group with methylprednisolone 16 mg × 2/day or placebo for 7 days. The EORTC QLQ-C30 (0-100) and the Pittsburgh Sleep Quality Index questionnaire (PSQI) (0-21) were used to assess the impact of corticosteroids on sleep at baseline and at day 7. Results: Fifty patients were randomized of which 25 were analyzed in the intervention group and 22 in the control group. Mean age was 64 years, mean Karnofsky performance status was 67 (SD 13.3), 51% were female, and the mean oral daily morphine equivalent dose was 223 mg (SD 222.77). Mean QLQ-C30 sleep score at baseline was 29.0 (SD 36.7) in the methylprednisolone group and 24.2 (SD 27.6) in the placebo group. At day 7, there was no difference between the groups on QLQ-C30 sleep score (methylprednisolone 20.3 (SD 32.9); placebo 28.8 (SD 33.0), p = 0.173). PSQI showed similar results. Conclusions: Methylprednisolone 16 mg twice daily for 7 days had no impact on patient-reported sleep in this cohort of patients with advanced cancer.

• Dolan, Ross D.; Laird, Barry J.A.; Klepstad, Pål; Kaasa, Stein; Horgan, Paul G. & Paulsen, Ørnulf [Show all 7 contributors for this article] (2019). An exploratory study examining the relationship between performance status and systemic inflammation frameworks and cytokine profiles in patients with advanced cancer. Medicine. ISSN 0025-7974. 98(37), p. 1–7. doi: 10.1097/MD.0000000000017019. Full text in Research Archive Show summary

  The role of cytokines in the systemic inflammatory response (SIR) is now well established. This is in keeping with the role of the SIR in tumorigenesis, malignant spread, and the development of cachexia. However, the relationship between performance status/systemic inflammation frameworks and cytokine profiles is not clear. The aim of the present study was to examine the relationship between the Eastern cooperative oncology group performance status/modified Glasgow prognostic score (ECOG-PS/mGPS) and cooperative oncology group performance status/neutrophil platelet score (ECOG-PS/NPS) frameworks and their cytokine profile in patients with advanced cancer.This was a retrospective interrogation of data already collected as part of a recent clinical trial (NCT00676936). The relationship between the independent variables (ECOG-PS/mGPS and ECOG-PS/NPS frameworks), and dependent variables (cytokine levels) was examined using independent Mann-Whitney U and Kruskal Wallis tests where appropriate.Of the 40 patients included in final analysis the majority had evidence of an SIR assessed by mGPS (78%) or NPS (53%). All patients died on follow-up and the median survival was 91 days (4-933 days). With increasing ECOG-PS there was a higher median value of Interleukin 6 (IL-6, P = .016) and C-reactive protein (CRP, P < .01) and lower albumin (P < .01) and poorer survival (P < .001). With increasing mGPS there was a higher median value of IL-6 (P = .016), Macrophage migration inhibitory factor (MIF, P = .010), erythrocyte sedimentation rate (ESR, P < .01) and poorer survival (P < .01). With increasing NPS there was a higher median value of TGF-β (P < .001) and C-reactive protein (P = .020) and poor survival (P = .001). When those patients with an ECOG-PS 0/1 and mGPS0 were compared with those patients with an ECOG-PS 2 and mGPS2 there was a higher median value of IL-6 (P = .017) and poorer survival (P < .001). When those patients with an ECOG-PS 0/1 and NPS0 were compared with those patients with an ECOG-PS 2 and NPS1/2 there was a higher median value of IL-6 (P = .002), TGF-β (P < .001) and poorer survival (P < .01).In patients with advanced cancer IL-6 was associated with the ECOG-PS/mGPS and ECOG-PS/NPS frameworks and survival in patients with advanced cancer. Therefore, the present work provides supporting evidence that agents targeting IL-6 are worthy of further exploration.

