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  • 1.
    Bränström, Richard
    et al.
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Petersson, Lena-Marie
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Saboonchi, Fredrik
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Wennman-Larsen, Agneta
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet; Sophiahemmet University.
    Alexanderson, Kristina
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Physical activity following a breast cancer diagnosis: Implications for self-rated health and cancer-related symptoms.2015In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, no 6, p. 680-685Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Studies have consistently shown an association between physical activity and increased health and well-being after a cancer diagnosis. Nevertheless, large proportions of breast cancer survivors do not meet recommended levels of physical activity. The aim of this study was to describe physical activity levels during the first two years after being diagnosed with breast cancer, and to explore the predictive ability of physical inactivity on longer-term self-rated health, physical symptoms, and psychological distress.

    METHOD: Study participants were women recently having had a first breast cancer surgery at one of the three main hospitals in Stockholm between 2007 and 2009. A total of 726 women were included and responded to six questionnaire assessments during the 24 months following diagnosis.

    RESULTS: Less than one third of the participants were sufficiently physically active at baseline. Physical activity decreased after surgery, increased at 8 month follow-up, and subsequently decreased slightly during the subsequent follow-up period. Physical inactivity was related to reduced health, increased symptoms such as pain, depression, and anxiety.

    CONCLUSION: This study provides additional support for the beneficial consequences of being physically active after a breast cancer diagnosis and highlights a potential target for intervention. This study provides additional support showing that being physically active even at a very low level seems to result in health benefits. Physical activity should be encouraged among patients treated for breast cancer.

  • 2.
    Edfeldt, Katarina
    et al.
    Uppsala universitet, Endokrinkirurgi.
    Ahmad, Tanveer
    Uppsala universitet, Institutionen för kirurgiska vetenskaper.
    Åkerström, Göran
    Uppsala universitet, Endokrinkirurgi.
    Janson, Eva T
    Uppsala universitet, Onkologisk endokrinologi.
    Hellman, Per
    Uppsala universitet, Endokrinkirurgi.
    Stålberg, Peter
    Uppsala universitet, Endokrinkirurgi.
    Björklund, Peyman
    Uppsala universitet, Endokrinkirurgi.
    Westin, Gunnar
    Uppsala universitet, Endokrinkirurgi.
    TCEB3C a putative tumor suppressor gene of small intestine neuroendocrine tumors2014In: Endocrine-Related Cancer, ISSN 1351-0088, E-ISSN 1479-6821, Vol. 21, no 2, p. 275-284Article in journal (Refereed)
    Abstract [en]

    Small intestinal neuroendocrine tumors (SI-NETs), formerly midgut carcinoids, are rare and slow-growing neoplasms. Frequent loss of one copy of chromosome 18 in primary tumors and metastases has been observed. The aim of the study was to investigate a possible role of TCEB3C (Elongin A3), currently the only imprinted gene on chromosome 18, as a tumor suppressor gene in SI-NETs, and whether its expression is epigenetically regulated. Primary tumors, metastases, the human SI-NET cell line CNDT2.5, and two other cell lines were included. Immunohistochemistry, gene copy number determination by PCR, colony formation assay, Western blotting, real-time quantitative RT-PCR, RNA interference, and quantitative CpG methylation analysis by pyrosequencing were performed. The large majority of tumors (33/43) showed very low to undetectable Elongin A3 expression and as expected 89% (40/45) displayed one TCEB3C gene copy. The DNA hypomethylating agent 5-aza-2'-deoxycytidine induced TCEB3C expression in CNDT2.5 cells, in primary SI-NET cells prepared directly after surgery, but not in two other cell lines. Also siRNA to DNMT1 and treatment with the general histone methyltransferase inhibitor 3-deazaneplanocin A induced TCEB3C expression in a cell type-specific way. CpG methylation at the TCEB3C promoter was observed in all analyzed tissues and thus not related to expression. Overexpression of TCEB3C resulted in a 50% decrease of clonogenic survival of CNDT2.5 cells, but not of control cells. The results support a putative role of TCEB3C as a tumor suppressor gene in SI-NETs. Epigenetic repression of TCEB3C seems to be tumor cell type-specific and involves both DNA and histone methylation.

  • 3.
    Johansson, Eva
    et al.
    Red Cross University College of Nursing. Karolinska Institutet.
    Larsen, Joacim
    Red Cross University College of Nursing.
    Schempp, Thérèse
    Red Cross University College of Nursing.
    Jonsson, Linnea
    Red Cross University College of Nursing.
    Winterling, Jeanette
    Red Cross University College of Nursing. Karolinska Institutet.
    Patients' goals related to health and function in the first 13 months after allogeneic stem cell transplantation2012In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 9, p. 2025-2032Article in journal (Refereed)
    Abstract [en]

    Purpose: Patient participation in goal setting and decision making is a core component of the rehabilitation process, but there is little information on what patients want to achieve after allogeneic stem cell transplantation (allo-SCT). The aim of this study was to describe adult patients' perceptions of goals related to health and function, as well as self-perceived limitations and facilitating strategies in the first 13 months after allo-SCT. Methods: Fifteen patients with a median age of 44 years (range, 22-65 years) were interviewed on one occasion during the first year after allo-SCT. Data were analysed using qualitative content analysis. Results: Results showed that patients felt that time after allo-SCT largely concerned: "to be healthy" and "to participate in a normal life". Some patients felt it was easy to set goals while others found it difficult. Most described goals had a long-term character. Patients were faced with a wide variety of limitations of which a few did not link to a described goal. Several facilitating strategies were described that either had or could help patients to reach their goals. Conclusions: Our results indicate that assistance with setting achievable goals, including individualised strategies and support from health care professionals to realise the goals, may assist in the rehabilitation to restore health and function after allo-SCT.

