Bakgrund: Cancer är ett av de folkhälsoproblem som drabbar många människor i hela världen. På lång sikt kommer en tredjedel av Sveriges befolkning ha fått en cancerdiagnos. Cancer kan orsaka smärta, särskilt i de avancerade stadierna. Eftersom smärta är en subjektiv upplevelse spelar sjuksköterskans kunskap om smärta en viktig roll.  Bristande kunskap hos sjuksköterskan kan leda till att patientens smärta blir underbehandlad och ökar risken för att lidandet blir ännu större samt att upplevelsen av cancervården försämras Syfte: Syftet är att beskriva patienternas upplevelse av vård vid cancerrelaterad smärta Metod: En systematisk litteraturöversikt som bygger på tio granskade artiklar där artiklar med kvalitativa och mixade metoder använts. Valda artiklar analyserades utifrån Fribergs beskrivning av kvalitativ analys som bygger på fem steg  Resultat: Efter analys av datamaterialet identifierades tre teman: betydelsen av information och att dela kunskap, betydelsen av smärtlindring och alternativa behandlingsmetoder och betydelsen av närvaro, stöd och kontinuitet Sammanfattning: Sjuksköterskans kunskap är av stor betydelse när det gäller vård av personer med cancer. Sjuksköterskekunskaper relaterade till smärthanteringsstrategier har visat sig vara otillräckliga. Denna litteraturöversikt kan vara användbar för alla sjuksköterskor inom cancervården, eftersom den tar upp nödvändig kunskap som behövs i vården av personer med cancer / Background: Cancer is one of the public health diseases that afflict many people around the world. In the long run, three parts of Swedish population will be diagnosed with cancer. Cancer can cause pain, especially in the advanced stage. Pain is a subjective experience; therefore, the nurse's knowledge of pain plays an important role. Lack of knowledge among nurses can lead to patient pain being undertreated and increases risk of suffering among patients as well as giving them a bad experience of cancer health care Aim: The aim is to describe patients´ experiences of care related to cancer pain Method: A Systematic literature review based on ten reviewed articles where articles with a qualitative and mixed method were used. The selected articles were analyzed based on Friberg's description of qualitative analysis based on five steps Results: After analysis of data material, three themes were identified: the importance of information and sharing knowledge, the importance of pain relief and alternative treatment methods and the importance of presence, support, and continuity Conclusion: Nurse knowledge is of great importance when it comes to care for a person with cancer. Nursing skills related to pain management strategies have been found to be insufficient. This literature review can be useful to all nurses within cancer care because the article has addressed the needed knowledge in the care of person with cancer

Pancreatic cancer is the seventh leading cause of cancer related mortalities worldwide and incidences are increasing. The prognosis remains poor as the 5-year survival rate is below 10%. This can be partly explained by the silent progression of disease as most patients present with advanced disease at time of diagnosis. In turn, surgical resection, the only potential curative measure, is not possible in nearly 80% of cases due to the occurrence of distant metastasis and/or infiltration of major vessels in close proximity to the pancreas. In patients with localized but advanced disease, resectability can be achieved in some cases by initiation of a neoCTx. However, as neoCTx is commonly conducted by administering multi-drug treatments, severe side effects occur frequently, which require an adaption of drug doses administered. In this study, we revealed the negative impact of these drug dose changes during neoCTx on the patients´ treatment outcome. R0 resections were significantly less frequently observed, and the N-status significantly impacted by the tumor regression grade, which in turn trended towards minor response in the cohort of patients that did not sustain full dose course prior surgery. In turn, treatment of LA PDAC could be improved by increasing the proportion of patients that undergo neoCTx without any changes of the treatment schedule. Patient-derived PDAC organoid could serve as an avatar of patients´ tumor disease on which optimal treatment protocols could be tested. In this study, a large living PDAC PDO biobank successfully has been established from surgical resection specimens as well as EUS guided FNA samples. Subsequently, a new protocol for molecular subtyping of PDAC on organoids was established by assessing the expression level of KRT81 and CFTR, as a replacement for HNF1a, using IF staining. Strikingly, we observed identical PDAC subtypes in PDOs and their respective tissue of origin in nearly all cases. This observation allowed the assumption that PDOs could indeed be used as patient-individual avatars to identify treatment sensitivities and resistances, as they share fundamental molecular properties with the tissue they have been initiated from. Extensive pharmacotyping was performed for many PDO lines by testing the response behavior to the multi-drug regimens FOLFIRINOX and Gem/Pac, as well as their respective single drug compounds. As a result, we observed diverse response patterns for each PDAC PDO line. A poor response to FOLFIRINOX did not necessarily imply a resistance to Gem/Pac. PDO pharmacotyping could guide treatment decision making in the foreseeable future. Moreover, when the non-efficient drug was removed, no changes of overall efficacy of treatment in PDOs was observed, implying that additional therapy improvements could be possible using this ex vivo model. This observation was true for both commonly used chemotherapy protocols, FOLFIRINOX and Gem/Pac and could result in less drug mediated side effects under (neo)adjuvant CTx without impacting treatment efficacy. Yet, the main goal of this study was to assess if PDAC PDOs can be used to predict the neoCTx outcome of PDAC patients. All methods required to address this issue in a prospective clinical trial have been established as a protocol for PDAC PDOs initiation from minimal starting material has been established and subsequently improved resulting in take rates of up to 80%. To support this study, we successfully secured patient enrollment from a second clinical center, which will increase the number of recruited patients in the future. Unfortunately, at the time of writing this thesis, patient numbers were not sufficient to answer the question of the predictive value of PDAC PDOs in regard to the current standard of care.

