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Normative health-related quality of life (HRQoL) data from the general population are regularly used to facilitate the interpretation of HRQoL as reported by cancer patients participating in cancer clinical trials, especially when conducting long-term follow-up studies after treatment. The aim of the present study is to compare two Swedish normative data sets, published in 2000 and 2019 respectively, and explore whether HRQoL as reported by the Swedish general population has changed over time. 'Sample 2000' was comprised of normative data from the Swedish general population who responded to the EORTC QLQ-C30 in a Swedish mail survey in 1999 (n = 3069). 'Sample 2019' consisted of data from the Swedish general population collected as part of a European norm data study using online panels, published in 2019 (n = 1027). Data were analyzed stratified by sex and age (40–49; 50–59; 60–69; 70–79 years). For most of the subscales and single items, no age group differences between the two samples were found, with the exception of the oldest age group (70–79 years), where Sample 2019 generally showed better HRQoL as compared to Sample 2000. Lower (worse) levels of Global quality of life and higher (worse) levels of Dyspnoea were found in Sample 2019 for most age groups. There were no differences found between the samples for most EORTC QLQ-C30 subscales and single items, with the exception of the oldest age group of both sexes in Sample 2019 who reported better HRQoL on many variables. When deciding which normative dataset to use, the mode of data collection and age group have to be considered. [ABSTRACT FROM AUTHOR]

The article presents a college thesis which investigated the determinants of the outcomes of lumbar spinal stenosis surgery and is based on several papers previously published by F. G. Sigmundsson, B. Jönsson and B.Strömqvist, including papers which appeared in a 2013 issue of "Acta Orthopaedica", a 2012 issue of "Acta Orthopaedica" and a 2014 issue of "Spine".

Background and purpose — The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods — From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results — We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p < 0.05). We found a higher rate of early revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p < 0.001). Interpretation — Reverse hybrid THAs had a slightly higher rate of revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs. [ABSTRACT FROM PUBLISHER]

Purpose. To study if partnership modifies the effect of gastrointestinal symptoms on quality of life after radiation therapy for prostate cancer. Material and methods. Using a study-specific questionnaire we conducted a cross-sectional follow-up of the occurrence gastrointestinal symptoms and quality of life after radiation therapy for prostate cancer. We obtained information from 874 prostate cancer survivors treated with radiation therapy at the Sahlgrenska University Hospital, Sweden between 1994 and 2006. In this paper we describe how partnership status affects the association between gastrointestinal symptoms and quality of life. Results. We found that unpartnered men with gastrointestinal symptoms reported a lower quality of life than unpartnered men without such symptoms. Unpartnered men with symptoms had an excess risk of low quality of life compared with unpartnered men without symptoms for those experiencing altered composition of stools, prevalence ratio 3.8 (95% CI 1.1-13.1), leakage, 3.6 (1.3-10.1), sensory bowel symptoms, 4.5 (1.6-12.8), and for urgency, 4.2 (1.2-15.1). We also found that unpartnered men with symptoms had an excess risk of low quality of life compared with partnered men with symptoms for those experiencing altered composition of stools, prevalence ratio 2.9 (95% CI 1.4-5.8), leakage 2.8 (1.2-6.4), sensory bowel symptoms 3.4 (1.5-7.4), urgency 2.6 (1.2-5.8), and for any gastrointestinal symptom 2.5 (1.3-4.9). Conclusion. Unpartnered men may represent a group that is specifically vulnerable to the distressful effects of gastrointestinal symptoms after radiation therapy for prostate cancer. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted as part of a higher educational thesis and investigated the epidemiology, radiology and histology of atypical femoral fractures which were linked to the use of drugs called bisphosphonates. In the article the author offers his opinions on the use of bisphosphonates and on the need for additional research on the treatment of atypical femoral fractures.

Background and purpose Modular cementless revision prostheses are being used with increasing frequency. In this paper, we review risk factors for the outcome of the Link MP stem and report implant survival compared to conventional cemented long-stem hip revision arthroplasties. Patients and methods We used data recorded in the Swedish Hip Arthroplasty Register. 812 consecutive revisions with the MP stem (mean follow-up time 3.4 years) and a control group with 1,073 cemented long stems (mean follow-up time 4.2 years) were included. Kaplan-Meier analysis was used to determine implant survival. The Cox regression model was used to study risk factors for reoperation and revision. Results The mean age at revision surgery for the MP stem was 72 (SD 11) years. Decreasing age (HR == 1.1, 95% CI: 1--1.1), multiple previous revisions (HR == 2.6, 95% CI: 1.1--6.2), short stem length (HR == 2.4, 95% CI: 1.1--5.2), standard neck offset (HR == 5, 95% CI: 1.5--17) and short head-neck length (HR == 5.3, 95% CI 1.4--21) were risk factors for reoperation. There was an overall increased risk of reoperation (HR == 1.7, 95% CI: 1.3--2.4) and revision (HR == 1.9, 95% CI: 1.2--3.1) for the MP prostheses compared to the controls. Interpretation The cumulative survival with both reoperation and revision as the endpoint was better for the cemented stems with up to 3 years of follow-up. Thereafter, the survival curves converged, mainly because of increasing incidence of revision due to loosening in the cemented group. We recommend the use of cemented long stems in patients with limited bone loss and in older patients. [ABSTRACT FROM AUTHOR]

Background: A diagnostic work-up leading to a lung cancer diagnosis is a severely stressful experience that may impact tumor progression. Yet, prospective data are scarce on psychological and biological components of stress at the time of lung cancer diagnosis. The aim of this study was to assess pre-to-post diagnosis change in psychological distress and urinary excretion of catecholamines in patients with suspected lung cancer. Methods: Participants were 167 patients within the LUCASS study, recruited at referral for suspected lung cancer to University Hospitals in Iceland and Sweden. Patients completed questionnaires on perceived distress (Hospital Anxiety and Depression Scale, HADS) before and after diagnosis of lung cancer or a non-malignant origin. A subpopulation of 85 patients also provided overnight urine for catecholamine analysis before and at a median of 24 days after diagnosis but before treatment. Results: A lung cancer diagnosis was confirmed in 123 (73.7%) patients, with a mean age of 70.1 years. Patients diagnosed with lung cancer experienced a post-diagnosis increase in psychological distress (p=0.010), while patients with non-malignant lung pathology showed a reduction in distress (p=0.070). Both urinary epinephrine (p=0.001) and norepinephrine (p=0.032) levels were higher before the diagnosis among patients eventually diagnosed with lung cancer compared to those with non-malignant lung pathology. We observed indications of associations between pre-to-post diagnosis changes in perceived distress and changes in urinary catecholamine levels. Conclusion: Receiving a lung cancer diagnosis is associated with an increase in psychological distress, while elevated catecholamine levels are evident already before lung cancer diagnosis. Abbreviations: HADS: Hospital Anxiety and Depression scale; HADS-A: Hospital Anxiety and Depression scale - anxiety score; HADS-D: Hospital Anxiety and Depression scale - depression score; HADS-T: Hospital Anxiety and Depression scale - total score; IQR: Interquartile range; LUCASS study: Lung Cancer, Stress and Survival study; NSCLC: Non-small cell lung cancer; PTSD: Post Traumatic Stress Disorder; SCLC: Small-cell lung cancer; SD: Standard Deviation; SNS: the Sympathetic Nervous System. [ABSTRACT FROM AUTHOR]

