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Objectives: There is little research on complicated grief (CG) in family caregivers in palliative care. The aim of the study was to assess the levels of complicated grief and depression in family caregivers after the death of a relative with cancer, to identify their need for support, to compare the palliative team staff's risk assessment of the relatives' grief reaction with measured levels of CG and depression, and to assess the use of bereavement support., Methods: All 114 eligible family caregivers to deceased patients treated in a palliative care unit in the year 2006 were asked to participate in the study, and 87 (77%) accepted. The participants completed a postal questionnaire 2, 6, 13, and 18 months after the loss measuring complicated grief (Inventory of Complicated Grief, Revised), depression (Beck's Depression Inventory II), and their use of bereavement services. The palliative team staff completed a form 1 month post-loss with their clinical risk assessment of the family caregivers' levels of complicated grief and need for support., Results: The prevalence of moderate to severe depression and CG was 15% and 40%, respectively, at 6 months post-loss. Professional risk assessment showed a sensitivity of 55% for CG and of 27% for depression and a specificity of 86% for depression and 63% for CG. The positive predictive value was 27% for depression and 21% for CG. Use of bereavement services was observed in 36% of the cases at 6 months after the loss. The proportion of bereaved with CG or depression at 6 months who had received bereavement services was 47% and 64%, respectively., Conclusions: The results suggest that a substantial number of family caregivers of diseased palliative care patients are at risk of developing CG and depression following their loss. While early identification of those at risk of developing CG could be helpful, the risk assessment of professionals may lack in precision. The results indicate that bereavement services could be utilized in a more targeted and perhaps more efficient manner. Guidelines for bereavement planning in palliative care are indicated.

Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved relatives, general practitioners (GPs) and community nurses (CNs) and to assess the agreement of their accounts. The study was a population-based, cross-sectional combined register and questionnaire study in Aarhus County, Denmark. The population comprised 599 deceased adult cancer patients who had died from 1 March to 30 November 2006 and were identified through merging of health registers. Relatives returned 198 questionnaires about patients' preferred place-of-death, GPs 333 and CNs 201. The study showed that most terminally ill cancer patients preferred home death (up to 80.7%). The reported preference for home death weakened as death approached (down to 64.4%). A better congruence was seen between relatives' and GPs' accounts of preference for place of death at the end of the palliative period (κ 0.71) than between relatives' and CNs' accounts (κ 0.37). In conclusion, bereaved relatives (and GPs and CNs) report retrospectively that most terminally ill cancer patients wish to die at home. The preference weakened significantly as death approached. The agreement between relatives' and GPs' accounts on patients' preferences at the end of the palliative period was 'substantial', whereas the agreement between relatives' and CNs' accounts at the same time was significantly less outspoken. This indicates that CNs may be facing a problem in assessing their patients' wishes retrospectively., (© 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.)

Background: Metastatic bone disease (MBD) is a frequent complication in patients with breast cancer and is associated with significant morbidity. This study assessed the pharmacokinetics, efficacy, and safety of odanacatib, a selective Cat K inhibitor, in reducing markers of bone resorption in women with breast cancer and MBD., Patients and Methods: Women with breast cancer and MBD were randomized 2:1 (double-blind) to oral odanacatib 5 mg daily for 4 weeks or intravenous (I.V.) zoledronic acid (ZA) 4 mg given once at study initiation. Plasma samples were collected for pharmacokinetic analysis. Bone resorption was assessed by measuring urinary N-telopeptide of type I collagen corrected for creatinine (uNTx; primary objective, pmol BCE/µmol creatinine). Adverse events (AEs) were monitored throughout the 4-week study and up to 14 days after last dose., Results: A total of 43 patients (mean age, 60 years) received odanacatib (n = 29) or ZA (n = 14); 40 patients completed 4 weeks of treatment. The mean percent change in uNTx values at week 4 was -77% (95% CI, -82 to -71; odanacatib) and -73% (95% CI, -80 to -62; ZA). Mean (standard deviation) plasma concentration of odanacatib was 511.7 (202.9) nM; the range was 63.7-844.8 nM. The most common AEs were nausea, vomiting, headache, and bone pain, which were generally not attributed to study drug., Conclusion: Odanacatib suppressed uNTx similarly to ZA after 4 weeks of treatment in women with breast cancer and MBD. Odanacatib was generally safe and well tolerated. These results suggest that Cat K inhibition is a potentially important, novel therapeutic approach for treating MBD.

