Our main findings in the present study are that parents of children surviving leukaemia have in general an average level of resilience. Regarding mental health, fathers show more mental health symptoms. Fathers struggle with depression and anxiety, while mothers show no such symptoms. Despite showing symptoms for depression and anxiety, fathers are still capable of being structured and having social competence in the daily life. The same goes for mothers who manage future planning well. As a result, the first hypothesis which stated that parents of ALL children had weaker resilience, as well as the second hypothesis about the relationship between high resilience and good mental health can be rejected. The course of childhood cancer is not predictable for either children or parents. Some children respond rapidly to treatment, and have a relatively smooth course, while others go through a tough time and experience more difficulties. Parents’ physical and mental health also fluctuates during the active cancer period. The child and the parents affect each other by their adaption and coping style. Besides researchers and health care professionals, other parents and family members in the same situation, will also gain from new knowledge about protective factors and other factors that might lead to or strengthening ones’ resiliency and mental.

Pancreatic cancer is one of the most lethal cancers and despite all research efforts the last 50 years, there are still no effective therapy for this terrible disease. Until quite recently most research in the field of pancreatic duct adenocarcinoma (PDAC) was focused on the tumor cells and mechanisms essential for their proliferation and survival. However, the tumor does not only consist of tumor cells, rather a combination of tumor cells and numerous stroma cell types, i.e. the tumor microenvironment. The tumor cells have developed the ability to activate the surrounding cells to produce factors important for the progression of the tumor. Cancer associated fibroblasts (CAFs) are the major stroma component and as much as 70% of the total PDAC tumor mass consists of these cells. In this thesis I have investigated the mechanisms involved in the cross-talk between tumor cells and CAFs and distinguished the local and systemic effects of this communication. Tumor derived IL-1α was identified as an important factor creating the inflammatory profile seen in CAFs. In PDAC patients, IL-1α was detected in 90% of the tumors and high expression was associated with poor clinical outcome. Moreover, the PDAC tumors had elevated expression levels of many inflammatory factors that were induced in CAFs by the tumor derived IL-1α in vitro. Consequently, this high expression of inflammatory factors in CAFs will attract immune cells including tumor associated macrophages (TAMs), dendritic cells (DCs), and CD8+ T cells. This indicates an immune suppressive role of CAFs, protecting the tumor cells by acting as decoy targets for immune cells homing into the tumor. The inflammatory factors produced in the PDAC microenvironment did not only affect the infiltrating immune cells, but had also systemic effects that included decreased levels of blood DCs in PDAC patients. Furthermore, these myeloid and plasmacytoid DCs were partly activated and had a semi mature phenotype and impaired immunostimulatory function. Low levels of blood DCs were direct associated with poor patient prognosis and the same was seen for low expression of ICOSL by the DCs. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor  promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. / Mindre än 5% av patienterna som drabbas av cancer i bukspottkörteln förväntas överleva i mer än fem år. De typiska symtomen kommer sent och sjukdomen framskrider snabbt. Några av de riskfaktorer som identifierats är tobaksrökning, fetma och typ 2 diabetes. Forskningen har hittills siktat in sig på tumörcellerna och de mekanismer de använder för att överleva och föröka sig. Men en tumör innehåller också normala kroppsceller och vid bukspottkörtelcancer kan så mycket som 70 procent bestå av i sig ofarliga bindvävsceller. Miljön i tumören skapas av samspelet mellan dessa celltyper. De cancerceller som är bäst på att utnyttja omgivningen för sin tillväxt fortlever och för sina egenskaper vidare. En sådan egenskap är att kunna manipulera bindvävsceller till att producera signalsubstanser och tillväxtfaktorer som gynnar tumören. Mekanismerna bakom denna kommunikation har studerats och ett viktigt fynd var att tumörcellerna producerar signalämnet interleukin 1-alpha (IL-1a). Detta protein upptäcktes i 90 procent av de undersökta tumörerna, och var kopplat till dålig prognos hos patienterna. Signalen via IL-1a sätter igång tillverkningen av substanser som behövs för nybildning och tillväxt av blodkärl, i sin tur en förutsättning för att tumören ska leva vidare och växa. Proteinet stimulerar också celldelning i tumören, bidrar till att lura kroppens immunförsvar och underlättar spridning av dottertumörer till andra delar av kroppen. När vi slår ut signaleringen kan tumörcellerna inte längre påverka bindvävscellerna lika effektivt, och således minskar förekomsten av flera faktorer som gynnar tumörtillväxten. IL-1a kan därför vara en lovande kandidat att utforska vidare för framtida som ett läkemedel mot bukspottkörtelcancer.