Introduction: Professional visual artists constitute a heterogeneous vocational group, including, but not limited to painters, photographers, textile artists, and sculptors who may face exposure to workplace hazardous substances and lifestyle factors that may contribute to the development of selected cancers. The objective of this registry-based cohort study was to assess the cancer incidence among Nordic visual artists. Materials and methods: This study is based on data from the Nordic Occupational Cancer (NOCCA) project that combines census data of 15 million people from all Nordic countries and cancer registries from 1961 to 2005. For the present study we selected a cohort of visual artists from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates. Results: In male visual artists, there were statistically significant excesses in cancers of the tongue (SIR 2.91, 95% confidence interval 1.74-4.55), oral cavity (2.09, 1.26-3.27), pharynx (2.18, 1.45--3.15), testis (1.91, 1.11-3.05), renal pelvis (2.48, 1.42-4.03) and bladder (1.33, 1.14-1.55). The risk was significantly decreased for cancers of the lip (0.45, 0.18-0.93) and stomach (0.65, 0.50-0.84). In female visual artists, the only significantly increased risk was observed for breast cancer (1.29, 1.13-1.48) and the only significantly decreased risk for stomach cancer (0.43, 0.17-0.88). The incidence of lung cancer was close to the population average in both sexes. Conclusions: The non-elevated incidence of lung cancer suggests a similar prevalence of smoking between visual artists and the general population, while the elevated risk of cancers of mouth and pharynx among male visual artists is suggestive of more widespread alcohol drinking. The excess risk of urogenital cancers might be associated with exposure to solvents. NOVELTY & IMPACT The exposure of visual artists to carcinogens remains unstudied and equivocal. The current study suggests that visual artists carry an overall cancer risk that is slightly above the risk among the general population of the four Nordic countries. We observed in men over two-fold excess risks of cancers of the tongue, oral cavity, pharynx, and renal pelvis, and also a significant risk of testis and bladder cancers. [ABSTRACT FROM AUTHOR]

The article focuses on assessing severe pneumococcal disease risks in splenectomized Hodgkin lymphoma patients from 1973 to 1995 in Sweden. Topics include the historical context of splenectomy, varying prophylactic measures in different countries, and the decreasing incidence of severe pneumococcal infections in more recent decades among splenectomized patients in Sweden.

We hypothesised that the use of the anti-androgenic drug 5α-reductase inhibitors (5-ARIs) improves survival in patients with oesophago-gastric cancer. This nationwide Swedish population-based cohort study included men who underwent surgery for oesophageal or gastric cancer between 2006-2015, with follow-up until the end of 2020. Multivariable Cox regression estimated hazard ratios (HR) for associations between 5-ARIs use and 5-year all-cause mortality (main outcome) and 5-year disease-specific mortality (secondary outcome). The HR was adjusted for age, comorbidity, education, calendar year, neoadjuvant chemo(radio)therapy, tumour stage, and resection margin status. Among 1769 patients with oesophago-gastric cancer, 64 (3.6%) were users of 5-ARIs. Compared to non-users, users of 5-ARIs were not at any decreased risk of 5-year all-cause mortality (adjusted HR 1.13, 95% CI 0.79-1.63) or 5-year disease-specific mortality (adjusted HR 1.10, 95% CI 0.79-1.52). Use of 5-ARIs was not associated with any decreased risk of 5-year all-cause mortality in subgroup analyses stratified by categories of age, comorbidity, tumour stage, or tumour subtype (oesophageal or cardia adenocarcinoma, non-cardia gastric adenocarcinoma, or oesophageal squamous cell carcinoma). This study did not support the hypothesis of improved survival among users of 5-ARIs after curatively intended treatment for oesophago-gastric cancer. [ABSTRACT FROM AUTHOR]

Background and purpose -- Scheuermann's disease is characterized by kyphosis and frequently mild back pain. As the level of kyphosis may progress over time, also the level of pain may increase. We evaluated the prevalence of Scheuermann's disease, and their pain, in Swedish elderly men. Patients and methods -- The Osteoporotic Fractures in Men (MrOS) Study Sweden (n = 3,014) is a population-based prospective observational study of community-living men aged 69-81 years. At baseline, participants answered a questionnaire including history of neck/back pain during the preceding year and characteristics of any pain (severity, sciatica, and neurological deficits). Lateral thoracic/lumbar spine radiographs were taken of 1,453 men. We included the 1,417 men with readable radiographs. Scheuermann's disease was defined as 3 or more consecutive vertebrae with > 5° wedging with no other explanation for the deformity. Results -- 92 of the 1,417 men (6.5%, 95% confidence interval 5.3-7.9) had Scheuermann's disease. 31% of men with and 31% without Scheuermann's disease reported neck pain (P = 0.90) and 51% with and 55% without the disease reported back pain (P = 0.4). Among men with Scheuermann's disease and back pain, none reported severe pain, 57% moderate, and 43% mild, compared with 7%, 50%, and 44% in those without Scheuermann's disease (P = 0.2). In those with Scheuermann's disease 63% reported no sciatica, 15% sciatica without neurological deficits, and 22% sciatica with neurological deficits, compared with 56%, 16%, and 28% in those without the disease (P = 0.6). Conclusion -- The prevalence of Scheuermann's disease in elderly Swedish men is between 5.3% and 7.9%. The condition seems at this age not to be associated with neck or back pain. [ABSTRACT FROM AUTHOR]

The article focuses on Plasma TKa levels that were determined using the DiviTum TKa assay in accordance with the manufacturer instructions, which has previously been reported. Topics include examines DiviTum TKa is a refined ELISA based assay reflecting cell proliferation rate by measuring TKa in serum, plasma or cells.

The net effect of menopausal hormone therapy on the risk of death is understudied, and current evidence is conflicting. Our aim was to investigate the association between menopausal hormones and risk of all-cause, cardiovascular, and cancer-specific mortality, based on the Swedish Prescribed Drug Registry and National Patient Registry. This Swedish population-based matched cohort study included all women, 40 years or older, who had received at least one prescription of systemic menopausal hormone therapy between 2005–2014 (n = 290,186), group level matched 1:3 to non-users (n = 870,165). Multivariable conditional logistic regression models estimated the relative risk of all-cause and cause-specific mortality, adjusting for several clinical factors and comorbidities. Ever-use of menopausal hormones was associated with a slightly lower overall odds of all-cause (OR = 0.97, 95%CI 0.95–0.98) and cardiovascular (OR = 0.97, 95%CI 0.95–0.99) mortality, whilst 30% lower overall odds of cancer-related mortality (OR = 0.70, 95%CI 0.68–0.72) was shown. The odds of all-cause and cancer-related mortality were consistently reduced among women who began menopausal hormone therapy ≤60 years, whereas the association with cardiovascular mortality was inconsistent. In contrast, oestrogen-only therapy was associated with elevated odds of all-cause (OR = 1.14, 95%CI 1.11–1.16) and cardiovascular mortality (OR = 1.04, 95%CI 1.01–1.06) among women who began treatment at ≥70 years. Among current users, oestrogen-only therapy was associated with higher odds of all-cause (OR = 1.48, 95%CI 1.44–1.52) and cardiovascular mortality (OR = 1.24, 95%CI 1.20–1.28), whereas past use of oestrogen-only therapy suggested lower odds of mortality. Our generalisable data suggest that early menopausal hormone treatment initiation does not increase the odds of mortality. However, the role of oestrogens in particularly cardiovascular mortality remains to be investigated. [ABSTRACT FROM AUTHOR]

