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  • 1.
    Karlsson, E.
    et al.
    Karolinska Inst, Canc Ctr Karolinska, Radiumhemmet, Dept Oncol Pathol, Stockholm, Sweden.;St Gorans Univ Hosp, S-11281 Stockholm, Sweden.;Cent Hosp Karlstad, Dept Oncol, S-65230 Karlstad, Sweden..
    Appelgren, Jari
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Solterbeck, A.
    Cent Hosp Karlstad, Dept Pathol, S-65230 Karlstad, Sweden..
    Bergenheim, M.
    Cent Hosp Karlstad, Dept Surg, S-65230 Karlstad, Sweden..
    Alvariza, V.
    Cent Hosp Karlstad, Dept Oncol, S-65230 Karlstad, Sweden..
    Bergh, J.
    Karolinska Inst, Canc Ctr Karolinska, Radiumhemmet, Dept Oncol Pathol, Stockholm, Sweden.;St Gorans Univ Hosp, S-11281 Stockholm, Sweden..
    Breast cancer during follow-up and progression - A population based cohort on new cancers and changed biology2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 17, p. 2916-2924Article in journal (Refereed)
    Abstract [en]

    Background: Emerging data indicate an important role for biopsies of clinically/radiologically defined breast cancer 'recurrences'. The present study investigates tumour related events (relapses, other malignancies, benign conditions) after a primary breast cancer diagnosis. Patients and methods: The cohort includes 2102 women, representing all patients, with primary invasive breast cancer during 2000-2011 in the county of Varmland, Sweden. A comparative analysis of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation (Ki67) between the primary tumour and the relapse was performed and related to outcome. Results: With a mean follow-up time of 4.8 years, 1060 out of 2102 patients have had a biopsy taken after the initial breast cancer diagnosis demonstrating 177 recurrences, 93 other malignancies (colorectal, lung, skin), 40 cancer in situ (skin, breast) and 857 benign lesions. Approximately 70% (177 out of 245) of all cases of relapsed breast cancer underwent a biopsy during this time period. For patients with recurrences, ER (n = 127), PR (n = 101), HER2 (n = 73) and Ki67 (n = 55) status in both primary tumour and the corresponding relapse were determined. The discordance of receptor status was 14.2%, 39.6%, 9.6% and 36.3%, respectively. Loss of ER or PR in the relapse resulted in a significant increased risk of death (hazard ratio (HR) 3.62; 95% confidence interval (CI), 1.65-7.94) and (HR 2.34; 95% CI, 1.01-5.47) compared with patients with stable ER or PR positive tumours. The proportion of patients losing ER was bigger in the group treated with endocrine therapy alone or in combination with chemotherapy, 16.7% and 13.3%, respectively, compared with the group treated with chemotherapy alone or that which received no treatment 4.3% and 7.7%, respectively. Conclusion: Discordance of biomarkers between the primary tumour and the corresponding relapse was seen in 10-40% of the patients, adjuvant therapies seem to drive clonal selections. Patients with tumours losing ER or PR during progression have worse survival compared with patients with retained receptor expression. (C) 2014 Elsevier Ltd. All rights reserved.