• Jakobsen, Gunnhild; Engstrøm, Morten; Paulsen, Ørnulf; Sjue, Karin; Raj, Sunil Xavier & Thronæs, Morten [Show all 10 contributors for this article] (2018). Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer: study protocol for a double-blind, randomized, placebo-controlled, clinical multicenter trial. Trials. ISSN 1745-6215. 19:707, p. 1–9. doi: 10.1186/s13063-018-3088-3. Full text in Research Archive
• Paulsen, Ørnulf; Laird, Barry J; Aass, Nina Kathrine; Lea, Tor Erling; Fayers, Peter & Kaasa, Stein [Show all 7 contributors for this article] (2017). The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer. PLOS ONE. ISSN 1932-6203. 12(5). doi: 10.1371/journal.pone.0177620. Full text in Research Archive
• Paulsen, Ørnulf; Klepstad, Pål; Rosland, Jan Henrik; Aass, Nina Kathrine; Albert, Eva & Fayers, Peter [Show all 7 contributors for this article] (2014). Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: A randomized, placebo-controlled, double-blind trial. Journal of Clinical Oncology. ISSN 0732-183X. 32(29), p. 3221–3228. doi: 10.1200/JCO.2013.54.3926. Show summary

  Purpose Corticosteroids are frequently used in cancer pain management despite limited evidence. This study compares the analgesic efficacy of corticosteroid therapy with placebo. Patients and Methods Adult patients with cancer receiving opioids with average pain intensity ≥ 4 (numeric rating scale [NRS], 0 to 10) in the last 24 hours were eligible. Patients were randomly assigned to methylprednisolone (MP) 16 mg twice daily or placebo (PL) for 7 days. Primary outcome was average pain intensity measured at day 7 (NRS, 0 to 10); secondary outcomes were analgesic consumption (oral morphine equivalents), fatigue and appetite loss (European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire C30, 0 to 100), and patient satisfaction (NRS, 0 to 10). Results A total of 592 patients were screened; 50 were randomly assigned, and 47 were analyzed. Baseline opioid level was 269.9 mg in the MP arm and 160.4 mg in the PL arm. At day-7 evaluation, there was no difference between the groups in pain intensity (MP, 3.60 v PL, 3.68; P = .88) or relative analgesic consumption (MP, 1.19 v PL, 1.20; P = .95). Clinically and statistically significant improvements were found in fatigue (−17 v 3 points; P .003), appetite loss (−24 v 2 points; P = .003), and patient satisfaction (5.4 v 2.0 points; P = .001) in favor of the MP compared with the PL group, respectively. There were no differences in adverse effects between the groups. Conclusion MP 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study.

• Kotlinska-Lemieszek, Aleksandra; Paulsen, Ørnulf; Kaasa, Stein & Klepstad, Pål (2014). Polypharmacy in patients with advanced cancer and pain: A european cross-sectional study of 2282 patients. Journal of Pain and Symptom Management. ISSN 0885-3924. 48(6), p. 1145–1159. doi: 10.1016/j.jpainsymman.2014.03.008. Show summary

  Context Patients with advanced cancer need multiple drugs to control symptoms and to treat cancer and concomitant diseases. At the same time, the goal of treatment changes as life expectancy becomes limited. This results in a risk for polypharmacy, maintained use of unneeded drugs, and drug-drug interactions (DDIs). Objectives The aim of the study was to analyze the use of medications and to identify unneeded drugs, and drugs and drug combinations with a risk for DDIs in a cohort of advanced cancer pain patients, defined by a need for a World Health Organization analgesic ladder Step III opioid. Methods All drugs taken within a study day by cancer patients receiving opioids for moderate or severe pain (Step III opioids) were analyzed. Nonopioids and adjuvants were analyzed for their use across countries. Unneeded medications and drugs and drug combinations with a risk for pharmacodynamic and pharmacokinetic DDIs were identified on the basis of published literature and electronic resources. Results In total, 2282 patients from 17 centers in 11 European countries were included. They received a mean of 7.8 drugs (range 1–20). Over one-quarter used 10 or more medications. The drugs and drug classes most frequently coadministered with opioids were proton pump inhibitors, laxatives, corticosteroids, paracetamol (acetaminophen), nonsteroidal anti-inflammatory drugs, metoclopramide, benzodiazepines, anticoagulants, antibiotics, anticonvulsants, diuretics, and antidepressants. The use of nonopioids and essential adjuvants varied across countries. Approximately 45% of patients received unnecessary or potentially unnecessary drugs, and about 7% were given duplicate or antagonizing agents. Exposures to DDIs were frequent and increased the risk of sedation, gastric ulcerations, bleedings, and neuropsychiatric and cardiac complications. Many patients were exposed to pharmacokinetic DDIs involving cytochrome P450, including about 58% who used a Step III opioid CYP3A4 (izoenzyme of cytochrome P450) substrate, and more than 10% who were given major CYP3A4 inhibitors or inducers. Conclusion Patients with cancer treated with a World Health Organization Step III opioid use a high number of drugs. Nonopioid analgesics and corticosteroids are frequently used, but different patterns of use between countries were found. Many patients receive unneeded drugs and are at risk of serious DDIs. These findings demonstrate that drug therapy in these patients needs to be evaluated continuously.