Background and purpose — Few studies have reported the mortality rate after skeletal fractures involving different locations, within the same population. We analyzed the 30-day and 1-year mortality rates following different fractures. Patients and methods — We included 295,713 fractures encountered in patients 16–108 years of age, registered in the Swedish Fracture Register (SFR) from 2012 to 2018. Mortality rates were obtained by linkage of the SFR to the Swedish Tax Agency population register. The standardized mortality ratios (SMR) at 30 days and 1 year were calculated for fractures in any location and for each of 27 fracture locations, using age- and sex-life tables from Statistics Sweden (). Results — The overall SMR at 30 days was 6.8 (95% CI 6.7–7.0) and at 1 year 2.2 (CI 2.2–2.2). The SMR was > 2 for 19/27 and 13/27 of the fracture locations at 30 days and 1 year, respectively. Humerus, femur, and tibial diaphysis fractures were all associated with high SMR, at both 30 days and 1 year. Interpretation — Patients sustaining a fracture had approximately a 7-fold increased mortality at 30 days and over 2-fold increased mortality at 1 year as compared with what would be expected in the general population. High mortality rates were seen for patients with axial skeletal and proximal extremity fractures, indicating frailty in these patient groups. [ABSTRACT FROM AUTHOR]

There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97–1.07) in men and 1.04 (0.94–1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73–6.60), esophageal cancer (2.08, 1.51–2.81), liver cancer (1.81, 1.26–2.52), and skin melanoma (1.40, 1.10–1.75). The risk was decreased in lip cancer (0.13, 0.02–0.48), stomach cancer (0.66, 0.50–0.82), and lung cancer (0.77, 0.65–0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04–2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied. [ABSTRACT FROM AUTHOR]

Men with prostate cancer (PCa) on gonadotropin-releasing hormone agonists (GnRH) have an increased risk of cardiovascular disease (CVD) compared to men with PCa not on GnRH as well as compared with PCa-free men. Whether the addition of androgen receptor targeted (ART) drugs to GnRH further increases CVD risk, remains to be fully elucidated. We investigated risk of CVD for men with castration resistant PCa (CRPC) on GnRH plus ART; abiraterone or enzalutamide vs 5,127 and 12,079 respective matched comparator men on GnRH in Prostate Cancer data Base Sweden (PCBaSeTraject) 4.1 between 1 June 2015 and 31 December 2018. PCBaSeTraject links National Prostate Cancer Register of Sweden to other healthcare registries and demographic databases. We conducted multivariable Cox proportional hazard models adjusting for PCa risk category, Charlson comorbidity index (CCI), insulin or statin use, civil status, level of education, history of CVD events and number of CVD drugs, with any incident or fatal CVD as the outcome. 1,310 men were treated with abiraterone and 3,579 with enzalutamide. In multivariable analysis, CVD risk was increased in men on abiraterone (hazard ratio (HR): 1.19; 95% confidence interval (CI): 1.03–1.38) and in men on enzalutamide (HR: 1.10; 95% CI: 1.01–1.20). Men with a recent CVD (<12 months) including both men on ART as well as comparators had a much higher probability of a new CVD vs men with no prior CVD. CVD risk was mildly increased in men with PCa on GnRH plus abiraterone or enzalutamide vs comparator men on GnRH. Residual confounding and detection bias may at least partly explain this association. [ABSTRACT FROM AUTHOR]

The authors discuss a study on granulomatosis with polyangitis (GPA) and lymphoma, including possible risk factors for lymphoma and lymphoma subtypes treatment and survival. Topics include clinical data and analyses of lymphoma tissues, the use of the Swedish Patient Register and the International Classification of Disease coding system, and cyclophosphamide treatment for GPA and survival after lymphoma.

Background and purpose — The direct lateral approach (DLA) and the posterior approach (PA) are the most common surgical approaches in total hip replacement (THR) in Sweden. We investigated how the relationship between surgical approach and risk of reoperation due to dislocation has evolved over time. Patients and methods — Data were extracted from the Swedish Hip Arthroplasty Register from 1999 to 2014. We selected all THRs due to osteoarthritis with head sizes 28, 32, and 36 mm that were performed with either the DLA or the PA. Resurfacing prostheses were excluded. Kaplan–Meier curves for risk of reoperation due to dislocation and all-cause for the 2 surgical approaches were compared for 2 periods (1999–2006 and 2007–2014) up to 2 years postoperatively. We used Cox regression for sex, age, type of fixation, and head size to determine hazard ratios (HR) with DLA set as reference. Results — 156,979 THRs met the selection criteria. In 1999–2006, the PA was associated with increased risk of reoperation due to dislocation (HR 2.3, 95% CI 1.7–3.0) but there was no difference in the risk of all-cause reoperation (HR 1.1, CI 0.9–1.2). In 2007–2014 there was no statistically significant difference in the risk of reoperation due to dislocation (HR 1.2, CI 0.9–1.6) but the risk of all-cause reoperation was lower (HR 0.8, CI 0.7–0.9) for the PA. Interpretation — This study confirms historic reports on the increased risk of early reoperations due to dislocations using the PA compared with the DLA. However, in contemporary practice, the higher risk of reoperation due to dislocation associated with PA has declined, now being similar to that after DLA. We believe improved surgical technique for the PA may explain the results. Surprisingly, the PA was associated with lower risk of all-cause reoperation in 2007–2014. This finding warrants further investigation. [ABSTRACT FROM AUTHOR]

Background and purpose — Data from several joint replacement registries suggest that the rate of early revision surgery after primary total hip arthroplasty (THA) is increasing. The ASA class, now widely recorded in arthroplasty registries, may predict early revision. We investigated the influence of ASA class on the risk of revision and other reoperation within 3 months and within 5 years of primary THA. Patients and methods — We used data from the Geneva and Swedish Hip Arthroplasty Registries, on primary elective THAs performed in 1996–2016 and 2008–2016, respectively. 5,319 and 122,241 THAs were included, respectively. Outcomes were all-cause revision and other reoperations evaluated using Kaplan–Meier survival and Cox regression analyses. Results — Within 3 months after surgery, higher ASA class was associated with greater risk of revision and other reoperation. 3-month cumulative incidences of revision by ASA class I, II, and III–IV respectively, were 0.6%, 0.7%, and 2.3% in Geneva and 0.5%, 0.8%, and 1.6% in Sweden. 3-month cumulative incidences of other reoperation were 0.4%, 0.7%, and 0.9% in Geneva and 0.2%, 0.4%, and 0.7% in Sweden. Adjusted hazard ratios (ASA III–IV vs. I) for revision within 3 months were 2.7 (95% CI 1.2–5.9) in Geneva and 3.3 (CI 2.6–4.0) in Sweden. Interpretation — Assessment of ASA class of patients prior to THA will facilitate risk stratification. Targeted risk-reduction strategies may be appropriate during the very early postoperative period for patients identified as at higher risk. Systematically recording ASA class in arthroplasty registries will permit risk adjustment and facilitate comparison of revision rates internationally. [ABSTRACT FROM AUTHOR]

Background and purpose — It is unclear whether physiotherapy interventions or patient education before total hip replacement (THR) is beneficial for patients postoperatively. Utilizing the Swedish Hip Arthroplasty Register (SHAR), we retrospectively studied the influence of preoperative self-reported exposure to physiotherapy and/or patient education on patient-reported outcomes 1 year after THR. Patients and methods — Data covering all THRs performed in Sweden for osteoarthritis, between the years 2012 and 2015, was obtained from SHAR. There were 30,756 patients with complete data. Multiple linear regression modelling was performed with 1-year postoperative PROMs (hip pain on a visual analogue scale [VAS], with the quality of life measures EQ-5D index and EQ VAS, and surgery satisfaction VAS) as dependent variables. Self-reported physiotherapy and patient education (yes or no) were used as independent variables. Results — Physiotherapy was associated with slightly less pain VAS (–0.7, 95% CI –1.1 to –0.3), better EQ-5D index (0.01, CI 0.00–0.01), EQ VAS (0.8, CI 0.4–1.2), and better satisfaction VAS (–0.7, CI –1.2 to –0.2). Patient education was associated with slightly better EQ-5D index (0.01, CI 0.00–0.01) and EQ VAS (0.7, CI 0.2–1.1). Interpretation — Even though we found statistically significant differences in favor of physiotherapy and patient education, the magnitude of those were too small and inconsistent to conclude a truly positive influence. Further research is needed with more specific and demarcated physiotherapy interventions. [ABSTRACT FROM AUTHOR]

