Stein Kaasa

• Engelaar, Merel; Bos, Nanne; van Schelven, Femke; Lorenzo i Sunyer, Nora; Couespel, Norbert & Apolone, Giovanni [Show all 19 contributors for this article] (2024). Collaborating with cancer patients and informal caregivers in a European study on quality of life: protocol to embed patient and public involvement within the EUonQoL project. Research Involvement and Engagement. ISSN 2056-7529. 10(1). doi: 10.1186/s40900-024-00597-9.
• Barratt, Daniel T.; Klepstad, Pål; Dale, Ola; Kaasa, Stein & Somogyi, Andrew A. (2024). Pharmacokinetic and neuroimmune pharmacogenetic impacts on slow-release morphine cancer pain control and adverse effects. The Pharmacogenomics Journal. ISSN 1470-269X. 24(3). doi: 10.1038/s41397-024-00339-w.
• Voskanyan, Viktorya; Marzorati, Chiara; Sala, Diana; Grasso, Roberto; Pietrobon, Ricardo & van der Heijden, Iris [Show all 20 contributors for this article] (2024). Psychosocial factors associated with quality of life in cancer survivors: umbrella review. Journal of Cancer Research and Clinical Oncology. ISSN 0171-5216. 150(5). doi: 10.1007/s00432-024-05749-8.
• Brenne, Anne Tove; Løhre, Erik Torbjørn; Knudsen, Anne Kari; Lund, Jo-Åsmund; Thronæs, Morten & Driller, Bardo [Show all 8 contributors for this article] (2024). Standardizing Integrated Oncology and Palliative Care Across Service Levels: Challenges in Demonstrating Effects in a Prospective Controlled Intervention Trial. Oncology and Therapy. ISSN 2366-1070. doi: 10.1007/s40487-024-00278-3.
• Lund, Jo-Åsmund; Lydersen, Stian; Aksnessæther, Bjørg Yksnøy; Solberg, Arne; Wanderås, Anne Dybdahl & Lervåg, Christoffer [Show all 8 contributors for this article] (2024). Image guided radiotherapy in curative treatment for prostate cancer. 5-year results from a randomized controlled trial (RIC-trial). Radiotherapy and Oncology. ISSN 0167-8140. 196. doi: 10.1016/j.radonc.2024.110309.
• Karlsson, Astrid Telhaug; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Skovlund, Eva; Kaasa, Stein & Yri, Olav Erich (2024). Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients. Cancers. ISSN 2072-6694. 16(8). doi: 10.3390/cancers16081486.
• Hjermstad, Marianne Jensen; Jakobsen, Gunnhild; Arends, Jann; Balstad, Trude Rakel; Brown, Leo R. & Bye, Asta [Show all 26 contributors for this article] (2024). Quality of life endpoints in cancer cachexia clinical trials: Systematic review 3 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. doi: 10.1002/jcsm.13453.
• Shkodra, Morena; Mulvey, Matthew; Fallon, Marie; Brunelli, Cinzia; Zecca, Ernesto & Bracchi, Paola [Show all 12 contributors for this article] (2024). Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer. Pain Reports. ISSN 2471-2531. 9(2). doi: 10.1097/PR9.0000000000001140.
• Vagnildhaug, Ola Magne; Balstad, Trude Rakel; Ottestad, Inger ; Bye, Asta; Greil, Christine & Arends, Jann [Show all 24 contributors for this article] (2024). Appetite and dietary intake endpoints in cancer cachexia clinical trials: Systematic Review 2 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. doi: 10.1002/jcsm.13434.
• 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.

• Dingemans, Anne-Marie; van Walree, Nico; Schramel, Franz; Soud, Magdolen Youssef-El; Baltruškevičienė, Edita & Lybaert, Willem [Show all 9 contributors for this article] (2023). High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients. ISSN 2072-6643. 15(24). doi: 10.3390/nu15245030.
• McDonald, James; Sayers, Judith; Anker, Stefan D.; Arends, Jann; Balstad, Trude Rakel & Baracos, Vickie [Show all 29 contributors for this article] (2023). Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series. Journal of Cachexia, Sarcopenia and Muscle. ISSN 2190-5991. doi: 10.1002/jcsm.13321. Full text in Research Archive
• Miranda, Rose; Raemdonck, Eveline; Deliens, Luc; Kaasa, Stein; Zimmermann, Camilla & Rodin, Gary [Show all 10 contributors for this article] (2023). Do cancer centres and palliative care wards routinely measure patients’ quality of life? An international cross-sectional survey study. Supportive Care in Cancer. ISSN 0941-4355. 31(8). doi: 10.1007/s00520-023-07964-4. Full text in Research Archive
• Diernberger, Katharina; Clausen, Eleanor; Murray, Gordon; Wee, Bee; Kaasa, Stein & Hall, Peter [Show all 7 contributors for this article] (2023). Cancer pain assessment and management: does an institutional approach individualise and reduce cost of care? BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2022-003547. Full text in Research Archive
• Rootwelt, Rebecca; Skovlund, Eva; Andreassen, Joakim Stray; Arvidsson, Lisa; Halvardson, Jonathan & Solheim, Ole Skeidsvoll [Show all 10 contributors for this article] (2023). Preoperative Prognostic Index for Patients with Brain Metastases—A Population-Based Multi-Centre Study. Cancers. ISSN 2072-6694. 15(12). doi: 10.3390/cancers15123174. Full text in Research Archive
• Skåre, Terese Solvoll; Midtbust, May Helen; Lund, Jo-Åsmund; Kaasa, Stein & Dreyer, Anne (2022). Barriers and Facilitators When Implementing Electronic Patient-Reported Outcome Measures at a Municipal Cancer Care Unit: A Qualitative Study. Cancer Nursing. ISSN 0162-220X. 46(4), p. E268–E275. doi: 10.1097/NCC.0000000000001120. Show summary

  Background Few qualitative studies of barriers and facilitators when implementing electronic patient-reported outcome measure (ePROM) in municipal cancer care exist within the large body of symptom assessment research. Such data, gathered from healthcare professionals’ (HCPs) perspective, are central to the development and design of sustainable interventions aiming for a systematic and patient-centered symptom assessment to patients with cancer. Objective The aim of this study was to identify and explore barriers and facilitators, as described by HCPs, in the implementation of the ePROM application “Eir” at a municipal cancer care unit in Norway. Methods The study applies a qualitative method, conducting an inductive data inquiry of semistructured individual interviews and focus groups with 14 Norwegian HCPs. Analysis was inspired by thematic analysis as described by Braun and Clarke. Results The analysis revealed 3 main themes affecting the implementation of ePROM in municipal cancer care: “achieving patient-centered care,” “crucial management and training,” and “technological barriers.” Conclusion The results from this study suggest that HCPs’ motivation plays a significant role when implementing ePROM. Motivation of HCPs was strongly influenced by whether the application added value to previously used symptom assessment. Hands-on management and a multiprofessional approach enabled the implementation by facilitating adaptations, training, and resources. Implications for Practice The findings show that adapting the implementation of ePROMs to patient population could be of major importance. Early integration of ePROMs in cancer care could facilitate use throughout the disease trajectory.

