Biomedical subjects

Nina Aass

Publications and source records attributed to Nina Aass.

10 recordsLinked to original sources

PubMed2007

Prevalence of pain in hospitalised cancer patients in Norway: a national survey.

PURPOSE: Pain severely impairs health-related quality of life and is a feared symptom among cancer patients. Unfortunately, patients often do not receive optimal care. We wanted to evaluate the quality of cancer pain treatment in Norwegian hospitals. PATIENTS AND METHODS: A one-day prevalence study targeting hospitalised cancer patients above 18 years of age was performed. A questionnaire based on the Brief Pain Inventory was used, and additional information regarding sex, age, diagnosis, break through pain (BTP), and treatment was included. RESULTS: Fifty two percent of the included patients stated having cancer related pain (n=453), and mean pain during the previous 24 hours for these patients was NRS 3.99 (Numeric Rating scale 1-10). Presence of metastasis, occurrence of BTP, and abnormal skin sensibility in the area of pain were associated with higher pain scores. Forty two percent of all patients used opioids. However, these patients still had higher pain scores, more episodes of BTP, and more influence of the pain on daily life functions than average. Thirty percent of patients with severe pain (NRS>or=5) did not use opioids, and some of these patients did not receive any analgesics at all. CONCLUSION: Although most cancer patients receive an acceptable pain treatment in Norwegian hospitals, there are patients who are not adequately managed. Lack of basic knowledge and individual systematic symptom assessment may be reasons for the underuse of analgesics and the resulting unnecessary suffering among the cancer patients.

Aged↗

PubMed2006

[Nausea, vomiting and constipation in palliative care].

Nausea/vomiting and constipation are frequent symptoms among patients with advanced disease and short survival expectancy. The aim of this paper is to present the aetiology, diagnostic work-up, prophylaxis and treatment of these symptoms in palliative patients, based on a literature review and clinical experience. Nausea/vomiting is not a diagnosis, but symptoms with multiple causes. There is no universally applicable treatment approach. General guidelines for good treatment are: 1) impeccable assessment and work-up, 2) choice of treatment according to underlying causes and involved mechanisms, 3) pharmacological treatment applied jointly with non-pharmacological measures, 4) thorough follow-up and readjustment of treatment. During work-up, or if underlying causes can not be identified, metoclopramide, alternatively haloperidol, is the first drug of choice. Oral administration should be avoided until vomiting is controlled. Adequate hydration is important. The same general guidelines are applicable to handle constipation. However, prophylactic measures are also essential, focusing on risk factors (fluid intake, activity and toilet accommodations). Stool softening laxatives should be administered, (polyethylene glycol or lactulose), and if needed, combined with a bowel stimulant (bisacodyl or sodium picosulphate). Opioid use is among the most common causes of constipation and prescription of opioids should always be accompanied by prescription of laxatives. Exceptions are diarrhoea, ileostomy and dying patients.

Antiemetics↗

PubMed2006

[Tumour-modifying therapy].

Symptom relief as well as symptom prevention may be achieved in patients with advanced malignant disease and short life expectancy by use of radiotherapy and systemic cancer treatment (hormones and chemotherapy). Sometimes the treatment may be life prolonging as well. This knowledge is mostly based upon empirical data and personal experiences - to a much lower extent on evidence-based medicine. For these patients, it is of particular importance to minimise the level and duration of acute treatment-related toxicity. Shortened radiotherapy regiments may be effective, with few side effects. The efficacy of the systemic treatment must be evaluated at regular intervals and terminated if there is a lack of response or high level of toxicity. Bisphosphonates are standard treatment of hypercalcaemia. In addition, in patients with bone metastasies from various cancer sites with a life expectancy of six months or more, bisphosphonates may reduce the number of skeletal events.

Antineoplastic Agents↗

PubMed2005

Randomized phase II/III trial of interferon Alfa-2a with and without 13-cis-retinoic acid in patients with progressive metastatic renal cell Carcinoma: the European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group (EORTC 30951).