Background and purpose — Uncemented cups in total hip arthroplasty (THA) are often augmented with additional screws to enhance their primary stability. We investigated whether there is a difference in the risk for revision between cups with screw holes and cups without screw holes. Patients and methods — We analyzed the risk for cup revision of uncemented cups registered in the Swedish Hip Arthroplasty Register (SHAR) between 2000 and 2017 with respe ct to the presence of screw holes. Only patients with primary osteoarthritis (OA) were included. 22,725 cups, including 12,354 without screw holes and 10,371 with screw holes, were evaluated. Revision rates at 2 and 10 years after the primary operation were analyzed. Results — At a median follow-up time of 3.4 years (0–18), 459 cup revisions were reported. The main reasons for cup revision during the whole observation time were infection, 52% of all cup revisions, and dislocation, 26% of all cup revisions. The survival rate with cup revision due to aseptic loosening as endpoint was 99.9% (95% CI 99.8–99.9) at 2 years for both cups with and cups without screw holes, and the survival rates at 10 years were 99.5% (CI 99.3–99.7) and 99.1% (CI 98.6–99.5), respectively. Cups without screw holes showed a decreased risk of revision due to any reason at both 2 years (adjusted hazard ratio [HR] 0.6, CI 0.5–0.8) and 10 years (HR 0.7, CI 0.5–0.9). Interpretation — We found a very low revision rate for aseptic loosening with modern, uncemented cup designs. Cups with screw holes had an increased risk of revision due to any reason in patients with primary OA [ABSTRACT FROM AUTHOR]

Background: Occupational exposure has been identified as the most important risk factor for bladder cancer second to smoking. The objective of this study was to estimate the occupational variation in risk of bladder cancer that is not attributable to smoking. Material and methods: In the Nordic Occupational Cancer study (NOCCA), 111,458 cases of bladder cancer and 208,297 cases of lung cancer cases were observed among men in Denmark, Finland, Iceland, Norway and Sweden during 1961-2005. Relative smoking prevalence in an occupation was estimated based on standardized incidence ratio (SIR) for lung cancer in the given occupation. Crude and smoking-adjusted SIRs with 95% confidence intervals (CI) for bladder cancer were calculated for each occupation. Results: The smoking-adjusted SIR for most of the occupations was closer to 1.00 than the unadjusted SIR. The highest statistically significant smoking-adjusted SIRs were observed among chimney sweeps (SIR 1.29, 95% CI 1.05-1.56), waiters (1.22, 1.07-1.38) hairdressers (1.14, 1.02-1.26), cooks and stewards (1.12, 1.01-1.25), printers (1.11, 1.04-1.18) and seamen (1.09, 1.03-1.14). Conclusions: Smoking is a strong risk factor for bladder cancer but there may also be other factors in some specific occupations in addition to smoking. The occupational variation in risk of bladder cancer is small when adjusted for smoking, but risk increasing factors are indicated in some occupations. [ABSTRACT FROM AUTHOR]

Background and purpose — Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods — By using official inpatient and outpatient data from the county of Skåne in Sweden, 1999–2010, we ascertained distal forearm fractures in children aged ≤ 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results — During the period 1999–2010, the distal forearm fracture rate was 634 per 105 patient years (750 in boys and 512 in girls). This was 50% higher than in the 1950s with a different age-rate distribution (p < 0.001) that was most evident during puberty. Also, within the period 1999–2010, there were increasing fracture rates per 105 and year (boys +2.0% (95% CI: 1.5–2.6), girls +2.4% (95% CI: 1.7–3.1)). Interpretation — The distal forearm fracture rate in children is currently 50% higher than in the 1950s, and it still appears to be increasing. If this higher fracture risk follows the children into old age, numbers of fragility fractures may increase sharply—as an upturn in life expectancy has also been predicted. The origin of the increase remains unknown, but it may be associated with a more sedentary lifestyle or with changes in risk behavior. [ABSTRACT FROM PUBLISHER]

Background and purpose — Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age. Children and methods — All children born in Malmö, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN. Results — 229 of 586 children referred because of suspected NIH received early treatment (age ≤ 1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1–3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1–9.8) vs. 11.1 mm (95% CI: 10.9–11.3) at 1 year (p < 0.001). Interpretation — Early treatment with the von Rosen splint for NIH is safe regarding AVN. The ossification of the femoral head is slower in children with NIH than in untreated children with neonatally stable hips. [ABSTRACT FROM PUBLISHER]

Background and purpose — A shortened tibial stem could influence the early prosthetic fixation. We therefore compared the short stem to the standard-length stem using radiostereometric analysis (RSA) as primary outcome measure. Patients and methods — 60 patients were randomized to receive a cemented Triathlon total knee arthroplasty (TKA) with a tibial tray of either standard or short stem length. The patients were blinded regarding treatment allocation. The micromotion of the tibial component was measured by RSA postoperatively, at 3 months, and after 1 and 2 years; clinical outcome was measured with the American Knee Society score (AKSS) and the knee osteoarthritis and injury outcome score (KOOS). Results — The maximum total point motion (MTPM) for the standard stem was 0.36 (SD 0.16) mm at 3 months, 0.51 (SD 0.27) mm at 1 year, and 0.54 (SD 0.28) mm at 2 years. For the short stem, it was 0.42 (0.24) mm, 0.59 (0.43) mm, and 0.61 (0.39) mm. 4 short-stemmed components and 2 standard-stemmed components had more than 0.2 mm of migration between the first- and second-year follow-up, and were classified as continuously migrating. Interpretation — The short-stemmed cemented tibial prosthesis showed an early prosthetic migratory pattern similar to that of the standard-stemmed cemented Triathlon knee prosthesis. The number of continuously migrating tibial plates in each group is predictive of a lower revision rate than 5% at 10 years. [ABSTRACT FROM AUTHOR]

Background.The strong female predominance of biliary tract cancer (BTC) may be related to reproductive factors. We aimed to clarify whether parity or age at first birth influence the risk of BTC. Methods.This was a population-based, case-control study including Swedish female and male cases of cancer of the gallbladder (GBC), extra hepatic bile ducts (EHCC), or the ampulla of Vater (AVC) between 1960 and 2008. For each case, 10 age- and sex-matched controls were randomly selected. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounders. Results.In total, 1169 cases of GBC, 432 cases of EHCC and 295 cases of AVC were included. Multi- and nulliparous women and men had an increased risk of all tumor locations in the biliary tract compared to uniparous women and men, respectively. Whereas higher age at first birth was associated with a decreased risk of GBC in women, no such association was found in men. There were no clear differences in the risk of EHCC and AVC between women and men. Conclusion.Sex hormones may play a role in the etiology of GBC. The associations between reproductive factors and EHCC and AVC are similar in women and men, which do not support the sex hormone hypothesis. [ABSTRACT FROM AUTHOR]