Every year more than 72,000 adolescents and young adults (AYAs) in the United States (US) aged 15-39 years are diagnosed with cancer. AYAs represent a population that falls into a care gap between pediatric and adult medical services. Additionally, AYAs have experienced increased cancer incidence and decreased five-year survival rates compared to other age groups. The spectrum of tumors seen in AYAs differs from children and older adults, with 90% of the tumors stemming from ten cancer types. Melanoma of the skin, characterized by the uncontrolled growth of pigment-producing cells, is the third most common cancer diagnosed among AYAs in the US. Overexposure to ultraviolet (UV) radiation from sunlight or artificial sources is the greatest risk factor for melanoma. AYAs seem to be particularly at risk for developing melanoma due to increased UV exposure early in life. This study’s objectives were to understand the unique characteristics of melanoma in AYAs in Tennessee and identify the predictors of late- stage diagnosis. The sample for this study includes all incident melanoma cancer cases (N=1109) in AYAs from the Tennessee Cancer Registry (TCR) for the years 2004-2008, inclusive. AYA cases were defined as cancer cases that were diagnosed in individuals ages 15-39 years, inclusive. Melanoma cases were defined according to the International Classification of Diseases- Oncology (ICD-O-3) site codes C440-C449. Melanoma cases that had a specified stage at diagnosis were included for final analysis (N= 315). Stage of diagnosis was determined through the SEER Summary Stage 2000 variable and coded into in situ, localized, and combined regional & distant stage. Univariate and multivariate analyses were performed for the following predictor variables: insurance status (private insurance vs. other), age group (5- year groups), and sex (male vs. female). The majority of the sample was white (96.5%), female (63.8%), had private insurance (85%) and was diagnosed with localized stage melanoma (69.4%). Individuals with government insurance were eight times more likely to be diagnosed with late stage melanoma compared to individuals with private insurance (OR 8.4, CI 3.0-23.3, p < 0.01). AYAs in the 15-19 year old age group were six times more likely to be diagnosed with late stage melanoma compared to 35-39 year olds (OR 6.3, CI 1.7-22.9, p=0.01). Females were 57% less likely to be diagnosed with late stage melanoma compared to males (OR 0.53, CI 0.30-0.93, p < 0.05). These findings indicate that individuals with government insurance may not receive adequate melanoma screening and preventative care compared to individuals with private insurance. While females were less likely to be diagnosed with late stage melanoma, females have a much greater risk of being diagnosed with melanoma at any stage. Finally, the increased risk of late stage diagnosis in the 15-19 year old age group may be associated with greater UV exposure from indoor and outdoor tanning. These data suggest the need for targeted cancer awareness and control activities specific to AYAs. Future studies are needed to explore the variations in late stage diagnosis of melanoma in AYAs in Tennessee.

Cette thèse s’inscrit dans la continuité des travaux sociologiques de réseaux sociaux qui s’intéressent au concept de soutien social. Le travail de recherche porte sur les ressources insérées dans le réseau de relations des patients atteints de cancer ainsi que sur la configuration de ces réseaux personnels. Pour ce faire, la thèse se focalise sur le soutien informationnel qui constitue un des grands types de soutien que l’on rencontre dans la littérature sociologique. Les informations de santé accessibles à travers l’entourage relationnel sont considérées comme des ressources qui permettent aux malades de répondre aux difficultés qu’ils rencontrent dans le cadre de la pathologie cancéreuse. L’analyse est basée sur des entretiens réalisés auprès de patients pris en charge dans des services d’oncologie. Cette thèse se donne deux objectifs : le premier est de rendre compte du soutien social dans le cadre d’une pathologie chronique telle que le cancer. De ce point de vue-là, la thèse montre les difficultés que les malades rencontrent pour obtenir les ressources recherchées. Le second objectif est de contribuer à la réflexion théorique sur la mobilisation des liens sociaux. La recherche décrit les contraintes et opportunités du réseau des malades notamment à travers l’analyse des modes de régulations des relations personnelles. / The thesis we sustain is rooted in the social network analysis interested in the concept of social support. This study deals with the resources embedded in the social network of cancer patients and on the structure of these personal networks. The thesis focuses on informational support that is one of the main kinds of support we can find in the sociological literature. Health information patients access through their social ties are social resources upon which they may draw when facing difficulties. Based on semi-structured interviews with cancer patients, this study pursues two aims: the first one is to describe social support in the case of chronic diseases such as cancer. From this perspective, the thesis shows the patient difficulties to obtain appropriate resources. The second aim is to contribute to the theoretical thought on social ties’ mobilization. This research describes the constraints and opportunities of patients’ network through an analysis of the social ties rules.

Drug combination therapies for cancer treatment show high efficacy but often induce severe side effects, resulting in dose or cycle number reduction. We investigated the impact of neoadjuvant chemotherapy (neoCTx) adaptions on treatment outcome in 59 patients with pancreatic ductal adenocarcinoma (PDAC). Resections with tumor-free margins were significantly more frequent when full-dose neoCTx was applied. We determined if patient-derived organoids (PDOs) can be used to personalize poly-chemotherapy regimens by pharmacotyping of treatment-naïve and post-neoCTx PDAC PDOs. Five out of ten CTx-naïve PDO lines exhibited a differential response to either the FOLFIRINOX or the Gem/Pac regimen. NeoCTx PDOs showed a poor response to the neoadjuvant regimen that had been administered to the respective patient in 30% of cases. No significant difference in PDO response was noted when comparing modified treatments in which the least effective single drug was removed from the complete regimen.Drug testing of CTx-naïve PDAC PDOs and neoCTx PDOs may be useful to guide neoadjuvant and adjuvant regimen selection, respectively. Personalizing poly-chemotherapy regimens by omitting substances with low efficacy could potentially result in less severe side effects, thereby increasing the fraction of patients receiving a full course of neoadjuvant treatment.