PURPOSE: A randomized phase II/III trial was conducted to determine whether combination treatment with 13-cis-retinoic acid (13-CRA) plus interferon alfa-2a (IFN-alpha-2a) was superior to IFN-alpha-2a alone in patients with progressive metastatic renal cell carcinoma. PATIENTS AND METHODS: Three hundred twenty patients were randomly assigned to treatment with IFN-alpha-2a plus 13-CRA or to IFN-alpha-2a alone. IFN-alpha-2a was given daily subcutaneously, starting at a dose of 3 million units (MU). The dose was escalated every 7 days from 3 to 9 MU by increments of 3 MU. Patients randomly assigned to combination therapy received oral 13-CRA 1 mg/kg/d plus IFN-alpha-2a. RESULTS: Median time to progression was 5.1 months for patients treated with the combination and 3.4 months for patients on IFN-alpha-2a alone (P = .008). Progression-free survival rates at 6 months were 43% for patients receiving combined therapy and 30% for patients on IFN-alpha-2a, and at 12 months, 27% and 17%, respectively. Median overall survival was 17.3 months for patients on IFN-alpha-2a and 13-CRA, and 13.2 months for patients treated with IFN-alpha-2a (P = .048). Twenty-two percent of the patients receiving the combination stopped treatment due to toxicity, as compared with 16% on IFN-alpha-2a. CONCLUSION: Progression-free and overall survival for patients with progressive metastatic renal cell carcinoma treated with IFN-alpha-2a plus 13-CRA were significantly longer compared with patients on IFN-alpha-2a alone (P = .007 and P = .048, respectively). Improvement in efficacy in the combination arm was accompanied by increased, though not serious, toxicity.

Administration, Oral↗

PubMed2004

Pre- and post-treatment daily life function in patients with hormone resistant prostate carcinoma treated with radiotherapy for spinal cord compression.

BACKGROUND AND PURPOSE: To identify prognostic factors and prospectively evaluate daily life function and pain experience in hormone resistant prostate cancer patients with spinal cord compression treated with radiotherapy. PATIENTS AND METHODS: Consecutive patients treated at the Norwegian Radium Hospital from May 1996 to October 1999 participated in the study. Daily life activities were assessed at start and discontinuation of radiotherapy and 2 and 6 months thereafter using a questionnaire based on a slightly modified Barthel activity of daily living Index. The patients were followed to death. Clinical parameters (histology, extent of disease at diagnosis, time from cancer diagnosis to start of radiotherapy, time from neurological symptoms to start of radiotherapy, age, number of spinal lesions, pre-treatment function) were assessed to try to prognosticate post-treatment function. RESULTS: Forty-nine patients were evaluable. Time from debut of neurological deficits to start of radiotherapy was median 4 days (range 1-66). Median target dose was 30 Gy (range 9-40). Overall survival from start of radiotherapy was median 3.5 months (range 0.3-36.0). In general, improvement with regard to mobility, daily life activities and sphincter control was reported after irradiation. Post-treatment the majority of patients reported pain, usually intermittent, although they used analgesics. No clinically relevant pre-treatment parameters that predicted function after radiotherapy were identified. CONCLUSIONS: Radiotherapy may improve mobility, daily life activity and sphincter control in patients with metastatic spinal cord compression due to hormone resistant prostate cancer. Radiotherapy should therefore be considered in all patients irrespective of the neurological deficits.

Activities of Daily Living↗

PubMed2004

[Palliative cytostatic treatment].

When chemotherapy is given with palliative intent, one should avoid treatment that is more troublesome to the patients than the disease itself. Palliative chemotherapy should be evidence-based in the same way as other treatment regimens. It is given in order to extend life, to prevent development of symptoms, and/or to relieve symptoms. The treatment intention has to be clarified to the patient as well as his or her significant others before chemotherapy is initiated. We recommend drawing up an oral or written agreement with the patient on the number of cycles, parameters for effect evaluation, and rules for when treatment should be stopped. It is important that non-effective chemotherapy is not given, even if it is without side effects, or even if the patient is eager to continue the treatment.

Antineoplastic Agents↗

PubMed2003

Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses.

PURPOSE: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was </= 20 mm in diameter after modern cisplatin-based induction chemotherapy. PATIENTS AND METHODS: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatin-based induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was </= 20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND. RESULTS: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was </= 10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass. CONCLUSION: One third of retroperitoneal postchemotherapy lesions </= 20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.

Adolescent↗

PubMed2002

Gonadal function and fertility in patients with bilateral testicular germ cell malignancy.