• 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.

• Fallon, M.; Dierberger, K.; Leng, M.; Hall, P.S.; Allende, S. & Sabar, R. [Show all 18 contributors for this article] (2022). An international, open-label, randomised trial comparing a two-step approach versus the standard three-step approach of the WHO analgesic ladder in patients with cancer. Annals of Oncology. ISSN 0923-7534. 33(12), p. 1296–1303. doi: 10.1016/j.annonc.2022.08.083. Full text in Research Archive
• Kreye, G.; Lundeby, Tonje; Latino, N.; Galotti, M. & Kaasa, Stein (2022). ESMO Designated Centres of Integrated Oncology and Palliative Care (ESMO DCs): education, research and programme development survey. ESMO Open. ISSN 2059-7029. 7(6). doi: 10.1016/j.esmoop.2022.100622. Full text in Research Archive
• Bye, Asta; Bjerkeset, Ellen; Stensheim, Hanne; Loge, Jon Håvard; Hjermstad, Marianne Jensen & Klepstad, Pål [Show all 9 contributors for this article] (2022). Benefits of Study Participation for Patients with Advanced Cancer Receiving Radiotherapy: A Prospective Observational Study. Palliative Medicine Reports (PMR). 3(1), p. 264–271. doi: 10.1089/pmr.2022.0044. Full text in Research Archive
• Shkodra, Morena; Brunelli, Cinzia; Zecca, Ernesto; Infante, Gabriele; Miceli, Rosalba & Caputo, Mariangela [Show all 10 contributors for this article] (2022). Cancer pain: Results of a prospective study on prognostic indicators of pain intensity including pain syndromes assessment. Palliative Medicine. ISSN 0269-2163. 36(9), p. 1396–1407. doi: 10.1177/02692163221122354. Full text in Research Archive
• Kristensen, Are Korsnes; Grønberg, Bjørn Henning; Fløtten, Øystein; Kaasa, Stein & Solheim, Tora S (2022). Trajectory of health-related quality of life during the last year of life in patients with advanced non-small–cell lung cancer. Supportive Care in Cancer. ISSN 0941-4355. 30, p. 9351–9358. doi: 10.1007/s00520-022-07359-x. Full text in Research Archive
• Habberstad, Ragnhild H; Aass, Nina Kathrine; Mollnes, Tom Eirik; Damås, Jan Kristian; Brunelli, Cinzia & Rossi, Romina [Show all 9 contributors for this article] (2022). Inflammatory Markers and Radiotherapy Response in Patients With Painful Bone Metastases. Journal of Pain and Symptom Management. ISSN 0885-3924. 64(4), p. 330–339. doi: 10.1016/j.jpainsymman.2022.06.018. Full text in Research Archive
• Aamdal, Elin; Skovlund, Eva; Jacobsen, Kari Dolven; Straume, Oddbjørn; Kersten, Christian & Herlofsen, Oluf [Show all 17 contributors for this article] (2022). Health-related quality of life in patients with advanced melanoma treated with ipilimumab: prognostic implications and changes during treatment. ESMO Open. ISSN 2059-7029. 7(5), p. 1–10. doi: 10.1016/j.esmoop.2022.100588. Full text in Research Archive Show summary

  Background: We have previously reported that the safety and efficacy of ipilimumab in real-world patients with metastatic melanoma were comparable to clinical trials. Few studies have explored health-related quality of life (HRQL) in real-world populations receiving checkpoint inhibitors. This study reports HRQL in real-world patients receiving ipilimumab and assesses the prognostic value of patient-reported outcome measures. Patients and methods: Ipi4 (NCT02068196) was a prospective, multicentre, interventional phase IV trial. Real-world patients (N = 151) with metastatic melanoma were treated with ipilimumab 3 mg/kg intravenously as labelled. HRQL was assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire at baseline and after 10-12 weeks. Results: The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire was completed by 93% (141/151 patients) at baseline, and by 82% at 10-12 weeks. Poor performance status and elevated C-reactive protein (CRP) were associated with worse baseline HRQL. Clinically relevant and statistically significant deteriorations in HRQL from baseline to weeks 10-12 were reported (P <0.05). Baseline physical functioning [hazard ratio (HR) 1.96, P = 0.016], role functioning (HR 2.15, P <0.001), fatigue (HR 1.60, P = 0.030), and appetite loss (HR 1.76, P = 0.012) were associated with poorer overall survival independent of performance status, lactate dehydrogenase (LDH), and CRP. We further developed a prognostic model, combining HRQL outcomes with performance status, LDH, and CRP. This model identified three groups with large and statistically significant differences in survival. Conclusions: Systemic inflammation is associated with impaired HRQL. During treatment with ipilimumab, HRQL deteriorated significantly. Combining HRQL outcomes with objective risk factors provided additional prognostic information that may aid clinical decision making.

• Aass, Nina Kathrine & Kaasa, Stein (2022). Pasientsentrert behandling – er det mulig? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 142(3), p. 1–3. doi: 10.4045/tidsskr.22.0072.
• Lundeby, Tonje; Finset, Arnstein; Kaasa, Stein; Wester, Torunn Elin; Hjermstad, Marianne Jensen & Dajani, Olav [Show all 8 contributors for this article] (2022). A complex communication skills training program for physicians providing advanced cancer care–content development and barriers and solutions for implementation. Journal of Communication in Healthcare. ISSN 1753-8068. doi: 10.1080/17538068.2022.2039468. Full text in Research Archive Show summary

  Background : Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article. Methods : A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer. Results : The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians’ communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training.

• Rootwelt, Rebecca; Hjermstad, Marianne Jensen; Skovlund, Eva; Aass, Nina Kathrine; Helseth, Eirik & Kaasa, Stein [Show all 8 contributors for this article] (2022). Surgery for brain metastases—impact of the extent of resection. Acta Neurochirurgica. ISSN 0001-6268. 164, p. 2773–2780. doi: 10.1007/s00701-021-05104-7. Full text in Research Archive
• Aamdal, Elin; Jacobsen, Kari Dolven; Straume, Oddbjørn; Kersten, Christian; Herlofsen, Oluf & Karlsen, Jarle [Show all 19 contributors for this article] (2021). Ipilimumab in a real-world population: A prospective Phase IV trial with long-term follow-up. International Journal of Cancer. ISSN 0020-7136. 150(1), p. 100–111. doi: 10.1002/ijc.33768. Full text in Research Archive Show summary

