SAMMANFATTNING Syfte: Syftet med undersökningen var att utvärdera effekterna av behandlingen i projektet ”Rehabilitering med samtalsterapi och yoga” med avseende på upplevt fysiskt, socialt, känslomässigt och funktionellt välbefinnande, samt undersöka deltagarnas tillfredsställelse med rehabiliteringen. Metod: Utvärderingen gjordes våren 2010 med kvantitativ metod och deskriptiv, longitudinell design. Alla som skulle börja i nybörjarkursen ombads att delta. Enkäter delades ut före och efter deltagande i max tre rehabiliteringskurser. Deltagarantalet i utvärderingen var 22. Svaren analyserades med hjälp av beskrivande statistik och beroende T-test. Resultat: Det kunde inte påvisas några signifikanta skillnader över tid mellan skalorna Fysiskt välbefinnande (p=,507), Socialt välbefinnande (p=,936), Känslomässigt välbefinnande (p=,493) och Funktionellt välbefinnande (p=,388). Vid analys av de enskilda frågorna i skalorna fanns heller inga signifikanta skillnader. Enligt patientutvärderingen ansåg alla deltagare att yoga- och samtalsterapin, i olika grad, har hjälpt dem att hantera sin situation och 95,5% (n=21) säger att de skulle kunna rekommendera denna kurs till en vän i liknande situation. Slutsats: Rehabiliteringsprojektet skulle kunna utvecklas ytterligare, men bör fortsätta ges som ett komplement till traditionell onkologisk behandling då den anses vara betydelsefull för deltagarna. P.g.a. brister skulle en ny utvärdering behöva göras. / ABSTRACT Aim: The aim of this study was to evaluate the effects of the treatment in the project “Rehabilitation with psychotherapy and yoga”, regarding physical, emotional, functional and social wellbeing, and to examine the participant’s satisfaction with the rehabilitation. Method: The evaluation was done during the spring in 2010 with a quantitative method and descriptive, longitudinal design. Everyone who was to begin the new beginners’ class was asked about participation. Questionnaires were given to the participants, before and after participation in maximum three rehabilitation courses. The number of participants was 22. The answers were analyzed with descriptive statistics and dependent T-test. Result: There are no significant differences over time regarding the physical (p=,507), social (p=,936), emotional (p=,493) and functional (p=,388) wellbeing of the participants. When analyzing the unique questions in the wellbeing-scales, no significant differences were found. According to the satisfaction questionnaires, every participants thought that the rehabilitationgroup, in different ways, helped them to cope with their situation and 95,5% (n=21) would recommend this psychotherapy and yoga group to a friend in a similar situation. Conclusion: The rehabilitationproject can be improved, but should continue to be provided as a complement to traditional oncological treatment, since it´s considered being of great value for its participants. Because of shortages a new evaluation is motivated.

The aims of this thesis were to investigate the utility of in vitro drug sensitivity testing to optimize the use of cancer chemotherapy and to assess the properties of a new cancer drug in a phase I clinical trial. Tumour cells from patients were analysed with the short-term Fluorometric Microculture Cytotoxicity Assay (FMCA). In samples from a wide spectrum of tumour types, the effect of the drug combination FEC (5Fu-epirubicin-cyclophosphamide) was generally appropriately predicted from the effect of the best component drug. However, of samples intermediately sensitive to the best single drug, 45% converted to sensitive when testing the combination. Thus, combination testing may identify advantageous interactions and improve in vitro test performance. In tumour samples from peritoneal carcinomatosis, significant differences in drug sensitivity between diagnoses were observed, cross-resistance between most drugs was modest or absent, and the concentration-effect relationships for two drugs in individual samples varied considerably. Thus, for optimal selection of drugs for intraperitoneal chemotherapy, differences in drug sensitivity at the diagnosis and individual patient level should be considered. In samples from patients with ovarian carcinoma, drug sensitivity was related to tumour grade, histologic subtype and patient treatment status. In a homogeneous subset of patients, the FMCA predicted individual patient tumour response with high sensitivity and specificity. Thus, if carefully interpreted in the context of important clinical variables, in vitro testing could be of value for individualizing chemotherapy in ovarian cancer. Employing a once weekly dosing schedule in a phase I trial, the mechanistically new and preclinically promising NAD depleting drug CHS 828 produced dose limiting thrombocytopenia and gastrointestinal toxicity without clear evidence of anti-tumour efficacy. It is concluded that in vitro drug sensitivity testing could be a way to optimize the use of chemotherapy and that successful development of new cancer drugs needs improved strategies.