Background.The leucine-rich repeats and immunoglobulin-like domains (LRIG) family of transmembrane proteins are involved in the regulation of cellular signal transduction. LRIG1 is an endogenous inhibitor of receptor tyrosine kinases (RTKs) and an emerging tumor suppressor. In the lung epithelium, the expression of LRIG1 is downregulated by tobacco smoking, and further downregulated in lung squamous cell carcinoma. Material and methods.The expression of LRIG proteins were analyzed in 347 cases of non-small cell lung cancer (NSCLC) by immunohistochemistry, andLRIG1mRNA expression was evaluated in 807 lung cancer samples in silico in the Oncomine database. Potential associations between the expression data and the clinical parameters, including patient survival, were investigated. Results.Expression of the LRIG1 protein was found to be an independent prognostic factor in NSCLC, whereas expression of LRIG2 or LRIG3 did not correlate with patient survival. The levels ofLRIG1mRNA also correlated with the survival of NSCLC patients. Conclusion.These findings demonstrate that LRIG1 is an independent prognostic factor in patients with NSCLC that could be important in future decision-making algorithms for adjuvant lung cancer treatment. [ABSTRACT FROM AUTHOR]

Background.Previous studies found an increased risk of cancer in hospitalized asthma patients, but it is not known whether patients from primary health care show a similar risk pattern. In addition, it is unclear whether the diagnosis of asthma can influence the prognosis of subsequent cancer. Methods.Asthma patients were identified from Swedish inpatient, outpatient, and primary health care registers, and were linked to the Swedish Cancer Registry to identify subsequent diagnoses of cancer. Standardized incidence ratios (SIRs) were used to examine the risk of cancer in asthma patients compared with subjects without asthma. In addition, we used Cox proportional hazards regression to estimate hazard ratios (HRs) for mortality in patients with both asthma and cancer. Results.A total of 10 649 cancers were diagnosed in patients with previous asthma, with a SIR of 1.19 (95% CI 1.17–1.21). A total of 15 cancer sites showed an increased incidence, whereas two cancer sites showed a decreased risk. Non-allergic asthma showed the highest risk of cancer (SIR = 1.25, 95% CI 1.18–1.32), followed by unspecified asthma (SIR = 1.22, 95% CI 1.19–1.25), status asthmaticus (SIR = 1.19, 95% CI 1.02–1.39), and allergic asthma (SIR = 1.14, 95% CI 1.06–1.22). The risk of cancer was similarly increased in asthma patients diagnosed in primary health care and those diagnosed in hospitals. Cancer patients with previous asthma had increased mortality, with a HR of 1.55 (95% CI 1.50–1.60). HRs ranged from 1.09 to 1.94 for different sites/types of cancer. Conclusions.Patients with asthma, irrespective of whether they were treated in primary health care or hospitals, had an increased risk of cancer. In addition, cancer patients with previous asthma had a worse prognosis compared with those without asthma, suggesting that these patients may require a multidisciplinary approach to manage the comorbidity. [ABSTRACT FROM AUTHOR]

Background. For Diffuse large B-cell lymphoma (DLBCL), the International Prognostic Index is the major tool for prognostication and considers an age above 60 years as a risk factor. However, there are several indications that increasing age is associated with more biological complexity, resulting in differences in DLBCL biology depending on age. Methods. We conducted a registry-based retrospective cohort study of all Swedish DLBCL patients diagnosed 2000-2013, to evaluate the importance of age at diagnosis for survival of DLBCL patients. Results. In total, 7166 patients were included for further analysis. Survival declined for every 10-year age group and every age group above the age of 39 had a statistically decreased survival compared to the reference group of 20-29 years. In an analysis of relative survival, and in a multifactorial model adjusted for stage, ECOG performance status, serum lactate dehydrogenase and involvement of extranodal sites, each age group above age 39 had a significantly higher risk ratio (p = 0.01) compared to the reference group. Conclusion. This is one of the largest population-based studies of DLBCL published to date. In this study, age persisted as a significant adverse risk factor for patients as young as 40 years, even after adjustment for other risk factors. [ABSTRACT FROM AUTHOR]

Background. We aimed to investigate cancer-bereaved youths' opinions and experiences of being told about a parent's imminent death from cancer and of barriers to this communication. Material and methods. This nationwide population-based survey included 622/851 (73%) youths (aged 18-26) who at age 13-16, 6-9 years earlier had lost a parent to cancer. Results. In total 595 of 610 (98%) of the participants stated that teenage children should be informed when the parent's death was imminent (i.e. a matter of hours or days, not weeks). 59% stated that they themselves had been told this, 37% by the parents, 7% by parents and healthcare professionals together and 8% by professionals only. Frequent reasons for why the teenager and parents did not talk about imminent death before loss were that one (n = 106) or both (n = 25) of the parents together with the teenage child had pretended that the illness was not that serious, or that none of the parents had been aware that death was imminent (n = 80). Up to a couple of hours before the loss, 43% of participants had not realized that death was imminent. Conclusion. In this population-based study virtually all youth who at ages 13-16 had lost a parent to cancer afterwards stated that teenagers should be told when loss is near, i.e. a matter of hours or days, not weeks. Many stated that they had not been given this information and few were informed by professionals, with implications for future improvements in end-of-life care of patients with teenage children. [ABSTRACT FROM AUTHOR]

Background. Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of B-cell lymphomas. Five clinical adverse risk factors are merged into the International Prognostic Index (IPI), which is the major tool for prognostication. In contrast to Hodgkin's lymphoma, gender is not considered as an adverse risk factor for DLBCL patients. As we clinically had observed a very good survival rate in young female patients we hypothesised that there was a gender difference in survival due to the hormonal status of the patient. Material and methods. We conducted a registry-based retrospective cohort study of all Swedish DLBCL patients diagnosed between 2000 and 2013, to evaluate the impact of gender for survival from DLBCL. Results. In total, 7166 patients were included for further analysis. No survival difference was found between the genders when the entire population was analysed. However, analysis of 880 young patients of pre-menopausal age (i.e. 52 years) revealed that women had a longer survival compared to men of the same age group (p = 0.007). This was not found for patients older than menopausal age. In a relative survival multifactorial model adjusted for stage, ECOG performance status, serum lactate dehydrogenase and two or more extranodal sites, male gender was found to be an adverse risk factor for patients younger than 52 years (RR 1.51, 95% CI 1.14-1.88), but not for older patients (RR 0.99, 95% CI 0.89-1.10). Conclusion. This is one of the largest population-based studies of DLBCL presented to date. Most interestingly, we found male gender to be a significant adverse risk factor compared to fertile women whereas we found no survival differences between genders in the older sub-population. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy. Methods. In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29-80. Results. Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41-2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors. Conclusion. The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms. [ABSTRACT FROM AUTHOR]

Background and purpose - Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The Swedish follow-up program for CP (CPUP) includes standardized monitoring of the hips. Migration percentage (MP) is a widely accepted measure of hip displacement. Coxa valga and valgus of the femoral head in relation to the femoral neck can be measured as the head-shaft angle (HSA). We assessed HSA as a risk factor for hip displacement in CP. Patients and methods - We analyzed radiographs of children within CPUP from selected regions of Sweden. Inclusion criteria were children with Gross Motor Function Classification System (GMFCS) levels III-V, MP of < 40% in both hips at the first radiograph, and a follow-up period of 5 years or until development of MP > 40% of either hip within 5 years. Risk ratio between children who differed in HSA by 1 degree was calculated and corrected for age, MP, and GMFCS level using multiple Poisson regression. Results - 145 children (73 boys) with a mean age of 3.5 (0.6-9.7) years at the initial radiograph were included. 51 children developed hip displacement whereas 94 children maintained a MP of < 40%. The risk ratio for hip displacement was 1.05 (p < 0.001; 95% CI 1.02-1.08). When comparing 2 children of the same age, GMFCS level, and MP, a 10-degree difference in HSA results in a 1.6-times higher risk of hip displacement in the child with the higher HSA. Interpretation - A high HSA appears to be a risk factor for hip displacement in children with CP. [ABSTRACT FROM AUTHOR]