  • 2.
    Karlsson, E.
    et al.
    Karolinska Institute, Sweden.
    Appelgren, Jari
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Solterbeck, A.
    Central Hospital Karlstad, Sweden.
    Bergenheim, M.
    Central Hospital Karlstad, Sweden.
    Alvariza, V.
    Central Hospital Karlstad, Sweden.
    Bergh, J.
    Karolinska Institutet, Sweden..
    Population based study investigating biopsy verifications of "breast cancer recurrences" and biomarker changes2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, p. S399-S400Article in journal (Other academic)
  • 3.
    Karlsson, E.
    et al.
    Karolinska Inst, Dept Oncol & Pathol, Cent Hosp Karlstad, Dept Oncol Karlstad, Stockholm, Sweden..
    Sandelin, K.
    Karolinska University Hospital, Sweden.
    Appelgren, Jari
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Wenjing, Z.
    Uppsala Univ, Dept Surg, Uppsala, Sweden.
    Jirstrom, K.
    Lund University, Sweden.
    Bergh, J.
    Karolinska Institute, Sweden.
    Warnberg, F.
    University Uppsala Hospital, Sweden.
    Receptor conversion between primary ductal carcinoma in situ (DCIS) and corresponding local relapse2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, p. S403-S403Article in journal (Other academic)
  • 4.
    Karlsson, Eva
    et al.
    Department of Oncology-Pathology, Radiumhemmet, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
    Sandelin, Kerstin
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Appelgren, Jari
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Zhou, Wenjing
    Department of Surgery, Uppsala University, Uppsala, Sweden.
    Jirström, Karin
    Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Bergh, Jonas
    Department of Oncology-Pathology, Radiumhemmet, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
    Wärnberg, Fredrik
    Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Clonal alteration of breast cancer receptors between primary ductal carcinoma in situ (DCIS) and corresponding local events2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 3, p. 517-524Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Emerging data propose biomarker alteration due to clonal selection between the primary invasive breast cancer and corresponding metastases. In addition, impact on survival has been demonstrated. The present study investigates the relationship between the oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) between primary ductal carcinoma in situ (DCIS) and intra-individually matched ipsilateral event.

    MATERIALS AND METHODS:The cohort includes 1504 patients, diagnosed with a primary DCIS between 1986 and 2004. Of the 274 patients who developed a local relapse, 135 developed a new in situ carcinoma and 139 an invasive cancer up to 31st December 2011. ER and PR were identified by immunohistochemistry (IHC) and HER2 by silver-enhanced in situ hybridisation (SISH) as well as IHC.

    RESULTS:ER (n=112), PR (n=113) and HER2 (n=114) status from both the primary DCIS and the corresponding relapse were assessed and were demonstrated to be discordant in 15.1%, 29.2% and 10.5% respectively. The receptor conversion was both from negative to positive and from positive to negative with no general pattern being seen in spite of sub-dividing into in situ relapse and invasive relapse. However, primary DCIS was HER2 positive in 40.3% whereas in situ and invasive relapses were HER2 positive in 42.9% and 34.5% respectively.

    CONCLUSIONS:Receptor conversion for ER, PR and HER2 status occurred between primary DCIS and corresponding local relapse in 10-30%. This study could not confirm that HER2 overexpression in primary DCIS had any impact on tumour progression to invasive cancer which has been proposed.

  • 5.
    Larsson, Maria
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Bjuresater, Kaisa
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    A Supportive Nursing Care Clinic for Patients With Head and Neck Cancer: Effects on Nutritional Status and Health Related Quality of Life2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, p. S325-S326Article in journal (Other academic)
  • 6.
    Larsson, Maria
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing. Univ Karlstad, Dept Nursing, Karlstad, Sweden..
    Bjuresater, Kaisa
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing. Univ Karlstad, Dept Nursing, Karlstad, Sweden..
    A Supportive Nursing Care Clinic for Patients With Head and Neck Cancer: Effects on Nutritional Status, Nutritional Treatment and Admissions to Hospital2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, p. S298-S298Article in journal (Other academic)
  • 7.
    Larsson, Maria
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Olsson, Cecilia
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kaisa, Bjuresäter
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sexual problems in patients with head and neck cancer- an area in need of further attention.2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852Article in journal (Refereed)
    Abstract [en]

    Background: Studies show that the incidence of sexual dysfunction ranges between 40% and 100% in patients where the tumor and treatment have a direct impact on sexuality. Head and neck cancer is a physically and emotionally devastating disease. Unlike other forms of cancer the disease and side-effects of treatment cannot be hidden as tumors of the head and neck affect the most visible area of the body. Treatment include surgery, radiotherapy and chemotherapy often in combination leading to severe side-effects such as facial disfigurement, pain in the mouth and throat, thick and ropy saliva and taste changes leading to malnutrition and loss of energy and strength.  In addition, fatigue, social isolation and low self esteem – factors that are known to influence sexuality – are common and apparently, patients with head and neck cancer are at high risk to develop sexual problems. However, little is known regarding sexual problems and sexual adjustments among this group of patients under treatment as well as during the rehabilitation period. Therefore this study was conducted with the objective to examine occurrence of sexual problems during and after the medical treatment.