  • 4.
    Kästel, Anne
    et al.
    Astrid Lindgren Childrens Hosp, Paediat Oncol Unit, Stockholm.
    Enskär, Karin
    Jönköping Univ, Sch Hlth Sci, Dept Nursing Sci.
    Parental views on participation in childhood cancer care2007In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 49, no 4, p. 557-557Article in journal (Other academic)
  • 5.
    Lidén, Y.
    et al.
    Karolinska Institutet.
    Olofsson, N.
    Karolinska Institutet.
    Landgren, O.
    Karolinska Institutet / Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, USA.
    Johansson, Eva
    Red Cross University College of Nursing. Karolinska Institutet.
    Pain and anxiety during bone marrow aspiration/biopsy: Comparison of ratings among patients versus health-care professionals2012In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 16, no 3, p. 323-329Article in journal (Refereed)
  • 6.
    Saboonchi, Fredrik
    et al.
    Red Cross University College of Nursing. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Wennman-Larsen, Agneta
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden / Sophiahemmet University College, Stockholm, Sweden.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Swede.
    Brännström, Richard
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: Patterns of transiency and severity of the distress response.2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 598-604Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.

    AIM: To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery.

    METHODS: Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression.

    RESULTS: There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness.

    DISCUSSION: The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.

  • 7.
    Saboonchi, Fredrik
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Wennman-Larsen, Agneta
    Sophiahemmet University College.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Centre for Occupational and Environmental Medicine, Stockholm County Council.
    Trajectories of anxiety among women with breast cancer: A proxy for adjustment from acute to transitional survivorship.2015In: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 33, no 6, p. 603-619Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination.

    AIM: To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within two years following BC surgery.

    METHODS: Survey data from a two-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and analysis of variance.

    RESULTS: A piece wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified of which a High Stable anxiety class showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties.

    CONCLUSION: Our results support an emphasize on the transitional nature of the stage that follows the end of primary active treatment, and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

  • 8.
    Saboonchi, Fredrik
    et al.
    Red Cross University College of Nursing. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet / Stress Research Institute, University of Stockholm.
    Wennman-Larsen, Agneta
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients2013In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 22, no 10, p. 2849-2856Article in journal (Refereed)
    Abstract [en]

    Purpose

    To examine the construct validity of the Swedish version of Hospital Anxiety and Depression Scale (HAD) in women with breast cancer.

    Method

    Acquired data on HAD from 727 women who recently had breast cancer surgery, were aged 20–63 years and worked before diagnosis, and had no previous breast cancer (n = 725) were subjected to confirmatory factor analysis examining the viability of three hypothesized measurement models.

    Results

    The analysis showed adequate fit to the data for both bi-dimensional and three-factorial models of HAD. The single-factorial model, however, was shown to have inferior fit to the data. Substantive correlations were found between anxiety and depression in the bi-dimensional model, and negative affectivity and anxiety in the three-factorial model of HAD.

    Conclusions

    The findings support the utility of scoring procedure based on the original bi-dimensional model, but add indication of co-occurrence of anxiety and depression in this patient population. The discriminant validity of a third factor of negative affectivity in a three-factorial model, however, remains unclear.

  • 9.
    Wennman-Larsen, Agneta
    et al.
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet; Sophiahemmet University.
    Nilsson, Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet; Department of Social Work, Karolinska University Hospital; Division of Social Work, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Olsson, Mariann
    Division of Social Work, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Fornander, Tommy
    Department of Oncology-Pathology, Karolinska Institutet; Department of Oncology, Karolinska University Hospital.
    Sandelin, Kerstin
    Department of Molecular Medicine and Surgery, Karolinska Institutet; Department of Breast and Endocrine Surgery, Karolinska University Hospital.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Can breast cancer register data on recommended adjuvant treatment be used as a proxy for actually given treatment?2016In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 22, p. 1-7Article in journal (Refereed)
  • 10.
    Wennman-Larsen, Agneta
    et al.
    Karolinska Institutet.
    Petersson, Lena-Marie
    Karolinska Institutet.
    Saboonchi, Fredrik
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Vaez, Marjan
    Karolinska Institutet.
    Consistency of Breast and Arm Symptoms During 
the First Two Years After Breast Cancer Surgery2015In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 42, no 2, p. 145-155Article in journal (Refereed)
    Abstract [en]

    Purpose/Objectives: To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms.


    Design: Prospective cohort study with two-year follow-up. 


    Setting: Three institutions in the Stockholm, Sweden, region.


    Sample: 645 women, aged 20–63 years, enrolled within 12 weeks of surgery for primary breast cancer. 


    Methods: Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis.


    Main Research Variables: Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer–specific quality-of-life questionnaire.


    Findings: Most participants had undergone breast-conserving 
surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years.


    Conclusions: Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms.


    Implications for Nursing: For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.

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