Introduction: Research suggests that cancer patients' age may affect the quality of their treatment. Yet, there is little knowledge of how and why age affects treatment quality. This study explores staff attitudes and perceptions of age-related differences in treatment and care at a Danish oncology department., Material and Methods: Qualitative analyses of nine semi-structured interviews with strategically selected staff members were conducted using a grounded theory-inspired approach. The interviews were independently coded by four raters through a process of meaning condensation and meaning was structured into core-categories., Results: Although eight of nine participants denied that age was a reason for differential treatment, all nine participants gave examples of age-related differences in treatment. Younger patients were generally offered: 1) more intensive treatment, 2) more consultation time with physicians, 3) allocation to physicians with higher seniority, and 4) increased continuity in the staff assigned to them. The differences were explained as due to: a) differences in patients' physical health and b) sympathy for younger patients' life situation and needs., Discussion: Two co-dominant values were identified: 1) "equality in treatment and care" and 2) "normative life course expectations" of serious disease belonging to old age and thus being more tragic for young individuals (life script model). Values of equality are explicit and govern formal health care system guidelines, while values related to the staff's life course expectations are more implicit and may account for some age-related differences in treatment quality.

Age differences in emotional control and their consequences were examined in women referred to mammography on the suspicion of breast cancer but with benign results of the examination. Under natural experimental conditions, the levels of emotional control and distress were measured 1 week prior to the examination as well as 4 and 12 weeks after the examination in 717 younger women (ages 19-39), middle-aged women (ages 40-59), and older women (ages 60-85). A higher level of emotional control was found in the older women; this indicates that, in these birth cohorts, emotion-focused coping is more prevalent in old age than in young adulthood, even when similar stressors are experienced. The analyses revealed an interaction between age and emotional control; higher levels of control were related to a reduction in distress during the course of the study in older women, whereas emotional control was unrelated to changes in distress in younger and middle-aged women. The findings support the life span theory of control, which suggests that secondary control strategies are more adaptive in old age., ((c) 2009 APA, all rights reserved.)

Objective: A number of cross-sectional studies have reported reduced cognitive function in cancer patients receiving chemotherapy compared with other cancer patients and healthy controls, suggesting that chemotherapy could be associated with cognitive side-effects. Recently published prospective studies question this hypothesis, but it is still unclear whether cancer patients should regard cognitive problems as a potential risk when receiving chemotherapy., Methods: In the present study we examine whether cancer patients (n=34) receiving chemotherapy differed in cognitive changes during treatment compared with cardiac patients (n=12) and healthy controls (n=12) tested at 3-4 months interval., Results: Our results showed no differences with respect to changes in cognitive performance over time between cancer patients in chemotherapy, cardiac patients, and healthy controls. In addition, the number of individuals showing reliable decline or improvement on cognitive tests did not differ between groups., Conclusion: Taken together, our results do not support a hypothesis of cognitive side-effects of standard-dose chemotherapy in breast cancer patients.

Background: Elevated levels of depressive symptoms are generally found among cancer patients, but results from existing studies vary considerably with respect to prevalence and proposed risk factors., Purpose: To study the prevalence of depressive symptoms and major depression 3-4 months following surgery for breast cancer, and to identify clinical risk factors while adjusting for pre-cancer sociodemographic factors, comorbidity, and psychiatric history., Patients and Methods: The study cohort consists of 4917 Danish women, aged 18-70 years, receiving standardized treatment for early stage invasive breast cancer during the 2 1/2 year study period. Of these, 3343 women (68%) participated in a questionnaire study 12-16 weeks following surgery. Depressive symptoms (Beck's Depression Inventory II) and health-related behaviors were assessed by questionnaire. The Danish Breast Cancer Cooperative Group (DBCG) and the surgical departments provided disease-, treatment-, and comorbidity data for the study cohort. Information concerning sociodemographics and psychiatric history were obtained from national longitudinal registries., Results: The results indicated an increased prevalence of depressive symptoms and major depression (13.7%) compared to population-based samples. The pre-cancer variables: Social status, net-wealth, ethnicity, comorbidity, psychiatric history, and age were all independent risk factors for depressive symptoms. Of the clinical variables, only nodal status carried additional prognostic information. Physical functioning, smoking, alcohol use, and BMI were also independently associated with depressive symptoms., Conclusion: Risk factors for depressive symptoms were primarily restricted to pre-cancer conditions rather than disease-specific conditions. Special attention should be given to socio-economically deprived women with a history of somatic- and psychiatric disease and poor health behaviors.