Bakgrund: Cancer är en sjukdom som drabbar många individer och kan ha dödlig utgång. I sjuksköterskans profession är det i vårdsammanhang sannolikt att kontakt sker med patienter som diagnostiserats med cancer. Denna litteraturöversikt är gjord för att belysa synen på kommunikation med patienter diagnostiserade med cancer. Syfte: Att beskriva sjuksköterskans kommunikation vid omvårdnad av patienter med cancer. Metod: En litteraturöversikt där 12 vetenskapliga artiklar analyserades. Resultat: Åtta kategorier identifierades, Sjuksköterskans erfarenhet av patientkommunikation har betydelse, osäkerhet om att berätta sanningen om diagnos och prognos påverkar kommunikation, partnerskapet mellan sjuksköterskan och patienten underlättar kommunikation, hinder för sjuksköterskan och patientens kommunikation, kommunikationen påverkades av att sjuksköterskan var en mellanhand i omvårdnaden, kommunikation om sexualitet var svårt, vidareutbildning ökar sjuksköterskans kommunikativa förmåga och det finns ett behov av att kommunicera på ett empatiskt sätt. Slutsats : Vid en personcentrerad vård är sjuksköterska-patient relationen viktig att upprätthålla för att patienten ska kunna ha bibehållen autonomi och självbestämmande. Genom att sjuksköterskan kommunicerar sanningsenligt och empatiskt kan detta vara möjligt. Kommunikationen mellan sjuksköterska och patienter med cancer är komplex. Kommunikationen är en viktig del för att skapa tillit i en god omvårdnad. Vidareutbildning i kommunikation behövs för att sjuksköterskor ska kunna förbättra sina kommunikativa förmågor och för att ge förbättrad omvårdnad. / Background: Cancer is a disease that affects many individuals and can be fatal. In the nurse's profession, it is likely that contact will occur with patients diagnosed with cancer during health care. Communication is one of the core competencies that the nurse should maintain. This literature review has been made to highlight the view of communication with cancer-diagnosed patients. Aim: To describe the nurse's communication in nursing patients with cancer. Method: A literature review in which 12 scientific articles were analyzed. Results : Eight categories were identified. Nursing's experience of patient communication has significance, uncertainty about telling the truth about diagnosis and prognosis affecting communication, the nurse partnership and patient facilitates communication, barriers in nurse and patient communication, communication was affected by the nurse being an intermediary in nursing, communication about sexuality was difficult, further education increases the communicative ability of the nurse, and there is a need to communicate in an empathetic way. Conclusion : In a person-centered care, the nurse-patient relationship is important for maintaining the patient's ability to retain autonomy and self-determination. By the fact that the nurse communicates truthfully and empathically, this is possible. Communication between nurse and cancer patients is complex. Communication is an important part of establishing trust in good care. Further education in communication is needed to enable nurses to improve their communicative skills and to provide improved nursing.