  Ipilimumab was the first treatment that improved survival in advanced melanoma. Efficacy and toxicity in a real-world setting may differ from clinical trials, due to more liberal eligibility criteria and less intensive monitoring. Moreover, high costs and lack of biomarkers have raised cost-benefit concerns about ipilimumab in national healthcare systems and limited its use. Here, we report the prospective, interventional study, Ipi4 (NCT02068196), which aimed to investigate the toxicity and efficacy of ipilimumab in a real-world population with advanced melanoma. This national, multicentre, phase IV trial included 151 patients. Patients received ipilimumab 3 mg/kg intravenously and were followed for at least 5 years or until death. Treatment interruption or cessation occurred in 38%, most frequently due to disease progression (19%). Treatment-associated grade 3 to 4 toxicity was observed in 28% of patients, and immune-related toxicity in 56%. The overall response rate was 9%. Median overall survival was 12.1 months (95% CI: 8.3-15.9); and progression-free survival 2.7 months (95% CI: 2.6-2.8). After 5 years, 20% of patients were alive. In a landmark analysis from 6 months, improved survival was associated with objective response (HR 0.16, P = .001) and stable disease (HR 0.49, P = .005) compared to progressive disease. Poor performance status, elevated lactate dehydrogenase and C-reactive protein were identified as biomarkers. This prospective trial represents the longest reported follow-up of a real-world melanoma population treated with ipilimumab. Results indicate safety and efficacy comparable to phase III

• Liposits, Gabor; Orrevall, Ylva; Kaasa, Stein; Österlund, Pia & Cederholm, Tommy (2021). Nutrition in cancer care: A brief, practical guide with a focus on clinical practice. JCO Oncology Practice. 17(7). doi: 10.1200/OP.20.00704.
• Slørdahl, Kathinka; Klotz, Dagmar; Olsen, Jan Åge; Skovlund, Eva; Undseth, Christine & Abildgaard, Heidi L. [Show all 17 contributors for this article] (2021). Treatment outcomes and prognostic factors after chemoradiotherapy for anal cancer. Acta Oncologica. ISSN 0284-186X. 60(7), p. 921–930. doi: 10.1080/0284186X.2021.1918763. Full text in Research Archive
• Korwisi, Beatrice; Hay, Ginea; Attal, Nadine; Aziz, Qasim; Bennett, Michael I. & Benoliel, Rafael [Show all 22 contributors for this article] (2021). Classification algorithm for the International Classification of Diseases-11 chronic pain classification: development and results from a preliminary pilot evaluation. Pain. ISSN 0304-3959. 162(7), p. 2087–2096. doi: 10.1097/j.pain.0000000000002208. Show summary

  The International Classification of Diseases-11 (ICD-11) chronic pain classification includes about 100 chronic pain diagnoses on different diagnostic levels. Each of these diagnoses requires specific operationalized diagnostic criteria to be present. The classification comprises more than 200 diagnostic criteria. The aim of the Classification Algorithm for Chronic Pain in ICD-11 (CAL-CP) is to facilitate the use of the classification by guiding users through these diagnostic criteria. The diagnostic criteria were ordered hierarchically and visualized in accordance with the standards defined by the Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. The resulting linear decision tree underwent several rounds of iterative checks and feedback by its developers, as well as other pain experts. A preliminary pilot evaluation was conducted in the context of an ecological implementation field study of the classification itself. The resulting algorithm consists of a linear decision tree, an introduction form, and an appendix. The initial decision trunk can be used as a standalone algorithm in primary care. Each diagnostic criterion is represented in a decision box. The user needs to decide for each criterion whether it is present or not, and then follow the respective yes or no arrows to arrive at the corresponding ICD-11 diagnosis. The results of the pilot evaluation showed good clinical utility of the algorithm. The CAL-CP can contribute to reliable diagnoses by structuring a way through the classification and by increasing adherence to the criteria. Future studies need to evaluate its utility further and analyze its impact on the accuracy of the assigned diagnoses.

• Borchgrevink, Petter Chr.; Glette, Mari; Woodhouse, Astrid; Butler, Stephen; Landmark, Tormod & Romundstad, Pål [Show all 12 contributors for this article] (2021). A Clinical Description of Chronic Pain in a General Population Using ICD-10 and ICD-11 (The HUNT Pain Examination Study). Journal of Pain. ISSN 1526-5900. 23(2), p. 337–348. doi: 10.1016/j.jpain.2021.08.007. Show summary

  The purpose was to present a total description, distribution, and ranking of chronic pain conditions in the general population. This was based on structured clinical examinations of a random sample from a population-based survey (HUNT3) with a calculated oversampling of participants with chronic pain. Supplemented with access to hospital reports, the examination was performed by experienced physicians and psychologists using a consistent definition of chronic pain as well as ICD-10- and the new ICD-11-classification. The main findings were that a higher proportion of the 551 participants had chronic pain assessed by clinical examination (399) than by self-report in a survey the same day (337). Among those with examination-verified chronic pain estimated from HUNT3 to represent 27.9% of the general population, 63% had chronic primary pain, 81% musculoskeletal pain, and 77% more than one chronic pain condition. When separating chronic primary from chronic secondary pain according to ICD-11, the weighted prevalence was 17.7% for chronic pain conditions of unknown and 10.2% of known cause. When all the participants’ conditions were accounted for, the most prevalent was nonspecific low back (10.8%) and neck pain (7.6%). Participants with chronic primary pain did not have significantly more psychopathology than those with chronic secondary pain: 14.5% versus 12.5%. Perspective: Since this study confirms the high prevalence in self-report surveys and indicates that two thirds of chronic pain conditions cannot be explained by underlying diseases, this huge health and societal problem should be solved primarily on a public health level directed toward prevention and rehabilitation.

• Muscaritoli, Maurizio; Arends, Jann; Bachmann, Patrick; Baracos, Vickie E.; Barthelemy, Nicole & Bertz, Hartmut [Show all 22 contributors for this article] (2021). ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition. ISSN 0261-5614. 40(5), p. 2898–2913. doi: 10.1016/j.clnu.2021.02.005.
• Brenne, Anne-Tove; Løhre, Erik T; Knudsen, Anne Kari; Thronæs, Morten; Lund, Jo-Åsmund & Kongshaug, Nina [Show all 11 contributors for this article] (2021). Implementing a Standardized Care Pathway Integrating Oncology, Palliative Care and Community Care in a Rural Region of Mid-Norway. Oncology and Therapy. ISSN 2366-1070. 9(2), p. 671–693. doi: 10.1007/s40487-021-00176-y. Full text in Research Archive Show summary

  Introduction To improve quality across levels of care, we developed a standardized care pathway (SCP) integrating palliative and oncology services for hospitalized and home-dwelling palliative cancer patients in a rural region. Methods A multifaceted implementation strategy was directed towards a combination of target groups. The implementation was conducted on a system level, and implementation-related activities were registered prospectively. Adult patients with advanced cancer treated with non-curative intent were included and interviewed. Healthcare leaders (HCLs) and healthcare professionals (HCPs) involved in the development of the SCP or exposed to the implementation strategy were interviewed. In addition, HCLs and HCPs exposed to the implementation strategy answered standardized questionnaires. Hospital admissions were registered prospectively. Results To assess the use of the SCP, 129 cancer patients were included. Fifteen patients were interviewed about their experiences with the patient-held record (PHR). Sixty interviews were performed among 1320 HCPs exposed to the implementation strategy. Two hundred and eighty-seven HCPs reported on their training in and use of the SCP. Despite organizational cultural differences, developing an SCP integrating palliative and oncology services across levels of care was feasible. Both HCLs and HCPs reported improved quality of care in the wake of the implementation process. Two and a half years after the implementation was launched, 28% of the HCPs used the SCP and 41% had received training in its use. Patients reported limited use and benefit of the PHR. Conclusion An SCP may be a usable tool for integrating palliative and oncology services across care levels in a rural region. An extensive implementation process resulted in improvements of process outcomes, yet still limited use of the SCP in clinical practice. HCLs and HCPs reported improved quality of cancer care following the implementation process. Future research should address mandatory elements for usefulness and successful implementation of SCPs for palliative cancer patients.

