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Ing-Marie Olsson,1,2 Marlene Malmström,1,2 Lisa Rydén,2,3 Ulrika Olsson Möller1,4 1Department of Health Sciences, Lund University, Lund, Sweden; 2Skåne University Hospital, Malmö, Sweden; 3Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden; 4Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, SwedenCorrespondence: Ing-Marie Olsson, Department of Health Sciences, Lund University, Box 157, Lund, 221 00, Sweden, Tel +46 701453530, Fax +46 40333674, Email Maivor_ing-marie.olsson@med.lu.seBackground: A substantial proportion of women with breast cancer (BC) experience a wide range of long-term persistent and troublesome side effects related to the disease and its treatment. The ReScreen randomized controlled trial is conducted aiming to evaluate the effect of early screening of distress followed by individualized rehabilitation after primary BC treatment.Purpose: To examine recruitment, retention, distribution of distress, relevance of intervention and reported problems in a pilot trial of the ReScreen RCT.Patients and methods: Based on international research, a cutoff of ≥ 7 on the Distress Thermometer was used to identify women in need of extended support. Those who reported high distress were randomized to intervention group (IG, n = 9) or control group (CG, n = 9), while women with low distress formed an observational group (OG, n = 67). Self-reported data was collected at baseline, 2 weeks and 3, 6, 9, and 12 months after start of treatment. The participants were recruited from a BC unit in Sweden. Descriptive statistics were used for analyses.Results: Eighty-five patients consented to participate. The recruitment rate was 73%, answer frequency was 98%, 64%, 95%, and retention rate was 100%, 56%, 91% in the IG, CG and OG, respectively. Few systematic errors were identified. When exploring the distribution of distress, it was evident that the participants scoring ≥ 7 were fewer (21.2%) than reported in previous studies (34– 43%). The most commonly problems reported were in line with previous reports of symptoms, including fatigue and worry.Conclusion: The satisfactory rates of inclusion and data collection and the few systematic errors indicate that the ReScreen study is feasible if well planned and executed. To identify patients in need of extended support, an adjustment of the cutoff in the main study is indicated. Based on self-reported problems, the intervention was found relevant in this context.Keywords: breast cancer, distress, fatigue, feasibility, rehabilitation, screening

Linn Rosell, 1, 2 Jessica Wihl, 1–3 Mef Nilbert, 2, 4, 5 Marlene Malmström 6, 7 1Regional Cancer Centre South, Region Skåne, Lund, Sweden; 2Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, Sweden; 3Department of Oncology and Hematology, Skåne University Hospital, Lund, Sweden; 4Clinical Research Centre, Hvidovre Hospital and Copenhagen University, Copenhagen, Denmark; 5Danish Cancer Society Research Centre, Copenhagen, Denmark; 6The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; 7Lund University, Faculty of Medicine, Department of Health Sciences, Lund, SwedenCorrespondence: Marlene MalmströmLund University, Department of Health Sciences, Box 157, Lund 22 100, SwedenTel +46 46 175950Email marlene.malmstrom@med.lu.sePurpose: Multidisciplinary team meetings (MDTMs) are an integral component of cancer care. Increasingly, virtual MDTMs are used to grant high-quality treatment recommendations across health-care regions, which expands and develops the local MDTM team to a regional or national expert network. We investigated health professionals’ experiences from national, virtual MDTMs for rare cancer with a focus on key enabling factors and barriers.Methods: Health professionals who participate in seven national, virtual MDTMs in Swedish health-care responded to a questionnaire exploring key enabling factors, barriers and opportunities for MDTM development. Conventional content analysis was used to identify thematic categories based on free-text responses.Results: Participants´ perspectives could be assigned into three categories ie, a national arena with potential for comprehensive knowledge and collaboration, prerequisites for decision-making and organization and responsibilities. These categories consisted of nine sub-categories that referred to, eg, collective competence, resources, clinical research, case discussion, meeting climate, patient-related information, MDTMs potential, referral and technical insufficiencies.Conclusion: National, virtual MDTMs represent a new multidisciplinary collaborative arena that introduces benefits as well as challenges. Consideration of key enabling factors and barriers may ease implementation and further optimize MDTMs in cancer care.Keywords: tumor board, rare cancer, healthcare team, treatment recommendation, decision-making, content analysis