Background. To provide further information about short-term effects on voice quality and health-related quality of life (HRQL) following radiotherapy for laryngeal cancer, comparing glottic and supraglottic tumours. Material and methods. Sixty-seven male patients who received radiotherapy for glottic and supraglottic tumours were included. Voice recordings were performed and patient reported outcome questionnaires filled in before radiotherapy and one-month post-completion. Acoustic and temporal measures were produced from the recordings and compared to an age-matched, vocally healthy control group (n = 23). Results. Deterioration of HRQL post-radiotherapy was noted for both the glottic and supraglottic cohort. Pre- radiotherapy the glottic cohort demonstrated acoustic and temporal measures that were statistically different from healthy controls, with improvements post-radiotherapy where several measures showed no statistically significant differences compared to healthy controls. The supraglottic cohort revealed voice measures comparable to the healthy controls but demonstrated statistically significant impairments in HRQL compared to the glottic cohort following radiotherapy. Conclusion. Patients with supraglottic tumours may experience more eating and swallowing related problems prior to radiotherapy compared to glottic tumours and demonstrate a more significant reduction in HRQL following treatment. However, in terms of voice measurements, subjective measures correlate poorly with objective acoustic parameters, thereby emphasising the importance of patient-reported outcomes as part of treatment evaluation. [ABSTRACT FROM AUTHOR]

Background and purpose -- Even small design modifications of uncemented hip stems may alter the postoperative 3-D migration pattern. The Furlong Active is an uncemented femoral stem which, in terms of design, is based on its precursor--the well-proven Furlong HAC--but has undergone several design changes. The collar has been removed on the Active stem along with the lateral fin; it is shorter and has more rounded edges in the proximal part. We compared the migration patterns of the uncemented Furlong HAC stem and the modified Furlong Active stem in a randomized, controlled trial over 5 years using radiostereometry (RSA). Patients and methods -- 50 patients with primary osteoarthritis were randomized to receive either the HAC stem or the Active stem. The patients underwent repeated RSA examinations (postoperatively, at 3 months, and after 1,2, and 5 years) and conventional radiography, and they also filled out hip-specific questionnaires. Results -- During the first 3 months, the collarless Active stem subsided to a greater extent than the collar-fitted HAC stem (0.99 mm vs. 0.31 mm, p = 0.05). There were, however, no other differences in movement measured by RSA or in clinical outcome between the 2 stems. After 3 months, both stem types had stabilized and almost no further migration was seen. Interpretation -- The Active stem showed no signs of unfavorable migration. Our results suggest that the osseointegration is not compromised by the new design features. [ABSTRACT FROM AUTHOR]

While the detrimental effects of cranial radiotherapy on the developing brain are well known, the effects on cognitive performance of low doses of ionizing radiation is less studied. We performed a population-based cohort study to determine whether low doses of ionizing radiation to the brain in infancy affects cognitive function later in life. Further we hypothesized that the dose to the hippocampus predicts cognitive late side effects better than the anterior or the posterior brain doses. Material and methods. During 1950-1960 3860 boys were treated with radiation in Sweden for cutaneous hemangiomas before the age of 18 months. Of these, 3030 were analyzed for military test scores at the age of 18 years and 2559 for the highest obtained educational level. Results. Logical, spatial and technical test scores were not affected by increasing irradiation doses. The verbal test scores displayed a significant trend for decreasing scores with increasing doses to the hippocampus (p = 0.005). However, the absolute mean difference between the zero dose and the highest dose category (median 680 mGy) was very small, only 0.64 stanine points, and the significance was dependent on the highest dose category, containing few subjects. The educational level was not affected by brain irradiation. Overall, the hippocampal dose was a better predictor of late cognitive side effects than the doses to the anterior or the posterior brain. In conclusion, there was no decrease in logical, spatial and technical verbal or global test scores after ionizing radiation doses up to 250 mGy, but a subtle decrease in verbal test scores if the highest dose category was included (median 680 mGy). However, the clinical relevance of this decline in the highest dose group is questionable, since we could not find any effect on the highest obtained educational level. [ABSTRACT FROM AUTHOR]

Background. T-cell lymphoblastic lymphoma (T-LBL) is a rare neoplasm of precursor lymphoblast origin, for which there is no standard treatment for adults. Results of current treatment strategies in selected populations do exist but are largely unreported for unselected series. Here, we aimed to investigate treatment outcome in a population-based cohort. Material and methods. Patients were identified through the Swedish Lymphoma Registry and data was retrospectively collected for all adult (≥ 18 years) Swedish T-LBL patients diagnosed during 2000-2009. Results. A total of 39 patients with median age 40 years (range 18-78) were identified with females being significantly older than males (median age 66 vs. 37, p = 0.027). The five-year overall survival for all patients was 42%. Female gender was associated with shorter survival also when adjusted for treatment strategy and age [hazard ratio (HR) 4.29; p = 0.002]. Thirty patients received intensive chemotherapy, otherwise used for treatment of acute lymphoblastic leukemia (ALL), which resulted in an overall response rate of 97% and a five-year progression-free survival (PFS) of 49%. In this group only CNS involvement at diagnosis predicted shorter PFS (HR 13.3; p = 0.03). Among patients treated with hyper-CVAD the addition of mediastinal irradiation resulted in prolonged time to progression compared to patients receiving only chemotherapy (p = 0.047). The major reason for treatment failure was relapse and in this series 18-fluoro-deoxyglucose positron emission tomography (PET) did not predict this risk. Conclusion. This population-based study indicates that all fit T-LBL patients should be considered for intensive treatment. Our results also suggest a beneficial effect of mediastinal irradiation in combination with hyper-CVAD treatment. Relapsing patients have a dismal outcome irrespective of salvage treatment. [ABSTRACT FROM AUTHOR]

Background. Few studies to date have described the clinical features of malignant melanoma in young adulthood. Also, little is known about patterns of care in young patients. We examined and compared clinical characteristics, management and survival between young adult (15-39 years) and older adult melanoma patients in Central Sweden. Material and methods. Patients diagnosed with invasive malignant melanoma between 1997 and 2011 were identified in the Regional Quality Register of Cutaneous Malignant Melanoma in Central Sweden, a population-based register covering a source population of about two million. Data on clinical characteristics, management and survival were retrieved and compared according to age at diagnosis. Results. Of 5915 patients included in the study, 584 (9.9%) were between 15 and 39 years of age at diagnosis. Compared with older patients, young adult patients were more likely to be female, with higher proportions of thin, non-ulcerated melanomas, superficial spreading melanoma and melanomas located on the lower extremity. Young adults had shorter waiting times for surgical procedures and a higher proportion received surgical treatment according to guidelines. Overall, young patients had better relative survival than older patients. Age-related survival differences varied by stage of disease at diagnosis, and were most prominent in stage II disease. Conclusion. The observed differences in clinical characteristics, management and survival between young adult and older melanoma patients call for an improved understanding of not only disease etiology but also factors driving management decisions. A better understanding of these differences may help improve care and prognosis for melanoma patients of all ages. [ABSTRACT FROM AUTHOR]

Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. Material and methods. Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite® range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. Results. No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. Conclusions. Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus. [ABSTRACT FROM AUTHOR]

Background. Oestrogen receptor (ER) status is important for the choice of systemic treatment of breast cancer patients. However, most data from randomised trials on the effect of adjuvant endocrine therapy according to ER status are based on the cytosol methods. Comparisons with immunohistochemical methods have given similar results. The aim of the present study was to examine whether different ER antibodies and heat-induced epitope retrieval (HIER) methods influence the prevalence of ER-positivity in primary breast cancer. Material and methods. This study is based on patients included in a clinical trial designed to compare the effect of two years of adjuvant tamoxifen versus no adjuvant systemic treatment in premenopausal women. From 1986 to 1991, 564 patients from two study centres in Sweden were enrolled and randomised. Patients were randomised independently of ER status. In the present study, ER status was assessed on tissue microarrays with the three different ER antibody/HIER combinations: 1D5 in citrate pH 6 (n = 390), SP1 in Tris pH 9 (n = 390) and PharmDx in citrate pH 6 (n = 361). Results. At cut-offs of 1% and 10%, respectively, the prevalence of ER-positivity was higher with SP1 (75% and 72%) compared with 1D5 (68% and 66%) and PharmDx (66% and 62%). At these cut-offs, patients in the discordant groups (SP1-positive and 1D5-negative) seem to have a prognosis intermediate between those of the double-positive and double-negative groups. Comparison with the ER status determined by the cytosol-based methods in the discordant group also showed an intermediate pattern. The repeatability was good for all antibodies and cut-offs, with overall agreement ≥ 93%. Conclusion. The present study shows that the choice of antibody and HIER method influences the prevalence of ER-positivity. We suggest that this be taken into consideration when choosing a cut-off for clinical decision making. [ABSTRACT FROM AUTHOR]

Background. Chemotherapy prolongs life and relieves symptoms in men with castration resistant prostate cancer (CRPC). There is limited information on a population level on the use of chemotherapy for CRPC. Material and methods. To assess the use of chemotherapy in men with CRPC we conducted a register-based nationwide population-based study in Prostate Cancer data Base Sweden (PCBaSe) and a nationwide in-patient drug register (SALT database) between May 2009 and December 2010. We assumed that men who died of prostate cancer (PCa) underwent a period of CRPC before they died. Results. Among the 2677 men who died from PCa during the study inclusion period, 556 (21%) had received chemotherapy (intravenous or per oral) detectable within the observation period in SALT database. Specifically, 239 (61%) of men < 70 years had received chemotherapy, 246 (30%) of men between 70 and 79 years and 71 (5%) men older than 80 years. The majority of men 465/556 (84%) had received a docetaxel-containing regimen. Among chemotherapy treated men, 283/556 (51%) received their last dose of chemotherapy during the last six months prior to death. Treatment with chemotherapy was more common among men with little comorbidity and high educational level, as well as in men who had received curatively intended primary treatment. Conclusion. A majority of men younger than 70 years with CRPC were treated with chemotherapy in contrast to men between 70 and 79 years of whom half as many received chemotherapy. Chemotherapy treatment was often administered shortly prior to death. The low uptake of chemotherapy in older men with CRPC may be caused by concerns about tolerability of treatment, as well as treatment decisions based on chronological age rather than global health status. [ABSTRACT FROM AUTHOR]

Background. There are large geographic differences in breast cancer risk but whether survival differs between low- and high-risk groups is less well-established. As the survival of cancer depends on the level of healthcare and awareness of disease risks, subtle differences in cancer biology cannot be revealed in international comparisons. Instead, comparison of diverse immigrant groups in a country of uniformly accessible healthcare system should enable conclusions to be made about ethnic determinants of cancer risk and survival. Material and methods. The Swedish Family-Cancer Database was used to calculate standardized incidence (SIRs) and hazard ratios (HRs) of death from female breast cancer in 12 505 and 137 547 patients diagnosed with breast cancer among immigrants and Swedes, respectively. The ratios were adjusted for age, period, region, parity, and age at first childbirth. Ordinal logistic regression analysis was used to estimate odds ratios (ORs) for the clinical TNM classes. The analyses were stratified by menopausal status and histology. Results. Turks, Southeast Asians, and Chileans had the lowest breast cancer risk (SIR = 0.44; 95% CI 0.37-0.51) and Iraqis the highest risk (1.19; 1.05-1.35), mainly due to premenopausal cancer (1.51; 1.27-1.78). The HRs for all breast cancers were between 0.98 (0.81-1.18) (low-risk Europeans) and 1.24 (0.94-1.63) (lowest-risk non-Europeans), but were not significant. No differences in survival of ductal carcinoma between immigrants and Swedes were found, while low-risk non-Europeans had a HR of 2.88 (1.37-6.08) for lobular carcinoma. Low-risk non-Europeans were diagnosed in a higher T-class (OR = 1.87; 1.21-2.87) than Swedes. Conclusion. We did not find any evidence that ethnic differences in breast cancer risk substantially affect the survival. The observed poor survival of some low-risk immigrants in lobular carcinoma may be related to treatment. The tendency of low-risk immigrants to present with higher T-class compared to Swedes may depend on their lower participation in the mammography screening program. [ABSTRACT FROM AUTHOR]

Background. The 7th TNM staging system for non-small cell lung cancer (NSCLC) developed by the International Association for the study of Lung Cancer (IASLC) has been applied in Sweden since the beginning of the year 2010. The aim of this retrospective study was to evaluate the prognostic role of the 7th TNM staging system in a surgical Swedish patient cohort with node-negative NSCLC. Material and methods. We collected data from stage I patients (pT1-2 pN0, 6th TNM system) who underwent surgery for NSCLC at Karolinska University Hospital from 1987 to 2002. Tumors were restaged according to the 7th TNM version. Cox multivariate survival analysis was implemented in order to determine the prognostic impact of pathological stage when classified according to either the 6th or the 7th TNM systems. Results. The patient population consisted of 452 subjects. Tumor size was ≤ 3 cm in 51% of cases. The predominant histology was adenocarcinoma (53%) and lobectomy was the most common surgical procedure (82% of patients). The five-year survival rate in patients with stage IA vs. IB (6th TNM) was 62% vs. 51%, respectively (log-rank p = 0.036). Corresponding figures for the 7th TNM system were 70% in stage IA-T1a, 51% in stage IA-T1b, 54% in stage IB, 51% in stage IIA and 35% in stage IIB (log-rank p = 0.002). On multivariate analysis, adjusted by age, gender, histology, kind of surgery, grade of differentiation and smoking status, pathological stage was an independent prognostic factor if classified according to the 7th TNM version (p = 0.001), but not if scored according to the 6th TNM edition (p = 0.090). Conclusion. The 7th TNM classification system is a more accurate predictor of prognosis in stage I operated patients than the old classification. The new system should be implemented even on retrospective cohorts especially when investigating the prognostic implication of the expression of molecular biomarkers. [ABSTRACT FROM AUTHOR]