• Bugge, Christoffer; Kaasa, Stein; Sæther, Erik Magnus; Melberg, Hans Olav & Kristiansen, Ivar Sønbø (2021). What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study. BMJ Open. ISSN 2044-6055. 11(9), p. 1–7. doi: 10.1136/bmjopen-2021-050564.
• Rootwelt, Rebecca; Vik-Mo, Einar Osland; Yri, Olav Erich; Aass, Nina Kathrine; Kaasa, Stein & Skovlund, Eva [Show all 8 contributors for this article] (2021). Surgery for brain metastases – real-world prognostic factors’ association with survival. Acta Oncologica. ISSN 0284-186X. 60(9), p. 1161–1168. doi: 10.1080/0284186X.2021.1930150. Full text in Research Archive
• Hjermstad, Marianne Jensen; Hamfjord, Julian; Aass, Nina Kathrine; Dajani, Olav; Lundeby, Tonje & Wester, Torunn Elin [Show all 7 contributors for this article] (2021). Using process indicators to monitor documentation of patient-centred variables in an integrated oncology and palliative care pathway—results from a cluster randomized trial. Cancers. ISSN 2072-6694. 13(9), p. 1–16. doi: 10.3390/cancers13092194. Full text in Research Archive Show summary

  Background. Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single–centre process evaluation monitors documentation of required patient-centred variables during an RCT. Methods. Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. Results. 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3–100%), relative to 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. Conclusions. The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus.

• Røen, Ingebrigt; Brenne, Anne-Tove; Brunelli, Cinzia; Stifoss-Hanssen, Hans; Grande, Gunn & Solheim, Tora Skeidsvoll [Show all 8 contributors for this article] (2021). Spiritual quality of life in family carers of patients with advanced cancer—a cross-sectional study. Supportive Care in Cancer. ISSN 0941-4355. 29, p. 5329–5339. doi: 10.1007/s00520-021-06080-5. Full text in Research Archive Show summary

  Purpose Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer. Methods Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models. Results In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R2) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age. Conclusion The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.

• Shkodra, Morena; Brunelli, Cinzia; Zecca, Ernesto; Formaglio, Fabio; Bracchi, Paola & Lo Dico, Silvia [Show all 9 contributors for this article] (2021). Neuropathic pain: clinical classification and assessment in patients with pain due to cancer. Pain. ISSN 0304-3959. 162(3), p. 1–9. doi: 10.1097/j.pain.0000000000002076. Full text in Research Archive Show summary

  Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.

• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Bjerkeset, Ellen; Abramova, Tatiana Mikhailovna & Garcia-Alonso, Elena [Show all 13 contributors for this article] (2021). Clinical Predictors for Analgesic Response to Radiotherapy in Patients with Painful Bone Metastases. Journal of Pain and Symptom Management. ISSN 0885-3924. 62(4), p. 681–690. doi: 10.1016/j.jpainsymman.2021.03.022. Full text in Research Archive Show summary

  Background Radiotherapy (RT) reduces pain in about 60% of patients with painful bone metastases, leaving many patients without clinical benefit. This study assesses predictors for RT effectiveness in patients with painful bone metastases. Materials and methods We included adult patients receiving RT for painful bone metastases in a multicenter, multinational longitudinal observational study. Pain response within 8 weeks was defined as ≥2-point decrease on a 0−10 pain score scale, without increase in analgesics; or a decrease in analgesics of ≥25% without increase in pain score. Potential predictors were related to patient demographics, RT administration, pain characteristics, tumor characteristics, depression and inflammation (C-reactive protein [CRP]). Multivariate logistic regression analysis with multiple imputation of missing data were applied to identify predictors of RT response. Results Of 513 eligible patients, 460 patients (90 %) were included in the regression model. 224 patients (44%, 95% confidence interval (CI) 39%−48%) responded to RT. Better Karnofsky performance status (Odds ratio (OR) 1.39, CI 1.15−1.68), breast cancer (OR 2.54, CI 1.12−5.73), prostate cancer (OR 2.83, CI 1.27−6.33) and soft tissue expansion (OR 2.00, CI 1.23−3.25) predicted RT response. Corticosteroids were a negative predictor (OR 0.57, CI 0.37−0.88). Single and multiple fraction RT had similar response. The discriminative ability of the model was moderate; C-statistic 0.69. Conclusion This study supports previous findings that better performance status and type of cancer diagnosis predicts analgesic RT response, and new data showing that soft tissue expansion predicts RT response and that corticosteroids is a negative predictor for RT response in patients with painful bone metastases.

• Karlsson, Astrid Telhaug; Hjermstad, Marianne Jensen; Omdahl, Therese; Aass, Nina Kathrine; Skovlund, Eva & Hellebust, Taran Paulsen [Show all 9 contributors for this article] (2021). Overall survival after initial radiotherapy for brain metastases; a population based study of 2140 patients with non-small cell lung cancer. Acta Oncologica. ISSN 0284-186X. 60(8), p. 1054–1060. doi: 10.1080/0284186X.2021.1924399.
• 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.

• Brunelli, Cinzia; Borreani, Claudia; Caraceni, Augusto Tomasso Giovanni; Roli, Anna; Bellazzi, Marco & Lombi, Linda [Show all 12 contributors for this article] (2020). PATIENT VOICES, a project for the integration of the systematic assessment of patient reported outcomes and experiences within a comprehensive cancer center: a protocol for a mixed method feasibility study. Health and Quality of Life Outcomes. ISSN 1477-7525. 18(1). doi: 10.1186/s12955-020-01501-1. Full text in Research Archive Show summary

  Abstract Background Listening to “patient voices” in terms of symptoms, emotional status and experiences with care, is crucial for patient empowerment in clinical practice. Despite convincing evidence that routine patient reported outcomes and experience measurements (PRMs) with rapid feed-back to oncologists can improve symptom control, patient well-being and cost effectiveness, PRMs are not commonly used in cancer care, due to barriers at various level. Part of these barriers may be overcome through electronic PRMs collection (ePRMs) integrated with the electronic medical record (EMR). The PATIENT VOICES initiative is aimed at achieving a stepwise integration of ePRMs assessment into routine cancer care. The feasibility project presented here is aimed at assessing the knowledge, use and attitudes toward PRMs in a comprehensive cancer centre; developing and assessing feasibility of a flexible system for ePRM assessment; identifying barriers to and developing strategies for implementation and integration of ePRMs clinical practice. Methods The project has been organized into four phases: a) pre-development; b) software development and piloting; c) feasibility assessment; d) post-development. A convergent mixed method design, based on concurrent quantitative and qualitative data collection will be applied. A web-survey on health care providers (HCPs), qualitative studies on patients and HCPs (semi-structured interviews and focus groups) as well as longitudinal and cross-sectional quantitative studies will be carried out. The quantitative studies will enroll 600 patients: 200 attending out-patient clinics (physical symptom assessement), 200 attending inpatient wards (psychological distress assessment) and 200 patients followed by multidisciplinary teams (patient experience with care assessment). The Edmonton symptom assessment scale, the Distress Thermometer, and a tool adapted from existing patient reported experience with cancer care questionnaires, will be used in quantitative studies. A multi-disciplinary stakeholder team including researchers, clinicians, health informatics professionals, health system administrators and patients will be involved in the development of potentially effective implementation strategies in the post development phase. Discussion The documentation of potential advantages and implementation barriers achieved within this feasibility project, will serve as a starting point for future and more focused interventions aimed at achieving effective ePRMs routine assessment in cancer care.