Background: This article examines whether the neighbourhood environment influences intermediate cardiovascular disease (CVD) risk factors, such as obesity (body mass index [BMI]), and lifestyle factors, such as no physical activity and smoking, when adjusted for the individual socioeconomic status (SES).Methods: The study consists of face-to-face interviews from the Swedish Annual Level of Living Survey (SALLS) matched with the social status of the respondents' residential areas measured by two composite indices, the Care Need Index (CNI) and the Townsend score. The response rate was about 80%. This study was limited to the residents aged 25-74 years and consists of 9240 interviews from the years 1988-1989, when there were extended items in the SALLS about health and lifestyle. The data were analysed using a hierarchical logistic regression model.Results: There was a gradient within every SES group so that respondents with a low (or intermediate or high) educational level exhibited an increasing proportion of daily smokers, physically inactive people and obese individuals with increasing neighbourhood deprivation. The multilevel model showed that respondents living in the most deprived neighbourhoods had an increased risk for being a daily smoker, engaging in no physical activity and being obese when adjusted for the individual SES.Conclusions: We showed that the area level has an important influence on risk factors for CVD which goes beyond the individual educational attainment. An increased level of living standard, more resources for primary health care and health promotion targeting the community level should be beneficial. [ABSTRACT FROM AUTHOR]

Objective: To compare the distribution and the amount of transforming growth factor beta (TGF beta) in labial salivary glands (LSG) in patients with Sjögren's syndrome (SS) and healthy controls.Methods: LSG from SS patients (n = 10) and healthy controls (n = 6) were labelled with peroxidase-antiperoxidase staining for TGF beta 2, which was quantitated in image analysis using Video Interactive Display System software.Results: In all LSGs in SS and healthy controls, TGF beta 2 was found in endothelial cells of the capillaries and in the capsular and stromal fibroblasts. In LSGs in SS, TGF beta 2 was also found in some lymphocytes in the inflammatory cell foci and in fibroblasts in fibrotic areas. The TGF beta 2 staining index (microns 2/mm2 tissue) was greater in SS than in control LSGs (3670 (SEM 430) v 2061 (176); p < 0.01), with no difference between the primary and secondary forms of SS (p > 0.05).Conclusion: The localisation and the level of expression of TGF beta 2 indicate its involvement in local tissue fibrosis, and may reflect attempts at immunosuppression. [ABSTRACT FROM AUTHOR]

Mast cells in labial salivary glands obtained from patients with xerostomia with or without focal sialadenitis/Sjögren's syndrome were studied. There was no significant correlation between the intensity of local lymphocyte infiltration and the morphometrically analysed number of mast cells staining positive with toluidine blue. Histamine staining with heterologous 11C antiserum showed significantly fewer positive cells than staining with toluidine blue (mean (SD) 62 (10) v 138 (30)). This suggests heterogeneity of the mast cell population. Furthermore, there was a correlation between the focus score and the number of mast cells containing histamine. This suggests that the proliferation of mast cells containing histamine may be locally regulated by the immune inflammation, possibly through mediators from macrophages and fibroblasts. In contrast, the number of mast cells staining positive with toluidine blue could not be used as a marker of the degree of local inflammation. Although transmission electron microscopic analysis did not disclose signs of 'en masse' mast cell degranulation, mast cells may have a role in the local disease process. [ABSTRACT FROM PUBLISHER]

Local lymphoplasmacytoid infiltration of the diseased exocrine glands is a cardinal sign of Sjögren's syndrome (SS). The state of T lymphocyte activation present in these local infiltrations was studied by three different techniques: determination of interleukin 2 (IL2) receptor (Tac) on cell surface membrane; autoradiography combined with immunoperoxidase staining of T cell epitopes; and electron microscopic analysis of the lymphoblast subclasses. Although 64 (SEM 4)% of the local inflammatory cells expressed Ia antigen, only 4 (SEM 1)% of them displayed the T cell activation antigen Tac. Autoradiography-immunoperoxidase double labelling showed that less than 1% of all T cells in situ were [3H]thymidine incorporating blasts. This finding suggests that although T lymphocyte is the dominant cell in situ, only a few of these cells have passed the G0/G1 interphase, and even fewer have been pushed to the S phase of the cell cycle by IL2. Transmission electron microscopy showed that few T blasts were present, even though there were many plasma cells. This result further confirms the impression that only a minor T cell subpopulation in situ is blast transformed despite the fact that many of the local T lymphocytes in the diseased salivary glands in SS are Ia positive. [ABSTRACT FROM PUBLISHER]