• Paulsen, Ørnulf; Aass, Nina Kathrine; Kaasa, Stein & Dale, Ola (2013). Do Corticosteroids Provide Analgesic Effects in Cancer Patients? A Systematic Literature Review. Journal of Pain and Symptom Management. ISSN 0885-3924. 46(1), p. 96–105. doi: 10.1016/j.jpainsymman.2012.06.019.
• Paulsen, Ørnulf; Aass, Nina Kathrine; Kaasa, Stein & Dale, Ola (2013). Do coricosteroids provide anlgesic effects in cancer patients? A systeamtic literature review. Journal of Pain and Symptom Management. ISSN 0885-3924. 46(1), p. 96–105. doi: 10.1016/j.jpainsymman.2012.06.019.
• Husby, Kristin Moksnes; Kaasa, Stein; Paulsen, Ørnulf; Rosland, Jan Henrik; Spigset, Olav & Dale, Ola (2012). Serum concentrations of opiods when comparing two switching strategies to methadone for cancer pain. European Journal of Clinical Pharmacology. ISSN 0031-6970. 68(8), p. 1147–1156. doi: 10.1007/s00228-012-1228-3.
• Oldervoll, Line Merethe; Loge, Jon Håvard; Lydersen, Stian; Paltiel, Hanne; Asp, May-Britt & Nygaard, Unni Vidvei [Show all 14 contributors for this article] (2011). Physical Exercise for Cancer Patients with Advanced Disease: A Randomized Controlled Trial. The Oncologist. ISSN 1083-7159. 16(11), p. 1649–1657. doi: 10.1634/theoncologist.2011-0133.
• Husby, Kristin Moksnes; Dale, Ola; Rosland, Jan Henrik; Paulsen, Ørnulf; Klepstad, Pål & Kaasa, Stein (2011). How to switch from morphine or oxycodone to methadone in cancer patients? A randomized clinical phase II trial. European Journal of Cancer. ISSN 0959-8049. 47(16), p. 2463–2470. doi: 10.1016/j.ejca.2011.06.047.
• Fyllingen, E H; Oldervoll, L.M.; Loge, Jon Håvard; Hjermstad, MJ; Haugen, DF & Sigurdardottir, KR [Show all 8 contributors for this article] (2009). Computer-Based Assessment of Symptoms and Mobility in Palliative Care: Feasibility and Challenges. Journal of Pain and Symptom Management. ISSN 0885-3924. 38, p. 827–836.
• Loge, Jon Håvard; Bjordal, Kristin; Paulsen, Ørnulf & Kaasa, Stein (2007). Den palliative konsultasjon. In Kaasa, Stein (Eds.), Palliasjon Nordisk lærebok. Gyldendal Akademisk. ISSN 978-82-05-35181-3. p. 63–74.
• Rosland, Jan Henrik; von Hofacker, Sebastian & Paulsen, Ørnulf (2006). Den døende pasient (The dying patient). Tidsskrift for Den norske legeforening. ISSN 0029-2001. 126(4), p. 467–470.

