Background: It is well recognized that not all patients with stage C colorectal cancer (CRC) derive a survival benefit from adjuvant chemotherapy. It would therefore be advantageous to identify factors that define a target group for treatment. It has been suggested that those most likely to benefit are women with proximal tumours. Recent work has suggested microsatellite instability (MSI) may be a useful marker however the limited studies performed are conflicting. Aim: To determine if gender, site, tumour histology or microsatellite (MSI) status predict survival benefit from 5FU-based adjuvant chemotherapy in stage C CRC. Method: Data was collated on stage C colorectal cancer cases that underwent curative resection over a 20-year period (inclusive of years prior to standard chemotherapy). Pathology was re-evaluated, DNA extracted from the formalin fixed paraffin specimen and MSI status established. Primary endpoint was cancer-related death. Kaplan-Meier curves were constructed for univariate analysis and differences analysed by log rank test. Multivariate analysis was performed using Cox proportional hazard model adjusting for age, gender, site, distinct pathological variables and MSI. A compounding effect between these factors and chemotherapy benefit was measured by interaction testing Results: 811 unselected cases were included in the study. Thirty-seven percent received chemotherapy. Chemotherapy significant improved cancer-specific survival (HR of dying 0.66 (95% CI 0.52-0.83 p=0.0003). Female gender offered a survival advantage overall (HR 0.81 95% CI 0.68-0.97; p=0.02) however site did not influence outcome (HR 1.03). On interaction testing, gender, site and tumour histology did not significantly influence the survival effect of chemotherapy. 802 cases were included in the MSI analysis of which 77 exhibited MSI. MSI status did not influence prognosis (HR of cancer death 1.45, 95% CI 0.90-2.21; p= 0.13). However, in the non-chemotherapy cohort, MSI conferred a significantly less favourable outcome (HR 1.89, 95%CI 1.13-3.16; p= 0.02). Chemotherapy produced a survival benefit in both the MSI (HR 0.08 95% CI 0.02-0.27; p=<0.0001) and the microsatellite stable (MSS) cohort (HR 0.62, 95% CI 0.47-0.81; p=0.001). On interaction testing, neither compounded the benefit of chemotherapy, however of all the tested parameters, MSI came closest to significance (p=0.08). Conclusion: These results suggest that 5FU-based adjuvant chemotherapy for stage C colorectal cannot be targeted using gender, tumour site, histological characteristics or MSI. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1522132 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2010

Every year an avorage of 40 000 Swedes fall ill with different forms of cancer. Chemotheraphy has an effect on the tumour cells as well as the healthy cells in the body, this causes many side effects which can be very problematic for the patient. The study was carried out in order to indicate the care measures that are taken to deal with the side effects i. e stomatit, loss of hair and sickness/vomiting, that are connected with chemotheraphy so that the outpatients will experience a quality of life. The method used was a qualitative interview with six nurses from the South if Sweden, all of whom are working with chemotheraphy patients. The results showed that the nurses thought that quality of life was individual, in their care work the patients needs and valuations were used as a starting point. Aside form the specific care measures for respective side-effects they put an emphasis on talking and giving information to patients. In addition, they indicated the relationship they had with their patients. Accordi ng to them a good relation to the patient is a prerequisite of good care work.