Katarina Velickovic,1 Ulrika Olsson Möller,1– 3 Lisa Ryden,4,5 Pär-Ola Bendahl,4 Marlene Malmström1,3 1Department of Health Sciences, Lund University, Lund, Sweden; 2Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden; 3Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; 4Department of Clinical Sciences Lund, Lund University, Lund, Sweden; 5Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, SwedenCorrespondence: Katarina Velickovic, Department of Health Sciences, Lund University, Sölvegatan 19, Lund, 223 62, Sweden, Email katarina.velickovic@med.lu.sePurpose: Resilience has been suggested as an important predictor of both physical and mental health-related quality of life in breast cancer patients. However, it is unclear why resilient women handle their diagnosis better, not only mentally, but also physically. The aim of this study was to investigate paths between resilience, physical activity, and mental, physical, and global health-related quality of life in breast cancer patients.Patients and Methods: Structural equation modeling was conducted to evaluate the proposed structural paths using a sample of 638 women with newly diagnosed breast cancer patients from Sweden.Results: Resilience was directly associated with physical activity and mental health-related quality of life. It was indirectly associated with physical functioning, through mental health-related quality of life and physical activity. Resilience was also indirectly associated with global quality of life, through mental health-related quality of life.Conclusion: Mental health support and encouraging physical activity may be especially relevant to enhance all aspects of health-related quality of life early in the breast cancer process. Results should be replicated longitudinally.Plain Language Summary: Receiving a breast cancer diagnosis can be highly disruptive to one’s worldview and sense of normalcy. Many women with breast cancer describe the diagnostic period as even more stressful than receiving treatment. However, some women handle their breast cancer diagnosis better than others. Resilience is a psychological trait that refers to one’s ability to cope with highly stressful events and maintain good wellbeing despite adversity. More resilient women were shown to handle a breast cancer diagnosis better, not only mentally, but also physically. They also describe their quality of life as higher than low resilient women. However, it is unclear why resilient women have not only better mental health, but also physical health. In this study, we addressed this question by examining the relationships between resilience, mental health, physical functioning, physical activity, and patients’ self-reported quality of life. We found that mental health and physical activity explained the relationship between resilience and physical functioning and self-reported quality of life. This suggests that highly resilient women experience less psychological distress following a breast cancer diagnosis and are more inclined to maintain physical activity during this stressful period. Consequently, they may manage to have better physical functioning and evaluate their quality of life as better. This study highlights the importance of psychosocial support and encouraging physical activity in women with breast cancer who may struggle to cope with their diagnosis. This study implies that this can not only alleviate psychological distress, but also aid one’s physical functioning and overall quality of life.Keywords: structural equation modeling, psychological distress, physical activity, newly diagnosed breast cancer, health-related quality of life