    Materials and method: In this descriptive study 40 consecutive patients treated with surgery and radiotherapy for head and neck cancer participated. Data were collected each week during radiotherapy and six and twelve months after completed radiotherapy using EORTC QLQ-30 and EORTC H&N35, for health-related quality of life. The questionnaires include specific questions regarding sexual functioning and sexual desire. Descriptive and non-parametric statistics were used.

    Results: Sexual problems were common and were reported to occur quite a lot or a lot by 60% after completed radiotherapy, 30% after six months, and by 32 % after one year. Data analysis is ongoing and further results will be presented at the conference.

    Conclusions: Sexual problems are common in patients with head and neck cancer and this issue needs to be further studied

  • 8.
    Olsson, Cecilia
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Bjuresäter, Kaisa
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Larsson, Maria
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Affected sexuality, body image and health related quality of life in patients treated for hematologic malignancies - a one year follow-up2015In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, p. S252-Article in journal (Refereed)
    Abstract [en]

    Background: Longitudinal studies examining sexuality, body image and health-related quality of life (HRQoL) in middle-aged and elderly patients treated with chemotherapy or chemoimmunotherapy for hematologic malignancies are lacking. The aim of this study was to describe and explore changes in sexuality, body image and HRQoL in patients treated

    for hematologic malignancies, from baseline until twelve months after treatment.

    Material and Methods: Patients above 45 years treated for Diffuse large B-cell Lymphoma (DLBCL), Chronic Lymphocytic Leukemia (CLL) or Acute Myeloid Leukemia (AML). Data were collected at baseline (n = 32), one (n = 25), six (n = 20) and 12 months (n = 19) after treatment by means of three instruments: The Sexual Adjustment Questionnaire (SAQ), The

    Body Image Scale (BIS) and The European Organization for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30, version 3). Descriptive- and non-parametric statistics were used.

    Results: One month after treatment scores were lowered regarding sexual interest (P = 0.005), sexual function (P = 0.031), sexual satisfaction (P = 0.016, P = 0.004) and sexual relationship. After six months the patient reported scores had returned almost entirely to baseline scores, except for sexual relationship. At 12 months, sexual relationship was still negatively affected. Body image was reported to be affected in a low extent during

    the study period. After six and 12 months, body image was reported to not be affected at all by 50% and 53%, respectively. However, women reported body-image to be more affected than men at one (P = 0.01) and 12 months (p = 0.021). Regarding HRQoL, patients reported gradually statistically significant improved scores during the study period.

    Conclusion: In this study, sexuality, body image and HRQoL became negatively affected in patients with hematologic malignancies 45 years and older during treatment. Improvements were gradually seen after treatment, but the scores regarding sexual relationship were still affected after one year. Although sexual interest was reported to be low this finding highlights the need of support to these patients regarding sexuality during follow-up care. Furthermore, body image was more affected in women than in men indicating that interventions should be adjusted for sex. This was a small study and future studies with larger sample are needed.

  • 9. Påhlman, S
    et al.
    Hoehner, J C
    Nånberg, Eewa
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för genetik och patologi.
    Hedborg, F
    Fagerström, S
    Gestblom, C
    Johansson, I
    Larsson, U
    Lavenius, E
    Ortoft, E
    Differentiation and survival influences of growth factors in human neuroblastoma.1995In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 31A, no 4, p. 453-458Article in journal (Refereed)
    Abstract [en]

    Human neuroblastoma cell lines are established from high-stage, highly malignant tumours. Despite this and the fact that these tumours are arrested at an early, immature stage, many cell lines have the capacity to undergo neuronal differentiation under proper growth conditions. One such cell line is the noradrenergic SH-SY5Y cell line. These cells can be induced to mature by a variety of modalities, resulting in different mature phenotypes. The use of this cell system as a model to study the stem cell character of neuroblastoma is reviewed and discussed. In particular, we focus on growth factor dependencies in the SH-SY5Y system, and compare that to the normal situation, i.e. growth factor control of sympathetic neuronal and neuroendocrine differentiation during human and rat embryogenesis.

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