Background. The diagnosis of childhood cancer often results in an altered life situation for the parents, characterized by difficulties regarding work, family and household demands. Previous research shows that parents' work situation and income are impacted, yet, few studies have explored the issue from a longitudinal perspective. This study sought to increase the knowledge about the socio-economic conditions of parents of children with cancer in Sweden by means of a longitudinal assessment of work situation, sick leave, and household income. Material and methods. The sample consisted of mothers (n = 139) and fathers (n = 138) of children with cancer recruited from 2002 to 2004. Data was collected by telephone interviews at six time points, ranging from the time of diagnosis to one year after the end of treatment. Results. Findings showed that parents' work situation was most evidently impacted during the child's treatment, when the greatest proportions of non-working and sick-listed parents were found. Compared with the time of diagnosis, fewer mothers worked up to three months after the end of treatment, and more mothers were on sick leave one year after the end of treatment. Although the extent of sick leave among fathers did not differ compared with the time of diagnosis, fewer fathers worked one year after the end of treatment. Household income was significantly reduced during the child's treatment and months thereafter, while income was at an equal level as before the diagnosis for most families one year after the end of treatment. Conclusion. The results offer a unique understanding of how mothers' and fathers' work situation and income are impacted in the short- and long-term, and give guidance on how to improve the comprehensive support given to parents of children with cancer. Socio-economical issues should be emphasized as these may provide targets for policy interventions aiming to reduce parental strain related to work and finances. [ABSTRACT FROM AUTHOR]

During the last decades, the possibilities to prolong survival with chemotherapy even in metastatic disease have increased. Our aim was to study treatment decisions and treatment discontinuation decisions in the proximity of death. Methods. The medical records of 346 patients with disseminated cancer and a recorded death during 2009 were assessed in relation to demographic and clinical variables and documented treatment decisions were recorded. Results. Palliative chemotherapy was offered in 54% or these cases and generally one or two regimens were administered, before ending treatment. During the last month of life, 32% received treatment and much more often as an oral (instead of intravenous) treatment than in earlier stages (p < 0.001). Younger patients (p = 0.02) and those with young children (p < 0.001) were treated to a higher degree and also closer to death (p = 0.03). Other variables associated with a higher probability of treatment were high education level (p = 0.001), living with a partner (p = 0.001), female gender (p = 0.023) and ethnicity of non-European origin (p = 0.031). In a multivariate analysis, young age and high education remained as independent factors. In 57% of the cases there was no formal documentation of treatment discontinuation or end-of-life discussions with the patient. Conclusion. Socioeconomic status (SES) is of importance for the treatment decisions. About half of the patients with disseminated disease receive palliative chemotherapy and of these, about one third are treated even during the last month of life. In a majority of cases, there is no formal documentation of treatment discontinuation or end-of-life discussions. [ABSTRACT FROM AUTHOR]

Background. Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of trismus and the patients' experience of trismus in daily life activities. The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. Material and methods. We used the criteria for trismus of maximum interincisal opening (MIO) ≤ 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). Results. The incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the tonsils were most prone to develop trismus. Patients with trismus reported greater HRQL impairments with regard to the GTQ domains; mouth opening (p < 0.001), jaw-related problems (p < 0.05), eating limitations (p < 0.05) and muscular tension (p < 0.001) six months post-treatment. EORTC QLQ H&N 35 scores indicated clinically significantly more problems with dry mouth, swallowing and pain for patients with trismus, 6-12 months post-treatment. Furthermore, all patients reported pain, anxiety and depression pre- and post-treatment. Conclusion. The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time. [ABSTRACT FROM AUTHOR]

Background and purpose The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004-2010. Patients and methods Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. Results The crude incidence rate was 31 per 104 person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 104 person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. Interpretation The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study was to investigate what bowel organ and delivered dose levels are most relevant for the development of 'emptying of all stools into clothing without forewarning' so that the related dose-responses could be derived as an aid in avoiding this distressing symptom in the future. Material and methods. Of the 77 gynecological cancer survivors treated with radiotherapy (RT) for gynecological cancer, 13 developed the symptom. The survivors were treated between 1991 and 2003. The anal-sphincter region, the rectum, the sigmoid and the small intestines were all delineated and the dose-volume histograms were exported for each patient. The dose-volume parameters were estimated fitting the data to the Relative Seriality (RS), the Lyman and the generalized Equivalent Uniform Dose (gEUD) model. Results. The dose-response parameters for all three models and four organs at risk (OARs) were estimated. The data from the sigmoid fits the studied models best: D50 was 58.8 and 59.5 Gy (RS, Lyman), γ50 was 1.60 and 1.57 (RS, Lyman), s was 0.32, n was 0.13 and a was 7.7 (RS, Lyman, gEUD). The estimated volume parameters indicate that the investigated OARs behave serially for this endpoint. Our results for the three models studied indicate that they have the same predictive power (similar LL values) for the symptom as a function of the dose for all investigated OARs. Conclusions. In our study, the anal-sphincter region and sigmoid fit our data best, but all OARs were found to have steep dose-responses for 'emptying of all stools into clothing without forewarning' and thus, the outcome can be predicted with an NTCP model. In addition, the dose to the four studied OARs may be considered when minimizing the risk of the symptom. [ABSTRACT FROM AUTHOR]

Background. The aim was to evaluate the feasibility and the effectiveness of neoadjuvant systemic chemotherapy followed by cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) in patients with peritoneal carcinomatosis (PC) from gastric cancer. Material and methods. Eighteen patients (median age 57 years, range 38-74) were scheduled for three months' neoadjuvant systemic chemotherapy followed by CRS + HIPEC + EPIC. Results. At the time of surgery, the peritoneal tumor burden was extensive with tumor growth on the entire peritoneal cavity. Only eight patients received the entire treatment and OS was 14.3 months (range 6.1-34.3, 95% CI 6.6-20.3). Six patients had macroscopically radical (CC0) surgery and for this subgroup OS was 19.1 months (range 6.1-34.3, 95% CI 6.9-27.1). Postoperative 90-day mortality was 10% (one patient) and the perioperative grades II-IV adverse events (AE) rate was 62.5%. Discussion. Neoadjuvant chemotherapy followed by CRS + HIPEC + EPIC does not seem to be associated with prolonged OS in patients with extensive PC growth from gastric cancer unless macroscopically radical surgery is achieved. However, morbidity from this treatment is considerable and it cannot be recommended for routine care until a prospective randomized trial has been performed. [ABSTRACT FROM AUTHOR]

Background. Carcinosarcomas are a highly malignant type of endometrial carcinomas where extra uterine spread and recurrences are frequent. There is no consensus regarding the best treatment of this group of malignancies. Material and methods. In a complete geographic series of 322 cases of primary uterine carcinosarcomas prophylactic pelvic irradiation and/or chemotherapy was used as postoperative treatment in the majority of the cases. Vaginal brachytherapy was also added as a boost. The primary surgery was extended hysterectomy in 23 cases (10%), and simple hysterectomy in 220 cases (90%). In 46 cases (14%) no major surgery was possible. Results. In the complete series 123 recurrences (38%) were recorded. Locoregional recurrences (11%) and distant recurrences (28%) were most frequent. Type and extent of surgery was not associated with the risk of tumor recurrence. Extended surgery did not reduce the risk of local and regional recurrences. In the complete series, the five-year overall survival rate was 30% and the recurrence-free survival (RFS) rate was 27%. The five-year pelvic disease control was 82% in stage I, 68% in stage II, and 76% for more advanced stages. The five-year locoregional RFS rate was 63% for patients treated with surgery alone, 68% after addition of adjuvant chemotherapy, 86% after adjuvant radiotherapy, and 95% after combined chemotherapy and radiotherapy. Conclusion. Radiotherapy seems to be the most important constituent of the adjuvant therapy. Serious late tissue reactions, requiring surgery, from the bladder and intestine occurred in 2.5% of the irradiated cases. The death of three patients could be related to radiotherapy and of four patients due to the cytotoxic treatment. This population-based series may serve as a baseline for improvements by, e.g. standard care programs and referral to a few specialist centers for this rare and serious disease. [ABSTRACT FROM AUTHOR]