Background: Individualized cancer rehabilitation should be an integral part of cancer care. Contact nurses play a key role in identifying patient needs and coordinating evidence-based interventions to support rehabilitation. However, cancer rehabilitation remains marginal in current practice, as contact nurses face challenges due to the lack of systematic processes for assessment, intervention, and follow-up, limiting its implementation across the cancer care trajectory. This study aims to explore contact nurses in cancer care views on their role in and prerequisites for cancer rehabilitation., Methods: Data were collected through 20 individual interviews with contact nurses working in Swedish cancer care and analyzed using qualitative content analysis., Results: A holistic approach to cancer rehabilitation was emphasized, yet establishing routines for assessment and addressing patients' changing needs was described as challenging. Contact nurses experienced themselves as responsible for rehabilitation even though their role often was unclear. Rehabilitation was further seen as a process often determined by the medical trajectory rather than patients' needs. To establish prerequisites for cancer rehabilitation supportive leadership and sufficient resources is essential., Conclusion: There is a gap between cancer rehabilitation guidelines and their implementation in clinical practice, emphasizing the need for structure to support contact nurses to provide evidence-based individualized cancer rehabilitation. To enable cancer rehabilitation, supportive leadership at the organizational level is essential for contact nurses to establish routines in their clinical practice. These routines should align the rehabilitation process with patient needs, ensuring that rehabilitative services are effectively integrated into regular healthcare visits., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted adhering to the principles of the Helsinki Declaration [42] and was approved by the Regional Ethics Review Board in Gothenburg, Sweden (registration number 2022-03764-01). All heads of departments signed an informed consent form with permission to contact eligible CNCCs. All participants received written and oral information and signed informed consent prior to the interview. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Treatment for breast cancer poses major challenges and leads to a variety of side-effects and problems that affect life for a long time. Experiences and symptoms vary, and research indicates a lack of structures for ensuring individualized rehabilitation. This qualitative focus group study aims to explore the experience of women with BC after participating in a complex randomized controlled trial (RCT) (Clinicaltrials.gov NCT03434717) focusing on cancer rehabilitation from a comprehensive perspective., Method: Nine semi-structured focus group interviews with women (n = 30) who participated in the Rescreen RCT were conducted. The women were interviewed divided into three RCT groups (intervention, control, or observation group). Data were initially analyzed inductively using conventional content analysis, followed by a deductive approach, guided by the result from the inductive analysis., Results: The inductive analysis resulted in two categories and four sub-categories and showed a great variation in experiences and needs. Some women described a well-functioning process, while others described lack of individualized information, continuity with healthcare providers, and clear pathways for support. After the deductive analysis, a variation between the groups appeared. Women in the intervention group expressed that a proactive and individualized approach facilitated rehabilitation and they experienced a feeling of being recognized as a person, which they highlighted as important. On the contrary, women from the control group described feelings of being abandoned from healthcare, hindering rehabilitation. The observation group expressed that their needs had been fulfilled within the healthcare system., Conclusions: This study adds important knowledge to the evaluation of the ReScreen model and contributes to existing research on how individualized rehabilitation after breast cancer can be applied in clinical practice. A proactive, person-centered approach in rehabilitation, aimed at those with extended needs, would potentially optimize rehabilitation and facilitate the recovery process after breast cancer treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Olsson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Family members play a crucial role in supporting women with breast cancer during their recovery. In the complex situation of being an informal caregiver, their own health and ability to support the patient needs to be acknowledged. The aim was to explore the experiences, needs and roles of family members throughout the rehabilitation process of women with breast cancer., Methods: A qualitative study was conducted, involving semi-structured individual telephone interviews with 20 purposefully selected family members of women with breast cancer (13 men aged 24-79 years, 7 women aged 19-76 years). Data analysis utilized conventional content analysis and used "casing" as the analysis technique. The study is part of the ReScreen randomized controlled trial and all participants gave informed consent., Results: The interviews revealed significant variation among family members, leading to the emergence of different typologies based on their reactions and specific preconditions. These typologies included: 1) The case of the assertive and confident team leader, 2) The case of the frustrated but persistent guardian, 3) The case of the reassured bystander, and 4) The case of the neglected outsider. While not mutually exclusive, the cases demonstrated clear similarities and differences in whether individuals felt secure or insecure in the rehabilitation process and their level of involvement in this process. Some described feelings of being involved and active in the process while others experienced not being involved and described feelings of abandonment. However, regardless of their role, family members reported that their own health was seldom considered by healthcare professionals., Conclusions: This study sheds light on the concept of "we-disease," where the role of a family member is interrelated with factors such as their health literacy, supporting role, level of involvement, relationship, and identity during the patient's rehabilitation process. This highlights significant divergence in whether family members perceive the rehabilitation process as a collaborative effort or an individual challenge. These perceptions greatly impact their own well-being and ability to support women with breast cancer, underscoring the importance of recognizing family members as informal caregivers and offering tailored support from healthcare professionals when needed., Trial Registration: ClinicalTrials.gov NCT03434717. Registered February 15, 2018., Competing Interests: Declarations. Ethical approval and consent to participate: This study was a part of the ReScreen study that was approved by the Regional Ethical Review Board in Lund, Sweden (Dnr 2015/505) and Swedish Ethical Review Authority (amendments 2018/924, 2020–04664). The potential participants received oral and written information about the study on several occasions and were given time to consider their participation. They were assured confidentiality and that they could decline participation or withdraw from the study at any time. Written informed consent was obtained from all family members willing to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Cancer affects not only the person with the disease but those around them. Being a family member is described as strenuous and, often, associated with stress, anxiety and feelings of loneliness. There is a heightened risk of distress for family of those with fast-progressing, severe oesophageal or gastric cancer. Early palliative care involving family is vital yet often overlooked. In order to include family members in early palliative care their management in everyday life needs to be explored., Method: Qualitative inductive interview study using content analysis guided by Graneheim and Lundman., Result: The analysis resulted in the overarching theme "Managing the disease together but still alone". Three categories were identified: Adapting to the disease, Taking control of the situation, Processing emotions. Each category described family members management in various aspects of everyday life together with the ill person and alone., Conclusion: The results may contribute to an awareness of family members' management of large parts of everyday life and, further, their feelings of loneliness, and indicates that family members should be included early in oesophageal or gastric cancer palliative care. Further studies are needed to develop the content of such family-inclusive early palliative care., (© 2024. The Author(s).)

