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Background: Dosage of chemotherapy for colon cancer is currently based on the patient's body surface area. Several studies have identified an association between low fat-free mass and chemotherapy toxicity among patients with metastatic colorectal cancer. This has been less widely studied for localised disease. This review aims to summarise studies that have investigated the association between clinical signs of disease-related malnutrition (low body mass index, weight loss and low muscle mass) and tolerance of chemotherapy in patients with localised colon cancer., Material and Method: We conducted a systematic search in PubMed with various synonyms of the terms 'colorectal cancer', 'adjuvant chemotherapy', 'nutritional status' and 'toxicity'. The search was concluded in May 2019. Of 553 articles, 39 were considered relevant and read in full text. Ten of these fulfilled the inclusion criteria for this review., Results: Nine of the ten studies indicate an association between clinical signs of disease-related malnutrition and dose-limiting toxicity. The association appears to be especially pronounced in patients with low fat-free mass., Interpretation: The results support the hypothesis that there is an association between disease-related malnutrition and the prevalence of toxicity and modification of the course of adjuvant chemotherapy in patients with localised colon cancer. The potential benefits of basing chemotherapy dosage on body composition in addition to body surface area should be investigated in clinical trials.

Background: The National Cancer Plan (NCP) provided the incentives needed to establish a technical infrastructure adequate to meet the medical needs of radiotherapy in cancer care. The goal of this study is to evaluate the development of radiotherapy in South-Eastern Norway Regional Health Authority (S-E NRHA) and to compare it with the aims of NCP., Material and Methods: The material includes the 86,000 courses of radiotherapy performed in S-E NRHA in the period 1985-2008. The data were extracted from existing patient registries and include cancer diagnosis and patient demographic information. The number of treatment series is coupled with cancer incidence of each county and that in S-E NRHA., Results: During the latter half of the 1980s, radiotherapy was only offered to 50 % (range 30-60 % in the various counties) of those who needed it. The situation had improved in 2007, when this figure was close to 80 %, but there was still a significant discrepancy between counties (67-91 %). With respect to the medical needs, 10 000 additional courses of radiotherapy should have been performed in S-E NRHA in the period 2003-2007., Interpretation: The demonstrated insufficient use of radiotherapy and the geographical differences between counties are not acceptable. A prerequisite for optimal use of radiotherapy in cancer treatment is that the medical professions strengthen their oncological competence.

Background: While it is widely accepted that periconceptional supplement of 400 microg (microgram) folic acid reduces the risk of neural tube defects in pregnancy, it remains to be established whether folic acid has other beneficial effects on larger population groups. Evidence concerning effect of increased intake on cardiovascular disease, cancer and other diseases has recently been evaluated in a report to the Directorate of Health and Social Welfare in Norway., Material and Methods: Research reports published mainly from 1998 to 2003 on folic acid intake and disease have been evaluated., Results: Sufficient evidence that increased folic acid intake may prevent cancer or cardiovascular diseases is not yet available, hence at present there is no indication for recommending augmented intake for other groups than fertile women. However, several intervention studies with folic acid supplementation are in progress to establish its effect on cardiovascular mortality and morbidity., Interpretation: If the ongoing intervention studies show a beneficial clinical effect on cardiovascular disease, it would be a further argument for fortification of foods, in addition to reducing the risk of neural tube defects in pregnancy.

Background: In order to prevent neural tube defects, a daily supplement of 400 microg (microgram) folic acid has been recommended in Norway since 1998, during the last month before conception and the first two or three months of pregnancy. Compliance with and effects of this recommendation has recently been evaluated in Norway in a report to the Directorate of Health and Social Welfare., Material and Methods: Reports published on periconceptional folic acid intake in Norway and some other countries from 1998 to autumn 2003 have been evaluated., Results: In spite of several information activities, few Norwegian women start folic acid supplementation before verified pregnancy. The supplementation is started too late for the prevention of neural tube defects. A reduction is not observed in Norway. Internationally, information has not proven effective either, whereas compulsory fortification of foods with folic acid has been associated with reduced incidence. Information about periconceptional folic acid intake should be intensified. Compulsory fortification of foods with folic acid will affect the whole population, not only the target group of fertile women. If ongoing large intervention studies show improved clinical prognosis for patients with cardiovascular disease, this will be an additional argument for fortification of foods.