<p>Syftet är att beskriva symtom och biverkningar som kvinnor med avancerad bröstcancer och cytostatikabehandling rapporterat i ett datoriserat rapporteringssystem före läkarbesök. Undersöka tillfredsställelsen med detta system; se om det finns en skillnad mellan äldre och yngre; undersöka kvinnornas uppfattning om vad som kan förbättras i uppföljningen av symtom/biverkningar samt stödet från läkare. Detta är en kvantitativ, deskriptiv tvärsnittsstudie baserat på rapporteringssystemets databas samt enkätundersökning.</p><p> </p><p>Biverkningarna trötthet, smärta och nervpåverkan rapporterades mest frekvent. Tidsåtgången för rapportering ansågs utav de flesta vara kort eller mycket kort och formuläret upplevdes av majoriteten vara ganska lätt till mycket lätt att använda oberoende av datorvana. Läkaren ansågs från hög grad till mycket hög grad vara ett stöd i att hantera symtom och biverkningar av två tredjedelar av respondenterna. Hälften ansåg att rapporterade biverkningar och symtom uppmärksammades av läkaren i hög grad till mycket hög grad.</p><p> </p><p>Undersökningen bekräftar det tidigare forskning visat om datoriserade rapporteringssystem i vården, att de är funktionella oavsett ålder samt att intresse finns för att använda dessa i större utsträckning. På grund av litet urval och relativt stort bortfall i enkätstudien kan dock inga direkta slutsatser dras men undersökningen antyder att behov finns att vidareutveckla rapporteringssystemet.</p> / <p>The aim of the study is to describe symptoms and side effects that women with advanced breast cancer and chemotherapy reported in an adverse drug reporting system before seeing their oncologist; examine the satisfaction with this system; if there are any differences between older and younger women; the women’s opinion of what improvements could be done in the follow-up of the symptoms/side effects and the support from the oncologist. This is a quantitative, descriptive cross-sectional study based on the database of the adverse drug reporting system and the questionnaire survey.</p><p> </p><p>The side effects fatigue, pain and peripheral neuropathy were most frequently reported. The time consumption for reporting was considered short or very short and the majority thought that the questionnaire was fairly easy to very easy to use independent of computer habits. The oncologists where considered from a high extent to a very high extent being a support in handling the symptoms/side effects by two thirds of the respondents. Two fourths felt that the oncologists attended reported symptoms/side effects from a high extent to a very high extent.</p><p>Because of a small sample and a relatively large drop-out no real conclusions can be drawn except the need for further development of the system.</p>

Syftet är att beskriva symtom och biverkningar som kvinnor med avancerad bröstcancer och cytostatikabehandling rapporterat i ett datoriserat rapporteringssystem före läkarbesök. Undersöka tillfredsställelsen med detta system; se om det finns en skillnad mellan äldre och yngre; undersöka kvinnornas uppfattning om vad som kan förbättras i uppföljningen av symtom/biverkningar samt stödet från läkare. Detta är en kvantitativ, deskriptiv tvärsnittsstudie baserat på rapporteringssystemets databas samt enkätundersökning.   Biverkningarna trötthet, smärta och nervpåverkan rapporterades mest frekvent. Tidsåtgången för rapportering ansågs utav de flesta vara kort eller mycket kort och formuläret upplevdes av majoriteten vara ganska lätt till mycket lätt att använda oberoende av datorvana. Läkaren ansågs från hög grad till mycket hög grad vara ett stöd i att hantera symtom och biverkningar av två tredjedelar av respondenterna. Hälften ansåg att rapporterade biverkningar och symtom uppmärksammades av läkaren i hög grad till mycket hög grad.   Undersökningen bekräftar det tidigare forskning visat om datoriserade rapporteringssystem i vården, att de är funktionella oavsett ålder samt att intresse finns för att använda dessa i större utsträckning. På grund av litet urval och relativt stort bortfall i enkätstudien kan dock inga direkta slutsatser dras men undersökningen antyder att behov finns att vidareutveckla rapporteringssystemet. / The aim of the study is to describe symptoms and side effects that women with advanced breast cancer and chemotherapy reported in an adverse drug reporting system before seeing their oncologist; examine the satisfaction with this system; if there are any differences between older and younger women; the women’s opinion of what improvements could be done in the follow-up of the symptoms/side effects and the support from the oncologist. This is a quantitative, descriptive cross-sectional study based on the database of the adverse drug reporting system and the questionnaire survey.   The side effects fatigue, pain and peripheral neuropathy were most frequently reported. The time consumption for reporting was considered short or very short and the majority thought that the questionnaire was fairly easy to very easy to use independent of computer habits. The oncologists where considered from a high extent to a very high extent being a support in handling the symptoms/side effects by two thirds of the respondents. Two fourths felt that the oncologists attended reported symptoms/side effects from a high extent to a very high extent. Because of a small sample and a relatively large drop-out no real conclusions can be drawn except the need for further development of the system.