Mange kreftpasienter ønsker å få omsorg i sitt eget hjem den siste perioden i livet. Pårørende har en nøkkelrolle i omsorgen for sin nærmeste. Samfunnet har et ansvar for å tilby helsetjenester for å gjøre dette mulig. Hensikten med studien er å få innsikt i pårørendes opplevelse av hvordan deres nærmeste fikk lindret sin lidelse av helsepersonell ved pleie og behandling i hjemmet. Gjennom deres perspektiv og erfaring søker man å få kunnskap om hvordan forholdene kan legges til rette for å gi best mulig omsorg til pasient og pårørende den siste tiden. Et kvalitativ design har blitt brukt for å beskrive og analysere pårørendes opplevelser. I denne studien har en Grounded theory tillempet metode blitt benyttet. Datainnsamlingen skjedde ved dybdeintervju som i hovedsak ble gjort i hjemmet. Alle familiene var blitt fulgt opp av offentlig helsetjeneste. De åtte pårørende ble intervjuet 2-11 måneder etter at den syke døde. De hadde hatt langvarige relasjoner som hadde vart fra 12-77 år . Analysen viser at det er mange områder som oppfattes som lidelse hos den alvorlig syke hjemmeboende kreftpasienten den siste tiden. Også for pårørende byr denne tiden på svært mange utfordringer av fysisk, psykisk, sosial og åndelig/eksistensiell art. Kjernekategorien ”En streben mot å gjenopprette hverdagslivets rytme og å mestre endring” beskriver at pasient og pårørende ønsker stabilitet og å leve så normalt som mulig. Dernest er strategien å mestre endringene som sykdommen fører til når den syke ikke kan opprettholde funksjons- og aktivitetsnivå. Pårørende har lite erfaring fra denne type omsorg og den som er syk har behov for kompetent hjelp til ”den kompliserte omsorgen”. Tilpasning og omsorg må bygge på det livet familiene har levd, slik at de kan mestre endringene ut fra egne ønsker, ressurser og muligheter. Til tross for at de pårørende synes sykdoms-perioden hjemme hadde vært krevende, angret ingen på at de hadde tatt på seg omsorgsoppgaven. Konklusjon: Omsorg til alvorlig syke og døende med kreft krever en stor innsats fra pårørende og helsepersonell for å møte utfordringene i hjemmet. Helsepersonell må møte endringene med tiltak som fremmer en mest mulig normal situasjon for den syke og familien, og hjelpe dem til å mestre endringene i livet / Many cancer patients prefer to be cared for at home the last period of their lives. The next-of kin has a key role in the care for their loved ones. The society has a responsibility to organise health care services to make this possible. The aim of the study is to explore the next of kin experiences in how their loved ones’ illness and suffering were met by professional health care workers in their home. Further through the relatives’ perspective and experiences to get knowledge about how the care for the ill person and the family should be performed to meet their needs in the terminal phase. A qualitative approach has been performed. The study was based upon principles of Grounded Theory. Data were collected by in-depth interviews, mainly performed in the deceased's home. Eight persons were interviewed. They had had close relationships lasting 12 to 77 years. The findings show that the seriously ill home living cancer patient considers many fields as sufferings in the last period of his life. Also for the next-of-kin there are many challenges of physical, social and spiritual/existential nature. The core category ”A strive towards restoration of every days rhythm and to cope with changes” describes that both the patient and the next-of-kin wants stability and to live as normal as possible. Secondly, the strategy is to manage the changes the illness leads to when the patients no longer can obtain their functional level and activities. The next-of-kin has little experience in this type of care, and the ill person has a need for professional assistance with “the complicated care”. Adjustments and care must be built upon the life the families have lived, in order to help them to cope with the changes in the perspective of their own wishes, resources and possibilities. Even though all of the next of kin felt it had been a challenging task, none of them regretted that they had decided to take care of their loved ones at home. Conclusion: Homecare for seriously ill and dying patients with cancer requires a great effort from the next-of-kin and the health personnel in order to meet the challenges in the home. The health personnel must meet the changes with strategies to promote a situation as normal as possible for the patient and the family, and help them to cope with the changes in life. / <p>ISBN 91-7997-137-7</p>

Hensikt: Hensikten med studien er å få innsikt i kreftpasienters behov for og opplevelse av informasjon i forbindelse med strålebehandling og hvordan de bruker informasjon i sin nye livssituasjon. Metode: Det ble gjort en kvalitativ intervjuundersøkelse med ti kreftpasienter som skulle gjennomgå strålebehandling. Intervjuene ble gjennomført i forkant av strålebehandlingen, med unntak av to tilfeller der samtalen ble gjennomført henholdsvis etter at strålebehandlingen begynte og etter at CT undersøkelsen var tatt. Dataanalysen ble utført med Grounded theory metode. Resultater: Kjernekategorien som sprang ut av data var det er det lille som teller. Kategoriene som kom frem var informasjonssynergi, følelse av usikkerhet og mestring. Seks underkategorier inngikk i de tre kategoriene. Følelser og uvitenhet inngikk i følelse av usikkerhet. Informasjonsønsker og informasjonsmåter inngikk i kategorien informasjonssynergi. Forståelse og trygghet inngikk i kategorien mestring. Konklusjon: Kjernekategorien det er det lille som teller sammenfatter viktigheten av å gi hver enkelt pasient svar på akkurat det han eller hun lurer på. Informasjonssynergi, følelse av usikkerhet og mestring er grunnsøyler for at pasientene er optimalt rustet til å gjennomgå strålebehandling. Dette vil stille større krav til helsevesenet med hensyn til å kommunisere med pasienter på forskjellige måter, både med dialog og visuelt i form av film og skriftlig informasjon. / Aim: This study aimed to increase understanding the information needs of cancer patients before and during radiation therapy. We also explored how cancer patients adapt such information to their new life situations. Method: Among 10 participants in our qualitative interview survey, eight individuals were interviewed before radiation therapy commenced, one was interviewed during treatment and one was interviewed following CT examination. We used grounded theory to analyse our data.Results: Our study identified one core category: small things matter. Other categories included information synergy (desire for information and manner of delivery), vulnerability (emotions and lack of knowledge), and coping skills (comprehension and security). Conclusions: This study identified the importance of answering patients´ questions. Providing accurate information, minimizing vulnerability, and enhancing coping skills all play an important role in optimizing patient preparation for radiation therapy. However, the process of developing a variety of communication methods (e.g., improved patient dialogue, printed information, and video presentations) will increase demands on the healthcare system. / <p>ISBN 978-91-86739-13-3</p>