Background: Clinical studies over the last 20 years using more intensive cytostatic regimens show improved results in children and adolescents with aggressive non-Hodgkin's lymphoma and in adult patients specifically with Burkitt's lymphoma., Material and Methods: We present a retrospective analysis of the use of the Berlin-Frankfurt-Munster (BFM) regimen for patients older than 15 years from three Norwegian university hospitals during the 1992-99 period., Results: Survival data for 24 patients 15-69 years old with Burkitt's lymphoma/B-cell acute lymphoblastic leukaemia (B-ALL) show an estimated overall five year survival of 70% (75% for Burkitt's lymphoma only). Eight of ten adolescent patients 15-20 years old with other aggressive lymphomas were alive and disease free at last follow-up. All nine patients given the regimen after failure of prior therapy died of lymphoma within six years., Interpretation: The BFM regimen yields impressive results as the primary treatment of adolescent and adult patients with Burkitt's lymphomas/B-ALL.

Background: Physical activity has been an important influence on the evolution of our gene pool and the optimal functioning of our body. Physical activity has recently been discussed as important in relation to cancer-risk., Material and Methods: A total of 182 studies related to the association between physical activity and risk of cancer are included in the present study. We have used international accepted criteria in the validation of the strength of the association between a potential risk factor and cancer-risk., Results: We conclude that there is convincing evidence that physical activity reduces the risk of colon cancer: the evidence is probable for breast cancer and possible for prostate, endometrial and lung cancer. Physical activity does not have any influence on rectal cancer. The evidence for all the remaining cancer sites reviewed remains insufficient to make any conclusions at this time. No increased risk due to high levels of physical activity has been observed for any cancer type. Physical activity has an independent protective effect on site-specific cancer; this effect cannot be explained by potentially confounding factors such as body mass or diet., Interpretations: We recommend including physical activity as a modifiable risk factor in order to reduce cancer risk throughout life. More studies focusing on biological mechanisms are needed. Furthermore, improvements in the physical activity assessments used associated with site-specific cancer risk is needed. Finally, there is a need for intervention studies designed to study the carcinogenic process and the specific cancer type with biological markers and intermediate steps in the development of cancer.

Background: In the past, patients suffering from cancer and other chronic diseases were told to avoid physical activity in order to rest and reduce discomfort. Recently, many studies have published new scientific evidence which indicates that physical activity may be an important factor in the rehabilitation for several chronic diseases. However, less is known about the importance of physical activity in the treatment and rehabilitation of cancer patients., Material and Methods: We performed a search on Medline and Pubmed. A total of 38 studies focusing on the importance of physical activity in the treatment and rehabilitation of cancer patients are included in the present study., Results: The performed studies that have assessed the effects of physical activity on quality of life following cancer diagnosis, consistently suggest that physical activity may improve quality of life for cancer patients and influence fatigue. No information exists on whether physical activity increases survival. The limitations of these clinical studies include small sample size, lack of adjustment for possible confounders, and short intervention spans., Interpretation: Physical activity is not part of the usual cancer rehabilitation program, yet clinical studies are promising and important. More studies are needed to improve our understanding of the effects and feasibility of physical activity for different groups of cancer patients. Furthermore, the importance of physical activity in relation to surgery, current conventional chemotherapy and radiation for these patients needs to be studied if we are to reduce the knowledge gap regarding the potential role of exercise in rehabilitation programmes for cancer patients compared with patients with other chronic diseases.