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• Paulsen, Ørnulf (2024). Pragmatic Trials Accomodate Clinical Practice and Scientific Rigour .
• Hjermstad, Marianne Jensen; Pirnat, Aleksandra; Aass, Nina Kathrine; Andersen, Sigve; Astrup, Guro Lindviksmoen & Dajani, Olav [Show all 19 contributors for this article] (2023). 1592MO Anticancer therapy at the end-of-life: A cluster-randomized trial. Annals of Oncology. ISSN 0923-7534. 34, p. S886–S886. doi: 10.1016/j.annonc.2023.09.789.
• Festvåg, Line Elida; Sverre, Beate Lie; Paulsen, Ørnulf & Eilertsen, Grethe (2022). Forhåndssamtale med eldre hjemmeboende pasienter med kreft i sen palliativ fase, deres pårørende og helsepersonell - En etnografisk studie.
• Festvåg, Line Elida; Sverre, Beate Lie; Paulsen, Ørnulf & Eilertsen, Grethe (2022). Forhåndssamtale med eldre hjemmeboende pasienter med kreft i sen palliativ fase, deres pårørende og helsepersonell-- en etnografisk studie.
• Yri, Olav Erich; Astrup, Guro Lindviksmoen; Karlsson, Astrid Telhaug; Paulsen, Ørnulf; van Helvoirt, Rene & Lund, Jo-Åsmund [Show all 12 contributors for this article] (2022). Brain metastases: Real-life treatment patterns, survival and patient-reported outcomes – Results from a population-based, prospective study in 914 patients. Annals of Oncology. ISSN 0923-7534. 33, p. S668–S668. doi: 10.1016/j.annonc.2022.07.416.
• Paulsen, Ørnulf; Østevik, Svend-Martin Lindland & Haugen, Dagny Renata Faksvåg (2022). Hvordan opplever pårørende den lindrende omsorgen mot slutten av livet for kreftpasienter i Telemark?
• Jakobsen, Gunnhild; Sjue, Karin; Paulsen, Ørnulf; Kaasa, Stein; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). Medikamentell behandling av insomni hos kreftpasienter.
• Astrup, Guro Lindviksmoen; Kaasa, Stein; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Lundeby, Tonje & van Helvoirt, Rene [Show all 9 contributors for this article] (2021). Patient-reported outcomes in cancer patients newly diagnosed with brain metastases. Annals of Oncology. ISSN 0923-7534. 32, p. S1076–S1076. doi: 10.1016/j.annonc.2021.08.206.
• Yri, Olav Erich; Astrup, Guro Lindviksmoen; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Lund, Jo-Åsmund & van Helvoirt, Rene [Show all 8 contributors for this article] (2021). Brain metastases: Extracranial disease status as a prognostic factor after whole brain radiotherapy. Results from a prospective, population-based study. Annals of Oncology. ISSN 0923-7534. 32, p. S526–S526. doi: 10.1016/j.annonc.2021.08.037.
• Jakobsen, Gunnhild; Kaasa, Stein; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Klepstad, Pål & Paulsen, Ørnulf (2021). Kortikosteroider påvirker ikke søvn hos alvorlig syke kreftpasienter med smerte .
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Andersen, Sigve; Brunelli, Cinzia; Dajani, Olav & Ahmed, Herish [Show all 20 contributors for this article] (2020). PALLiON - PALLiative care Integrated in ONcology: Study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials. ISSN 1745-6215. 21:303, p. 1–17. doi: 10.1186/s13063-020-4224-4. Full text in Research Archive
• Sande, Rikka Frøyen; Thoresen, Lene; Løhre, Erik Torbjørn; Nygard, Astrid Signe; Paulsen, Ørnulf & Ottestad, Inger [Show all 8 contributors for this article] (2019). Parenteral nutrition therapy in patients with incurable cancer: A retrospective medical chart review of current practice. Show summary

  Rationale: Indication for use, dose and duration of parenteral nutrition (PN) in patients with incurable cancer is understudied. The aim of the study was to describe current practice of PN treatment in adult patients with incurable cancer at St. Olavs University Hospital, Trondheim, Norway. Methods: A retrospective medical chart review of patients with incurable cancer receiving PN between 2011 and 2017 was conducted. Of 271 identified patients, data from the first 78 patients was included in this preliminary analysis. Medical information was collected from start of PN until patients’ death. Results: The mean (SD) age was 63.5 (12.9) years, 41 women and 37 men. All patients received PN concomitant with anti-cancer treatment at some point in time. The most common indications for PN were “insufficient oral or enteral intake” (n=67) or “gastrointestinal malfunction” (n=17). At start of PN, there were no differences between subgroups in s-albumin, C-reactive protein level, metastatic disease, or ascites. The main reason for discontinuation of PN was imminently dying patient (n=36), patient preferences (n=19), and complications (n=12). The table presents available data on PN treatment and survival in subgroups defined by duration of PN treatment. Data presented as n or median (Q1-Q3). Variables < 2 weeks 2 weeks -1 month 1 month - 2 months > 2 months P1 n Patients (n) 14 20 16 16 66 PN treatment Highest received PN dose, kcal 1100 (612-1600)#,¤ 1600 (1100-2200)# 1600 (1100-1600) 1750 (1450-2200)¤ 0.001 62 Received dose (percentage of estimated energy need) 73 (43-73) 78 (62-101) 69 (50-94) 97 (73-118) 0.03 52 Documented oral food intake, n 9 16 15 15 0.09 55 Survival From start of PN, days 19 (13-74)& 39 (26- 384) 61 (43-115) 168 (88-295)& 0.001 66 From PN termination, days 10 (4-70) 16 (5-358)§ 4.5 (1-70) 2 (1-7)§ 0.016 66 1Kruskal-Wallis test, Dunn’s Post Hoc test; # P=0.04, ¤ p=0.003, & P=0.001, § P=0.02 Conclusion: To our knowledge, this is the first study describing clinical practice with respect to dose, duration and termination of PN in incurable cancer patients. Preliminary data suggest that the use of PN was dynamic and differentiated. Termination of PN was based on expected patient survival, patient preferences, and treatment complications.