Increased understanding of the molecular mechanisms underlying cancer development has shifted drug discovery towards target driven drug development the last decades, but the development of effective cancer drugs has been hampered by the lack of predictive preclinical models. 3-D cultures, considered to more accurately reflect solid tumors in vivo, have been proposed as one way to increase the predictability of clinical efficacy in cancer drug discovery and development. The aims of this thesis were to improve preclinical models for cancer drug development, with focus on colorectal cancer (CRC) and use of multicellular tumor spheroids (MCTS), and also to mechanistically characterize some potentially new anticancer drugs (papers I – IV). The most important technical improvement was the development of direct measurement of green fluorescent protein (GFP) marked cells in spheroids, simplifying live collection of viability data and enabling high-throughput screening (HTS) in the MCTS model (paper I). In paper III and IV, the 3-D model was adapted to enable studies on the interaction between drugs and radiation. Two potentially new anticancer drugs, VLX50 and VLX60, were mechanistically characterized. VLX60, a novel copper containing thiosemicarbazone, induced reactive oxygen species (ROS) formation, was selectively active against BRAF mutated colon cancer cells and exhibited anticancer activity in vivo (paper II). Furthermore, two potentially new anticancer drugs were found suitable for further development for use in combination with radiation (papers III and IV). In paper III, synergy with radiation in spheroids compared to monolayer cultured colon cancer cells was shown with the novel iron-chelating inhibitor of oxidative phosphorylation, VLX600. In paper IV, the antiprotozoal drug nitazoxanide was shown to sensitize quiescent clonogenic colon cancer cells to radiation. In conclusion, introduction of measurement of fluorescence of GFP marked cells in spheroids makes clinically relevant 3-D models feasible for HTS experiments and characterization of candidate drugs and radiosensitizers in early cancer drug discovery and development. VLX60 has several characteristics suitable for further development into a cancer drug, notably against BRAF mutated colorectal cancer cells. VLX600 and nitazoxanide show radiosensitizing properties making them promising for further development for use as cancer drugs in combination with radiation.

Duktal bröstcancer är den vanligaste formen av invasiva brösttumörer. Graderingssystemet för bröstcancer har definierats av Elston och Ellis och är baserat på tre parametrar. En av dessa är räkning av antal mitoser på preparat färgade med Hematoxylin och Eosin (HE). Som ett komplement vid bedömning av bröstcancer analyseras Ki67, en proliferationsmarkör, med hjälp av immunhistokemi (IHC).  Fosfohiston H3 (pHH3) är ett histonprotein som finns i cellkärnan. Proteinet tros vara en specifik markör för mitos eftersom den är fosforylerad enbart under M-fasen och i slutet av G2-fasen. Syftet med studien var att utvärdera pHH3 som potentiell markör för mitos vid diagnostiseringen av duktal bröstcancer. Syftet var även att jämföra metoden med räkning av antal mitoser och Ki67-positiva celler, samt att studera den interindividuella skillnaden vid bedömningen av preparaten. Materialet bestod av 20 sektorresektat med invasiv duktal bröstcancer. Preparaten färgades med IHC och bedömdes mikroskopiskt. Celler som var positiva för pHH3 och Ki67 samt antal mitoser räknades, av tre läkare. Ett medelvärde för varje patientfall och metod beräknades från läkarnas bedömningar. Metodernas variationskoefficienter och dess medelvärden beräknades. Variationskoefficienterna uppvisade medelvärden på 0,21 för Ki67 +/- 0,10 SD, 0,33 för pHH3 +/- 0,14 SD och 0,46 för mitosräkning +/- 0,34 SD. Korrelationskoefficienterna för metoderna och respektive läkare uppvisade en spridning. Korrelationerna uppvisade medelvärden på r = 0,78 för Ki67 och pHH3, r = 0,74 för Ki67 och mitos samt r = 0,83 för pHH3 och mitos. Enligt studien verkar antipHH3 vara ett bra komplement vid bedömning av duktal bröstcancer. Dock krävs tydliga kriterier för vad som ska räknas som en pHH3-positiv cell. Intervariabiliteten verkar bli mindre med anti-pHH3 än vid räkning av mitoser, som är mer tidskrävande. Minst intervariabilitet ses vid bedömning av anti-Ki67 som en proliferationsmarkör. / Ductal carcinoma of the breast is the most common form of invasive breast tumours. The grading system for breast cancer is defined by Elston and Ellis and is based on three criterions. One of these criterions is the mitotic count in pathological sections of breast carcinomas stained with Hematoxylin Eosin. A common method often applied as a complement in diagnosis of breast carcinoma is immunohistochemical staining with use of antibodies directed