• Sandmæl, Jon Arne; Bye, Asta; Solheim, Tora S; Balstad, Trude Rakel; Thorsen, Lene & Skovlund, Eva [Show all 9 contributors for this article] (2020). Physical rehabilitation in patients with head and neck cancer: Impact on health-related quality of life and suitability of a post-treatment program. Laryngoscope Investigative Otolaryngology (LIO). ISSN 2378-8038. 5(2), p. 330–338. doi: 10.1002/lio2.368. Full text in Research Archive Show summary

  Objective: Physical rehabilitation programs hold the potential to mitigate deterioration in health-related quality of life (HRQoL) in patients with head and neck cancer. The objective was to assess development in relevant domains of HRQoL following a physical exercise and nutrition intervention administrated during or after treatment. Methods: In a pilot study, 41 patients were randomized to resistance training and oral nutritional supplements during (EN-DUR, n = 20) or after (EN-AF, n = 21) radiotherapy. Global health status/QoL (GHS) and physical functioning (PF) were measured by the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire at baseline, week 6, and week 14. Differences between the groups were assessed by analysis of covariance. A difference of ≥10 points in GHS and PF was interpreted as clinically relevant. Results: No statistically significant differences were detected between the groups; however, clinically relevant changes and differences in GHS and PF were observed. From baseline to week 6, GHS decreased 9 points in the EN-DUR group and 23 points in the EN-AF group and PF decreased 13 points and 21 points, respectively. From week 6 to week 14, GHS increased 14 points in the EN-DUR group and 26 points EN-AF group and PF did not change (0 points) in the EN-DUR group and increased 16 points in the EN-AF group. Conclusion: The findings from the present pilot study are promising and indicate that a physical rehabilitation program may have a positive impact on HRQoL during treatment and enhance recovery after treatment. A definitive randomized trial is warranted. Level of evidence: 1b-Individual randomized controlled trial.

• Lindemann, Kristina; Martinsson, L.; Kaasa, Stein & Lindquist, David (2020). Elderly gynaecological cancer patients at risk for poor end of life care: a population-based study from the Swedish Register of Palliative Care. Acta Oncologica. ISSN 0284-186X. 59(6), p. 636–643. doi: 10.1080/0284186X.2020.1744717. Full text in Research Archive
• Balstad, Trude Rakel; Brunelli, Cinzia; Pettersen, Caroline Hild; Schønberg, Svanhild Margrethe Arentz; Skorpen, Frank & Fallon, Marie T. [Show all 11 contributors for this article] (2020). Power comparisons and clinical meaning of outcome measures in assessing treatment effect in cancer cachexia: secondary analysis from a randomised pilot multimodal intervention trial . Frontiers in Nutrition. ISSN 2296-861X. 7:602775, p. 1–9. doi: 10.3389/fnut.2020.602775. Full text in Research Archive
• Ekström, Magnus P.; Palmqvist, Sebastian; Currow, David C.; Sjøgren, Per; Kurita, Geana Paula & Jakobsen, Gunnhild [Show all 8 contributors for this article] (2020). Mild to Moderate Cognitive Impairment Does Not Affect the Ability to Self-Report Important Symptoms in Patients With Cancer: A Prospective Longitudinal Multinational Study (EPCCS). Journal of Pain and Symptom Management. ISSN 0885-3924. 60(2), p. 346–354.e2. doi: 10.1016/j.jpainsymman.2020.03.007. Full text in Research Archive
• Colombo, Francesca; Pintarelli, Giulia; Galvan, Antonella; Noci, Sara; Corli, Oscar & Skorpen, Frank [Show all 15 contributors for this article] (2020). Identification of genetic polymorphisms modulating nausea and vomiting in two series of opioid-treated cancer patients. Scientific Reports. ISSN 2045-2322. 10(1). doi: 10.1038/s41598-019-57358-y. Full text in Research Archive
• Kochovska, Slavica; Huang, Chao; Johnson, Miriam J.; Agar, Meera; Fallon, Marie & Kaasa, Stein [Show all 10 contributors for this article] (2020). Intention-to-Treat Analyses for Randomized Controlled Trials in Hospice/Palliative Care: The Case for Analyses to be of People Exposed to the Intervention. Journal of Pain and Symptom Management. ISSN 0885-3924. 59(3), p. 637–645. doi: 10.1016/j.jpainsymman.2019.10.026.
• Krogstad, Hilde; Loge, Jon Håvard; Grotmol, Kjersti S.; Kaasa, Stein; Kiserud, Cecilie E. & Salvesen, Øyvind [Show all 7 contributors for this article] (2020). Symptoms in the general Norwegian adult population - prevalence and associated factors. BMC Public Health. ISSN 1471-2458. 20. doi: 10.1186/s12889-020-09109-2. Full text in Research Archive
• Frydenberg, Hanne; Harsem, Nina Kittelsen; Ofigsbø, Åsa; heid, hanne skoglund; Brandengen, Morten & Kaasa, Stein [Show all 7 contributors for this article] (2020). Chemotherapy During Pregnancy for Advanced Colon Cancer: A Case Report. Clinical colorectal cancer. ISSN 1533-0028. 19(2), p. 141–144. doi: 10.1016/j.clcc.2020.02.013. Full text in Research Archive
• Brenne, Anne-Tove; Knudsen, Anne Kari; Raj, Sunil Xavier; Skjelvan, Laila Strand; Lund, Jo-Åsmund & Thronæs, Morten [Show all 10 contributors for this article] (2020). Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model. Pain and Therapy. ISSN 2193-8237. 9, p. 297–318. doi: 10.1007/s40122-020-00163-7. Full text in Research Archive Show summary

  Introduction Early access to cancer palliative care is recommended. Descriptions of structures and processes of outpatient palliative care clinics operated within smaller hospitals are scarce. This paper presents the development and operation of a fully integrated cancer and palliative care outpatient clinic at a local hospital in a rural region of Mid-Norway offering palliative care concurrent with cancer treatment. A standardized care pathway was applied. Methods Palliative care is in Norway part of the public healthcare system. Official recommendations recent years point out action points to improve delivery of palliative care. An integrated cancer and palliative care outpatient clinic at a local hospital and an innovative care delivery model was developed and operated in this setting. Patients were recruited for a descriptive study of the patient population. Clinical data were collected by clinical staff and 13 symptom intensities were reported by the patients. Results Cancer and palliative care were provided by one team of healthcare professionals trained in both fields. There was a close collaboration with the other departments at the hospital, with its affiliated tertiary hospital, and with community health and care services to provide timely referral, enhanced continuity, and improved coordination of care. Eighty-eight patients were included. Mean age was 65.6 years, the most common cancer diagnoses were digestive organs (22.7%), male genital organs (20.5%) or breast (25.0%), 75.0% had metastatic or locally advanced cancer, 59.1% were treated with non-curative intention and 93.1% had Karnofsky Performance Status ≥ 80%. Median scores of individual symptoms ranged from 0 to 3 (numerical rating scale, 0–10) and 61.0% reported at least one clinically significant symptom rating (≥ 4). Conclusion This delivery model of integrated outpatient cancer and palliative care is particularly relevant in rural regions allowing cancer patients access to palliative care earlier in the disease trajectory and closer to home.