OBJECTIVE: To evaluate gonadal function and fertility in patients with bilateral testicular cancer (TC). METHODS: In 1999, 63 patients with bilateral invasive TC or carcinoma in situ (CIS) in the contralateral testis completed a mailed questionnaire evaluating their fatherhood (Cases). Their gonadal function had also been assessed after the first orchiectomy for TC before further treatment. The results were compared with those from 174 patients with unilateral TC (Controls). RESULTS: In Cases the post-orchiectomy serum levels of FSH and LH were above those of the Controls (p<0.001). Serum testosterone was similar, whereas sperm concentrations were lower in Cases (p<0.001). In Cases with metachronous invasive TC the level of serum FSH was associated with the interval between the two diagnoses. After the first orchiectomy, 10 of 25 Cases (40%) initiated a pregnancy, in 4 Cases by assisted fertilization. In the Control group 74% of the patients who attempted fatherhood succeeded (p=0.002). CONCLUSIONS: After unilateral orchiectomy for TC elevated serum FSH and/or oligospermia represent a high-risk factor of metachronous bilateral TC or synchronous CIS. At least one-third of these patients attempting fatherhood are successful after the first orchiectomy. Assisted fertilization is often necessary and the overall paternity rate is below that of patients with unilateral TC.

Adolescent↗

PubMed2002

Ultrasound-guided fine needle cytology of retroperitoneal masses in patients with malignant germ cell tumours: diagnosis and therapeutic impact.

PURPOSE: There are few reports on the use of fine needle cytology (FNC) for the detection of retroperitoneal lymph node metastases from malignant germ cell tumours (MGCT). In order to determine efficiency of the procedure and its impact on therapeutic approaches, this study reviews experience with ultrasound-guided transabdominal FNC in patients with MGCT. PATIENTS AND METHODS: Twenty-four patients with known malignant germ cell tumour and four patients without previous histology, presented with retroperitoneal masses. They underwent ultrasound-guided fine needle cytology (aspirations were done twice in two patients). Clinical data were retrieved from the medical records and all cytological specimens were reviewed. In metastatic cases, the cytologic findings were correlated with the histology of the primary tumour. RESULTS: Twenty-one of 30 specimens (70%) were diagnosed as malignant, 6 (20%) were benign, and 3 (10%) were unsatisfactory for the cytologic diagnosis. Five of the 21 malignant lesions were < or =10mm. FNC yielded the correct diagnosis in all four cases of extragonadal malignant germ cell tumours. In four other patients, FNC solved significant staging problems at the diagnosis. In 7 of 11 patients with the suspicion of retroperitoneal recurrence and normal serum tumour markers during follow-up, FNC confirmed the malignant morphology of the lesions. CONCLUSIONS: In experienced hands, ultrasound-guided FNC can be a valuable method for the morphological diagnosis of retroperitoneal manifestations from MGCT. FNC should be added in follow-up and staging procedures (radiological imaging and serum tumour markers) in selected patients in whom the histological verification of such lesions is critical for the patient's management.

Adolescent↗

PubMedDate not supplied

Candidate genes for testicular cancer evaluated by in situ protein expression analyses on tissue microarrays.

By the use of high-throughput molecular technologies, the number of genes and proteins potentially relevant to testicular germ cell tumor (TGCT) and other diseases will increase rapidly. In a recent transcriptional profiling, we demonstrated the overexpression of GRB7 and JUP in TGCTs, and confirmed the reported overexpression of CCND2. We also have recent evidences for frequent genetic alterations of FHIT and epigenetic alterations of MGMT. To evaluate whether the expression of these genes is related to any clinicopathological variables, we constructed a tissue microarray with 510 testicular tissue cores from 279 patients diagnosed with TGCT, covering various histological subgroups and clinical stages. By immunohistochemistry, we found that JUP, GRB7, and CCND2 proteins were rarely present in normal testis, but frequently expressed at high levels in TGCT. Additionally, all premalignant intrabular germ cell neoplasias were JUP-immunopositive. MGMT and FHIT were expressed by normal testicular tissues, but at significantly lower frequencies in TGCT. Except for CCND2, the expressions of all markers were significantly associated with various TGCT subtypes. In summary, we have developed a high-throughput tool for the evaluation of TGCT markers, and utilized this to validate five candidate genes whose protein expressions were indeed deregulated in TGCT.

Biomarkers, Tumor↗