• Paulsen, Ørnulf; Haugstøl, Torunn & Rosland, Jan Henrik (2016). Palliative team på sykehus. In Kaasa, Stein & Loge, Jon Håvard (Ed.), Palliasjon. Nordisk lærebok. 3. utgave. Gyldendal Akademisk. ISSN 9788205488403. p. 139–147.
• Paulsen, Ørnulf; Aass, Nina Kathrine; Klepstad, Pål & Kaasa, Stein (2015). Reply to A. Molfino et al. Journal of Clinical Oncology. ISSN 0732-183X. 33(13). doi: 10.1200/JCO.2014.60.6475.
• Paulsen, Ørnulf (2014). Kortison demper ikke kreftsmerter. [Internet]. oslo universitetssykehus.
• Paulsen, Ørnulf (2014). Kortison demper ikke kreftsmerter . [Internet]. dagens medisin.
• Paulsen, Ørnulf (2014). Kortison demper ikke kreftsmerter. [Newspaper]. adressavisen.
• Paulsen, Ørnulf (2014). Kortison virker ikke på kreftsmerter . [Internet]. NRK.
• Paulsen, Ørnulf (2014). Kortison demper ikke kreftsmerter.
• Paulsen, Ørnulf; Klepstad, Pål; Rosland, Jan Henrik & Kaasa, Stein (2012). Do corticosteroids have immediate analgesic effects in palliative cancer patietns with pain? A randomized placebo-controlled trial.
• Husby, Kristin Moksnes; Kaasa, Stein; Paulsen, Ørnulf; Rosland, Jan Henrik; Spigset, Olav & Dale, Ola (2011). Serum concentrations of opioids when comparing two switching strategies to methadone for cancer pain.
• Oldervoll, Line Merethe; Loge, Jon Håvard; Paltiel, H; Nygaard, Unni Vidvei; Oredalen, E & Frantzen, Tone-Lise [Show all 14 contributors for this article] (2010). Physical Exercise in Palliative Care Cancer Patients - A Phase II Randomised Clinical Trial (RCT). Palliative Medicine. ISSN 0269-2163. 24(4).
• Moksness, Kristin; Rosland, Jan Henrik; Paulsen, Ørnulf; Klepstad, Pål & Kaasa, Stein (2010). How to switch from morphine or oxycodone to methadone. A randomized clinical phase III trial. Palliative Medicine. ISSN 0269-2163. 24(4).
• Moksness, Kristin; Rosland, Jan Henrik; Paulsen, Ørnulf; Klepstad, Pål & Kaasa, Stein (2010). How to switch from morphine or oxycodone to methadone. A randomized clinical phase III trial.
• Husby, Kristin Moksnes; Dale, Ola; Rosland, Jan Henrik; Paulsen, Ørnulf; Klepstad, Pål & Kaasa, Stein (2010). How to switch from morphine or oxycodone to methadone in cancer patients? A randomized clinical phase II trial. Show summary

  The stop and go strategy was not more effective nor as safe as the 3 days switch when switching to methadone in cancer patients. A 3 days switch should still be the standard procedure.

• Fyllingen, Even Hovig; Hjermstad, Marianne Jensen; Oldervoll, Line Merethe; Sigurdardottir, Katrin Rut; Kaasa, Stein & Paulsen, Ørnulf (2008). Computer-based symptom assessment in palliative cancer care: To what extent is time expenditure influenced by age, gender, educational level and Karnofsky performance status? Journal of Palliative Medicine. ISSN 1096-6218. 22(4).
• Faksvåg Haugen, Dagny; Engstrand, Per; Paulsen, Ørnulf; Jordhøy, Marit S; Kaasa, Stein & Wist, Erik [Show all 8 contributors for this article] (2004). Norsk standard for palliasjon.
• Nordbotten, Leif; Brelin, Siri; Haugen, Dagny Faksvåg; Paulsen, Ørnulf & ROGG, LOTTE VICTORIA (2015). Forsøksordning Kompetanseområde palliativ medisin. Rapport. IS-2279. Helsedirektoratet.

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