Background: A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development., Method: This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%., Results: Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021)., Conclusions: Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions., (© 2023. The Author(s).)

Background: Multidisciplinary team meetings (MDTMs) represent an integral component of modern cancer care and have increasingly been implemented to ensure accurate and evidence-based treatment recommendations. During MDTMs, multiple and complex medical and patient-related information should be considered by a multi-professional team whose members contribute various perspectives. Registered nurses (RNs) are expected to share information on the patient perspective at MDTMs. However, research suggests that RNs' contributions to case discussions are limited and that patient perspective is generally underrepresented. Our aim was to explore RNs' views of the prerequisites for and barriers to the inclusion of the patient perspective in MDTMs in Swedish cancer care., Methods: Data were collected from four focus group interviews with 22 RNs who worked as contact nurses in Swedish cancer care. Interviews were transcribed and analysed using inductive content analysis., Results: The analysis identified two categories and five subcategories. The participants presented different views and expressed ambivalence about the patient perspective in MDTMs. Subcategories were related to medical versus holistic perspectives, the added value of patient perspective, and possibilities for patient contributions. The participants also discussed prerequisites for the patient perspective to be considered in MDTM decision-making process, with subcategories related to structures promoting attention to the patient perspective and determinants of RNs' contributions to case discussions in MDTMs., Conclusions: This study demonstrates various views related to the patient perspective in MDTMs and identifies a great need to clarify the RN's role. Our results indicate that if enhanced presentation of the patient perspective in MDTMs is desired, key information points and structures must be established to collect and present relevant patient-related information., (© 2022. The Author(s).)

Background: Patients with oesophageal and gastric cancer have a low likelihood of being cured and suffer from a broad spectrum of symptoms and problems that negatively affect their quality-of-life (QOL). Although the majority (67-75%) of patients at the time of diagnosis suffer from an incurable disease, research has primarily focused on the pre- and postoperative phase among patients treated with curative intent, with little attention to symptoms and problems in the diagnostic phase, especially in those who cannot be offered a cure., Methods: In this cross-sectional study 158 patients newly diagnosed with oesophageal and gastric cancer visiting the surgical outpatient department for a preplanned care visit were included consecutively during 2018-2020. The validated instruments QLQ-C30 and QLQ-OG25, developed by the European Organization for Research and Treatment of Cancer (EORTC), and selected items from the Integrated Patient Outcome Scale (IPOS) were used to assess QOL, symptoms and problems. Differences between patients with a curative and a palliative treatment strategy were analysed using t-test and Mann-Whitney U test. The QLQ-C30 and QLQ-OG25 scores were compared to published reference data on the general Swedish population., Results: Among all, the QOL was markedly lower, compared with general Swedish population (mean ± SD, 55.9 ± 24.7 vs 76.4 ± 22.8, p < 0.001). Compared to general population, the patients had significant impairment in all QOL aspects, particularly for role and emotional functioning and for symptoms such as eating-related problems, fatigue, insomnia and dyspnea. Majority of patients also reported severe anxiety among family and friends. Among patients with oesophageal cancer those with a palliative treatment strategy, compared with curative strategy, reported significantly lower QOL (mean ± SD, 50.8 ± 28.6 vs 62.0 ± 22.9 p = 0.030), physical (65.5 ± 22.6 vs 83.9 ± 16.5, p < 0.001) and role functioning (55.7 ± 36.6 vs 73.9 ± 33.3, p = 0.012), and a higher burden of several symptoms and problems. No significant differences between treatment groups were shown among patients with gastric cancer., Conclusions: Patients newly diagnosed with oesophageal and gastric cancer, and especially those with incurable oesophageal cancer, have a severely affected QOL and several burdensome symptoms and problems. To better address patients' needs, it seems important to integrate a palliative approach into oesophageal and gastric cancer care., (© 2022. The Author(s).)