• Boland, Jason W.; Allgar, Victoria; Boland, Elaine G.; Bennett, Mike I; Kaasa, Stein & Hjermstad, Marianne Jensen [Show all 7 contributors for this article] (2019). The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study. European Journal of Clinical Pharmacology. ISSN 0031-6970. doi: 10.1007/s00228-019-02801-2. Full text in Research Archive
• Stene, Guro Birgitte; Balstad, Trude Rakel; Leer, Anne Silja Mäkitalo; Bye, Asta; Kaasa, Stein & Fallon, Marie T. [Show all 9 contributors for this article] (2019). Deterioration in muscle mass and physical function differs according to weight loss history in cancer cachexia. Cancers. ISSN 2072-6694. 11(12), p. 1–14. doi: 10.3390/cancers11121925. Full text in Research Archive Show summary

  Background: Muscle mass and physical function (PF) are common co-primary endpoints in cancer cachexia trials, but there is a lack of data on how these outcomes interact over time. The aim of this secondary analysis of data from a trial investigating multimodal intervention for cancer cachexia (ClinicalTrials.gov: NCT01419145) is to explore whether changes in muscle mass and PF are associated with weight loss and cachexia status at baseline. Methods: Secondary analysis was conducted using data from a phase II randomized controlled trial including 46 patients with stage III–IV non-small cell lung cancer (n = 26) or inoperable pancreatic cancer (n = 20) due to commence chemotherapy. Cachexia status at baseline was classified according to international consensus. Muscle mass (assessed using computed tomography (CT)) and PF outcomes, i.e., Karnofsky performance status (KPS), self-reported PF (self-PF), handgrip strength (HGS), 6-minute walk test (6MWT), and physical activity (PA), were measured at baseline and after six weeks. Results: When compared according to cachexia status at baseline, patients with no/pre-cachexia had a mean loss of muscle mass (−5.3 cm2, p = 0.020) but no statistically significant change in PF outcomes. Patients with cachexia also lost muscle mass but to a lesser extent (−2.8 cm2, p = 0.146), but demonstrated a statistically significant decline in PF; KPS (−3.8 points, p = 0.030), self-PF (−8.8 points, p = 0.027), and HGS (−2.7 kg, p = 0.026). Conclusions: Weight loss history and cachexia status at baseline are of importance if one aims to detect changes in PF outcomes in cancer cachexia trials. To improve the use of co-primary endpoints that include PF in future trials, outcomes that have the potential to detect change relative to weight loss should be investigated further.

• Verkissen, Mariëtte N.; Hjermstad, Marianne Jensen; van Belle, Simon; Kaasa, Stein; Deliens, Luc & Pardon, Koen (2019). Quality of life and symptom intensity over time in people with cancer receiving palliative care: Results from the international European Palliative Care Cancer Symptom study. PLOS ONE. ISSN 1932-6203. 14:e022988(10), p. 1–16. doi: 10.1371/journal.pone.0222988. Full text in Research Archive
• Jakobsen, Gunnhild; Engstrøm, Morten; Thronæs, Morten; Løhre, Erik Torbjørn; Kaasa, Stein & Fayers, Peter [Show all 8 contributors for this article] (2019). Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy. Supportive Care in Cancer. ISSN 0941-4355. p. 1–9. doi: 10.1007/s00520-019-04998-5. Full text in Research Archive
• Tøndel, Hanne; Solberg, Arne; Lydersen, Stian; Jensen, Christer André; Kaasa, Stein & Lund, Jo-Åsmund (2019). Rectal volume variations and estimated rectal dose during 8 weeks of image-guided radical 3D conformal external beam radiotherapy for prostate cancer. Clinical and Translational Radiation Oncology. ISSN 2405-6308. 15, p. 113–117. doi: 10.1016/j.ctro.2019.02.003. Full text in Research Archive
• Landmark, Tormod; Romundstad, Pål Richard; Butler, Stephen; Kaasa, Stein & Borchgrevink, Petter Chr. (2019). Development and course of chronic widespread pain: the role of time and pain characteristics (the HUNT pain study) . Pain. ISSN 0304-3959. 160(9), p. 1976–1981. doi: 10.1097/j.pain.0000000000001585. Full text in Research Archive
• 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.

• Vagnildhaug, Ola Magne; Brunelli, Cinzia; Hjermstad, Marianne Jensen; Strasser, Florian; Baracos, Vickie & Wilcock, Andrew [Show all 10 contributors for this article] (2019). A prospective study examining cachexia predictors in patients with incurable cancer. BMC Palliative Care. ISSN 1472-684X. 18:46, p. 1–10. doi: 10.1186/s12904-019-0429-2. Full text in Research Archive Show summary

  Background Early intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors. Methods A secondary analysis of a prospective, observational, multicentre study was conducted. Patients, who attended a palliative care programme, had incurable cancer and did not have cachexia at baseline, were amenable to the analysis. Cachexia was defined as weight loss (WL) > 5% (6 months) or WL > 2% and body mass index< 20 kg/m2. Clinical and demographic markers were evaluated as possible predictors with Cox analysis. A classification and regression tree analysis was used to create a model based on optimal combinations and cut-offs of significant predictors for cachexia development, and accuracy was evaluated with a calibration plot, Harrell’s c-statistic and receiver operating characteristic curve analysis. Results Six-hundred-twenty-eight patients were included in the analysis. Median age was 65 years (IQR 17), 359(57%) were female and median Karnofsky performance status was 70(IQR 10). Median follow-up was 109 days (IQR 108), and 159 (25%) patients developed cachexia. Initial WL, cancer type, appetite and chronic obstructive pulmonary disease were significant predictors (p ≤ 0.04). A five-level model was created with each level carrying an increasing risk of cachexia development. For Risk-level 1-patients (WL < 3%, breast or hematologic cancer and no or little appetite loss), median time to cachexia development was not reached, while Risk-level 5-patients (WL 3–5%) had a median time to cachexia development of 51 days. Accuracy of cachexia predictions at 3 months was 76%. Conclusion Important predictors of cachexia have been identified and used to construct a predictive model of cancer cachexia.