Bone metastases are a frequent condition leading to fractures, hypercalcaemia and spinal compression. The treatment will depend on the possibility to treat the cancer. Secondly local treatment should be considered. To relief pain radiotherapy, given as 1 fraction with 8 Gy, is an effective treatment. Radiotherapy can also be used to treat complications from the metastasis. The use of bisphosphonates is now established in the treatment of breast cancer with bone metastasis to prevent complications from bone metastasis. Surgery is a growing possibility both as treatment of manifest fractures and prophylactic. Selection of patients to surgery is important to keep complication rate low.

Goals of Work: The objective of this study is to estimate the frequency and severity of nail changes due to treatment with the cytotoxic drug docetaxel and, secondly, to estimate how the nail changes effects the patients cosmetically and functionally in their daily activities. Finally, we want to clarify whether fungal infection could contribute in causing the nail changes., Materials and Methods: Fifty-five patients with metastatic breast cancer in treatment with the cytotoxic drug docetaxel participated in the study. They filled out two questionnaires about their experience with possible nail changes. The frequency of fungal infection was examined. At each of the two visits, information about the number of treatment cycles, dose of docetaxel the patient received, frequency of lymph oedema, previous treatment with chemotherapy and the reason of discontinuance of treatment, if relevant, were registered. Finally, photos were taken to document the nail changes in hands and feet., Main Results: Fifty-eight percent had some degree of nail changes and an increase to 88.5% was seen after three additional cycles. A large proportion of the patients experienced the nail changes as a cosmetic nuisance, and more than 32% had functional problems., Conclusion: Nail changes occur more frequently than previous studies have shown. Furthermore, our study indicates that the nail changes are affecting a large proportion of the patients, both cosmetically and functionally, which may lead to a decrease in their quality of life. No significant association was found according to the possible relation between nail changes and fungal infection.

Medical treatments including chemotherapy, endocrine therapy, and antibody therapy effectively reduce the risk of recurrence after breast cancer and are also used against metastatic disease. This article reviews patients' experience of these treatments. Common side effects of chemotherapy include hair loss, nausea, hot flushes, mucositis, fatigue, and cognitive side effects. Overall quality of life, social relations, and sexuality may also be affected. Endocrine therapies are characterised by hot flushes, vaginal dryness, arthralgias, and reduced libido.

Introduction: Cancer can have a serious impact on patient well-being and quality of life. The international literature reports a higher prevalence of psychosocial problems among cancer patients; primarily problems associated with difficulties in the family, duties in the household, work and leisure, sexuality and finances. The prevalence of these problems among Danish cancer patients is still unknown., Materials and Methods: A questionnaire assessing psychosocial problems and needs was mailed out to all patients who had been at the Department of Oncology, Aarhus Hospital in week 35, 2004. A total of 71%, i.e. 515 patients (34% men and 66% women) in active treatment and control returned the questionnaire., Results: High levels of emotional distress were reported by 39% of the patients. High levels of distress were primarily related to problems with worries about their spouses, household duties, financial problems and experiences of insufficient collaboration between health care and social services. Between 19% and 25% of the patients required further help to handle emotional problems, legal and financial problems and practical problems in the home., Conclusion: A considerable proportion of oncology patients experience significant levels of distress. This group of distressed patients also report unmet needs for psychosocial support.

To examine the influence of smoking on observer based morbidity scores and patient assessed health related quality of life after treatment for head and neck cancer. The results of EORTC C30 and H&N35 questionnaires and DAHANCA morbidity scores were studied according to smoking status in 114 recurrence free head and neck cancer patients. In contrast to observer based toxicity scoring, smoking had a significantly negative influence on 20 of the 33 quality of life scales. Previous smokers had quality of life scores in between never smokers and continuous smokers. Smoking after treatment of head and neck cancer adversely influenced a wide range of quality of life endpoints. Quitters had better quality of life than patients who continued to smoke after treatment, suggesting that smoking cessation may improve quality of life in addition to reducing the risk of new cancer.