Background: Population-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients., Methods: This is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI., Results: A total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI - 20 to - 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI - 33 to - 3)., Conclusions: One year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT., (© 2021. The Author(s).)

Background: Patients diagnosed with oesophageal and gastric cancer face a poor prognosis and numerous challenges of symptom management, lifestyle adjustments and complex treatment regimens. The multifaceted care needs and rapid disease progression reinforce the need for proactive and coherent health care. According to the national cancer strategy, providing coherent health care and palliative support is an area of priority. More knowledge is needed about health care utilization and the characteristics of the health care service in order to understand the readiness, accessibility and quality of current health care. The aim of this study was to describe individuals' health care use from the time of treatment decision until death, and investigate the impact of the initial treatment strategy and assignment of a contact nurse (CN) on health care use among patients with oesophageal and gastric cancer., Methods: This population-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Oesophageal and Gastric Cancer, the National Cause of Death Register, and the National Patient Register, 2614 individuals were identified. Associations between the initial treatment strategy and CN assignment, and health care use were investigated. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression., Results: Patients receiving palliative treatment and those receiving no tumour-directed treatment had a higher IRR for unplanned hospital stays and unplanned outpatient care visits compared with patients who received curative treatment. Patients receiving no tumour-directed treatment also had a lower IRR for planned hospital stays and planned outpatient care visits compared with patients given curative treatment. Compared with this latter group, patients with palliative treatment had a higher IRR for planned outpatient care visits. Patients assigned a CN had a higher IRR for unplanned hospital stays, unplanned outpatient care visits and planned outpatient care visits, compared with patients not assigned a CN., Conclusions: A palliative treatment strategy and no tumour-directed treatment were associated with higher rates of unplanned health care compared with a curative treatment strategy, suggesting that a proactive approach is imperative to ensure quality palliative care., (© 2021. The Author(s).)

Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here., Competing Interests: The authors have declared that no competing interests exist.

Background: Oesophageal and gastric cancer are highly lethal malignancies with a 5-year survival rate of 15-29%. More knowledge is needed about the quality of end-of-life care in order to understand the burden of the illness and the ability of the current health care system to deliver timely and appropriate end-of-life care. The aim of this study was to describe the impact of initial treatment strategy and survival time on the quality of end-of-life care among patients with oesophageal and gastric cancer., Methods: This register-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Esophageal and Gastric Cancer, the National Cause of Death Register, and the Swedish Register of Palliative Care, 2156 individuals were included. Associations between initial treatment strategy and survival time and end-of-life care quality indicators were investigated. Adjusted risk ratios (RRs) with 95% confidence intervals were calculated using modified Poisson regression., Results: Patients with a survival of ≤3 months and 4-7 months had higher RRs for hospital death compared to patients with a survival ≥17 months. Patients with a survival of ≤3 months also had a lower RR for end-of-life information and bereavement support compared to patients with a survival ≥17 months, while the risks of pain assessment and oral assessment were not associated with survival time. Compared to patients with curative treatment, patients with no tumour-directed treatment had a lower RR for pain assessment. No significant differences were shown between the treatment groups regarding hospital death, end-of-life information, oral health assessment, and bereavement support., Conclusions: Short survival time is associated with several indicators of low quality end-of-life care among patients with oesophageal and gastric cancer, suggesting that a proactive palliative care approach is imperative to ensure quality end-of-life care., Competing Interests: The authors have declared that no competing interests exist.