• Ricchini, Francesca; Caraceni, Augusto Tomasso Giovanni; Zecca, Ernesto; Pigni, Alessandra; Centurioni, Fabio & Manzoni, Andrea [Show all 8 contributors for this article] (2019). Effect of opioid exposure on efficacy and tolerability of sublingual fentanyl and subcutaneous morphine for severe cancer pain episodes. Secondary analysis from a double-blind double-dummy, randomized trial. Journal of Pain and Symptom Management. ISSN 0885-3924. p. 1–9. doi: 10.1016/j.jpainsymman.2019.06.016.
• Thronæs, Morten; Balstad, Trude Rakel; Brunelli, Cinzia; Løhre, Erik Torbjørn; Klepstad, Pål & Vagnildhaug, Ola Magne [Show all 9 contributors for this article] (2019). Pain management index (PMI)-does it reflect cancer patients' wish for focus on pain? Supportive Care in Cancer. ISSN 0941-4355. p. 1–10. doi: 10.1007/s00520-019-04981-0. Full text in Research Archive Show summary

  Background The pain management index (PMI) was developed to combine information about the prescribed analgesics and the self-reported pain intensity in order to assess physicians’ response to patients’ pain. However, PMI has been used to explore undertreatment of cancer pain. The present study explores prevalence of negative PMI and its associations to clinical variables, including the patient-perceived wish for more attention to pain. Methods A single-center, cross-sectional, observational study of cancer patients was conducted. Data on demographics and clinical variables, as well as patient-perceived wish for more attention to pain, were registered. PMI was calculated. Negative PMI indicates that the analgesics prescribed might not be appropriate to the pain intensity reported by the patient, and associations to negative PMI were explored by logistic regression models. Results One hundred eighty-seven patients were included, 53% had a negative PMI score. Negative PMI scores were more frequent among patients with breast cancer (OR 4.2, 95% CI 1.3, 13.5), in a follow-up setting (OR 12.1, 95% CI 1.4, 101.4), and were inversely associated to low performance status (OR 0.14, 95% CI 0.03, 0.65). Twenty-two percent of patients with negative PMI scores reported that they wanted more focus on pain management, versus 13% among patients with a non-negative PMI score; the difference was not statistically significant. Conclusion A high prevalence of negative PMI was observed, but only 1/5 of patients with a negative PMI wanted more attention to pain by their physician. Our findings challenge the use of PMI as a measure of undertreatment of cancer pain.

• Bye, Asta; Meli, Kari; Solheim, Tora Skeidsvoll; Laird, Barry J; Kaasa, Stein & Stene, Guro Birgitte [Show all 7 contributors for this article] (2019). Food intake by Patient-Generated Subjective Global Assessment (PG-SGA) corresponds to energy and protein intake as well as weight change in patients with advanced cancer. Clinical Nutrition Experimental. ISSN 2352-9393. 25, p. 20–28. doi: 10.1016/j.yclnex.2019.03.003. Full text in Research Archive
• Røen, Ingebrigt; Stifoss-Hanssen, Hans; Grande, Gunn; Kaasa, Stein; Sand, Kari & Knudsen, Anne Kari (2019). Supporting carers: health care professionals in need of system improvements and education - a qualitative study. BMC Palliative Care. ISSN 1472-684X. 18(1), p. 58–68. doi: 10.1186/s12904-019-0444-3. Full text in Research Archive Show summary

  Abstract Background: Health care professionals should prevent and relieve suffering in carers of patients with advanced cancer. Despite known positive effects of systematic carer support, carers still do not receive sufficient support. Carers have reported to be less satisfied with coordination of care and involvement of the family in treatment and care decisions than patients. In a rural district of Mid-Norway, cancer palliative care services across specialist and community care were developed. Participants’ experiences and opinions were investigated as part of this development process. Methods: The aim of this qualitative study was to explore and describe health care professionals’ experiences with carer support from their own perspective. Data were collected in focus groups. Purposeful sampling guided the inclusion. Six groups were formed with 21 professionals. The discussions were audio-recorded, transcribed, and analyzed using systematic text condensation. Results: In the analyzis of the focus group discussions, ten categories emerged from the exploration of health care professionals’ carer support, assessment of needs, and factors hampering carer support: 1) dependent on profession, role, and context, 2) personal relationship, 3) personal skills and competence, 4) adjusted to the stage of the disease, 5) informal assessment of carers’ needs, 6) lack of education 7) lack of systems for carer consultations, 8) lack of systems for documentation, 9) lack of systems for involving GPs, and 10) lack of systematic spiritual care. Conclusions: Health care professionals built a personal relationship with the carers as early as possible, to facilitate carer support throughout the disease trajectory. Systematic carer support was hampered by lack of education and system insufficiencies. Organizational changes were needed, including 1) education in carer support, communication, and spiritual care, 2) use of standardized care pathways, including systematic carer needs assessment, 3) systematic involvement of general practitioners, and 4) a system for documentation of clinical work with carers. Keywords: Health care professionals, Oncology, Palliative care, Family carers, Carer support, Needs assessment, Integration

• Løhre, Erik Torbjørn; Thronæs, Morten; Brunelli, Cinzia; Kaasa, Stein & Klepstad, Pål (2019). An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Supportive Care in Cancer. ISSN 0941-4355. p. 1–12. doi: 10.1007/s00520-019-04836-8. Full text in Research Archive
• Treede, Rolf-Detlef; Rief, Winfried; Barke, Antonia; Aziz, Qasim; Bennett, Michael I. & Benoliel, Rafael [Show all 23 contributors for this article] (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. ISSN 0304-3959. 160(1), p. 19–27. doi: 10.1097/j.pain.0000000000001384.
• Scholz, Joachim; Finnerup, Nanna B.; Attal, Nadine; Aziz, Qasim; Baron, Ralf & Bennett, Michael I. [Show all 33 contributors for this article] (2019). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. ISSN 0304-3959. 160(1), p. 53–59. doi: 10.1097/j.pain.0000000000001365.
• Bennett, Michael I.; Kaasa, Stein; Barke, Antonia; Korwisi, Beatrice; Rief, Winfried & Treede, Rolf-Detlef (2019). The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain. ISSN 0304-3959. 160(1), p. 38–44. doi: 10.1097/j.pain.0000000000001363.
• Boland, Jason W.; Allgar, Victoria; Boland, Elaine G.; Kaasa, Stein; Hjermstad, Marianne Jensen & Johnson, Miriam J. (2019). Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study . Palliative Medicine. ISSN 0269-2163. 33(2), p. 206–2012. doi: 10.1177/0269216318811011. Full text in Research Archive
• Habberstad, Ragnhild H; Hjermstad, Marianne Jensen; Brunelli, Cinzia; Kaasa, Stein; Bennett, Michael I & Pardon, Koen [Show all 7 contributors for this article] (2019). Which factors can aid clinicians to identify a risk of pain during the following month in patients with bone metastases? A longitudinal analyses. Supportive Care in Cancer. ISSN 0941-4355. 27(4), p. 1335–1343. doi: 10.1007/s00520-018-4405-9. Full text in Research Archive

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• Cherny, Nathan I; Fallon, Marie; Kaasa, Stein & Portenoy, Russell K. (2021). Oxford Textbook of Palliative Medicine, 6th ed. Oxford University Press. ISBN 9780198821328. 1408 p.

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• Lillekroken, Daniela; Bye, Asta; Halvorsrud, Liv Torill; Yri, Olav Erich; Wester, Torunn Elin & Hjermstad, Marianne Jensen [Show all 9 contributors for this article] (2024). Living with brain metastases - A qualitative study about patient-and family members' coping strategies.
• 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.
• Henmo, Ola; Kaasa, Stein & Dajani, Olav (2023). Setter personen, ikke pasienten i sentrum. [Internet]. Kreftforeningen.
• Fallon, M.T.; Caraceni, Augusto Tomasso Giovanni; Laird, Barry J & Kaasa, Stein (2023). Reply to the Letter to the Editor “A simple way of doing the complex but utmost important things: cancer pain management” by S. Singhal, M. Verma and D. Kukreja. Annals of Oncology. ISSN 0923-7534. 34(5), p. 496–497. doi: 10.1016/j.annonc.2023.02.005.
• Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Gravli, Trine H.; Smeland, Sigbjørn & Kaasa, Stein (2023). Pasientsentrert kreftbehandling. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(1). doi: 10.4045/tidsskr.22.0668.
• 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.
• Urrizola, Amaia; Dajani, Olav; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Kaasa, Stein & Klepstad, Pål [Show all 9 contributors for this article] (2022). Nutrition Impact Symptoms in Oncology –Why should we address them?
• Lundeby, Tonje; Wester, Torunn Elin; Aass, Nina Kathrine; Hjermstad, Marianne Jensen; Yri, Olav Erich & Bye, Asta [Show all 7 contributors for this article] (2022). Living with brain metastases: A longitudinal qualitative study of patient experiences from time of diagnosis.
• Jakobsen, Gunnhild; Sjue, Karin; Paulsen, Ørnulf; Kaasa, Stein; Hjermstad, Marianne Jensen & Klepstad, Pål (2022). Medikamentell behandling av insomni hos kreftpasienter.
• Kristiansen, Hege; Kaasa, Stein & Sagabråten, Ståle Onsgård (2022). Reagerer på behandling av døende barn. Dagbladet. ISSN 0805-3766.
• Yri, Olav Erich; Aass, Nina Kathrine & Kaasa, Stein (2022). Helhjernebestråling bør begrenses. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 142(17). doi: 10.4045/tidsskr.22.0696.
• Raanes, Ida Ervik; Balstad, Trude Rakel; Martinez, Amaia; Rosendahl-Riis, Hanne; Dajani, Olav & Solheim, Tora S [Show all 12 contributors for this article] (2022). The role of inflammation in development of malnutrition in advanced cancer.
• Lundereng, Elias David; Hjermstad, Marianne Jensen; Aass, Nina Kathrine; Lundeby, Tonje; Fallon, Marie & Velikova, Galina [Show all 9 contributors for this article] (2022). Developing Innovative Digital Patient Centered Care Pathways for Cancer Patients using Agile Design: A pre pilot study.
• 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.
• Diernberger, Katharina; Shinkins, Bethany; Hall, Peter; Kaasa, Stein & Fallon, Marie T. (2021). Incompatible: End-of-life care and health economics. BMJ Supportive & Palliative Care. ISSN 2045-435X. 11(3), p. 296–298. doi: 10.1136/bmjspcare-2020-002388.
• 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 .
• Krause, Rene; Nyakabau, Anna; Gwyther, Liz Gwyther; Luyirika, Emmanuel & Kaasa, Stein (2020). Calling for advocacy, education and public policy actions on pain control for patients with cancer in Africa. ESMO Open. ISSN 2059-7029. 5(4), p. 1–2. doi: 10.1136/esmoopen-2020-000757.
• Kaasa, Stein; Bahus, Marianne; Andersen, Sigve; Broen, Peder; Farsund, Helge & Flovik, Anne Marie [Show all 10 contributors for this article] (2020). De er døende. Gi dem lindring. Dagbladet. ISSN 0805-3766.
• Bahus, Marianne; Andersen, Sigve; Broen, Peder; Farsund, Helge; Flovik, Anne Marie & Hagerup, Søren Vincent [Show all 10 contributors for this article] (2020). Organisering av det palliative tilbudet Faglig begrunnet eller et udemokratisk politisk spill? Fædrelandsvennen. ISSN 0805-3790.
• 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
• Habberstad, Ragnhild H; Frøseth, Trude Camilla Salvesen; Aass, Nina Kathrine; Bjerkeset, Ellen; Abramova, Tatiana Mikhailovna & Garcia-Alonso, Elena [Show all 13 contributors for this article] (2019). Clinical predictors for analgesic response to radiotherapy in patients with painful bone metastases. Annals of Oncology. ISSN 0923-7534. 30, p. v662–v662. doi: 10.1093/annonc/mdz261.003.
• Fredheim, Olav Magnus; Kaasa, Stein & Borchgrevink, Petter Chr. (2019). Smertebehandling ved kronisk kreftsykdom. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 139(13). doi: 10.4045/tidsskr.19.0226.
• Bye, Asta; Meli, Kari; Solheim, Tora Skeidsvoll; Laird, Barry J.; Kaasa, Stein & Stene, Guro Birgitte [Show all 7 contributors for this article] (2018). Food intake assessed by Patient-Generated Subjective Global Assessment (PG-SGA) corresponds to energy and protein intake in patients with advanced cancer .
• Lau, Ka Po; Knudsen, Anne Kari; Brunelli, Cinzia; Kaasa, Stein & Brenne, Anne-Tove (2018). Preferred Place of Death and its Associated Factors among Patients with Advanced cancer in Norway. Palliative Medicine. ISSN 0269-2163. 32(1_suppl), p. 167–167.
• Røen, Ingebrigt; Brunelli, Cinzia; Stifoss-Hanssen, Hans; Grande, Gunn; Kaasa, Stein & Brenne, Anne-Tove [Show all 7 contributors for this article] (2018). Spiritual wellbeing in Family carers of Advanced cancer patients.
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein & Loge, Jon Håvard [Show all 9 contributors for this article] (2018). Usability testing of EirV3 - a computer-based tool for patient reported outcome measures in cancer. Annals of Oncology. ISSN 0923-7534. 29, p. viii625–viii625. doi: 10.1093/annonc/mdy300.068.
• Krogstad, Hilde; Sundt-Hansen, Stine Marie; Hjermstad, Marianne Jensen; Hågensen, Liv Ågot; Kaasa, Stein & Loge, Jon Håvard [Show all 9 contributors for this article] (2018). Usability testing of EirV3 - a computer-based tool for patient reported outcome measures in cancer.
• Jakobsen, Gunnhild; Engstrøm, Morten; Hjermstad, Marianne Jensen; Løhre, Erik Torbjørn; Fayers, Peter & Thronæs, Morten [Show all 8 contributors for this article] (2018). Sleep Quality in advanced cancer.

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