against Ki67, a proliferation marker. Phosphohistone H3 is a histone protein that is located in the cell nucleus. The protein is believed to be a specific marker for mitosis since it only is phosphorylated during mitosis, and to some extent at the end of the G2-phase. The purpose of this study was to evaluate pHH3 as a potential marker for mitosis when diagnosing ductal breast cancer. The purpose was also to compare the method to mitotic figuring and the count of Ki67-positive cells, and to study the inter-individual variability when assessing the histological sections. The material consisted of 20 biopsies containing invasive ductal breast cancer. The sections were stained using IHC and all sections were evaluated microscopically. Cells positive for pHH3, Ki67 and mitotic cells were quantified, by three doctors. From the doctors results an average value was determined for each case and method. To be able to compare the methods the coefficient of variation was calculated. The average value of the coefficient of variation was determined for each method and also the standard deviation (SD). The coefficient of variation showed average values of 0,21 for Ki67 +/- 0,10 SD, 0,33 for pHH3 +/- 0,14 SD and 0,46 for mitotic figuring +/- 0,34 SD. The correlation coefficients for the methods and each doctor showed dispersion. The correlations showed average values of r = 0,78 for Ki67 and pHH3, r = 0,74 for Ki67 and mitosis and r = 0,83 for pHH3 and mitosis. According to this study it seems as though anti-pHH3 could complement the other methods. However explicit criteria which defines a threshold value of which cells should be considered pHH3-positive needs to be established. The inter-individual differences seem to decrease using antipHH3 compared with mitotic counting, which is more time consuming. Although the minimum difference can be seen when assessing anti-Ki67 as a proliferation marker.

Bakgrund: Varje år insjuknar ca 320 barn mellan 0-18 år av cancer i Sverige vilket innebär att många syskon kan få en förändrad vardag. Cancer orsakas av att celler i kroppen börjar dela sig okontrollerat samt ökar i storlek, vilket resulterar i en cancertumör. Hur ett syskon reagerar när en bror eller syster får sin cancerdiagnos är beroende på ålder och tidigare erfarenheter. I mötet med ett sjukt barn och dess familj är det viktigt att som sjuksköterska stötta och hantera hela familjens upplevelser i den rådande situationen. Syfte: Syftet med studien var att beskriva syskons upplevelse av att ha en bror eller syster med cancer samt att studera de inkluderade artiklarnas undersökningsgrupp. Metod: En deskriptiv litteraturstudie som inkluderar elva vetenskapliga artiklar som söktes via databasen Medline via PubMed. Artiklarna analyserades med hjälp av Polit och Becks niostegsmodell för ett objektivt urval. Huvudresultat: Syskon som hade en bror eller syster med cancer upplevde många omställningar i livet, både emotionellt, fysiskt och psykiskt. Resultatet visar tre centrala stora upplevelser som syskonen upplevde, ”Känslosamma ögonblick”, “Att rätt information skapar trygghet” samt “Att leva i en förändrad tillvaro”. Undersökningsgrupperna i de inkluderade artiklarna var individer mellan 6-22 år och både pojkar och flickor samt att antalet varierade mellan 6-125 deltagare. Slutsats: Ett syskon till en bror eller syster med cancer upplever många känslor och förändringar samt påverkas av den nya tillvaron som uppstår efter cancerbeskedet. Detta innebär att familjesituationen, relationer och skolan påverkas på olika sätt.

Background and aims: The clinical course of prostate cancer is highly variable and difficult to predict.Stage at presentation, grade and PSA at diagnosis are traditionally used to predict outcome. The aimof this thesis was to identify strategies for improved survival prediction in men with prostate cancer.The way in which prostate cancer affects a population based‐cohort and how routinely measuredvariables can be used to predict survival in an intermediate to long follow‐up period were explored.From this large cohort we separately evaluated how survival can be predicted in men with incidentalcarcinoma (T1a and b) and locally advanced disease (lymph node‐ positive). Immunohistochemistrywas added to routinely measured variables in the subgroup of men with incidental carcinoma.Furthermore, we assessed how the outcome of metastatic disease may be predicted from informationavailable at diagnosis, and during the first six months after treatment. Finally we predicted survivalfor men with metastatic hormone‐refractory prostate cancer (HRPC). Material and methods: From the Swedish South‐East Region Prostate Cancer Register data on 8887men were studied and the impact of tumour grade, serum PSA concentration, TNM classification andtreatment was studied in relation to survival.Furthermore, an evaluation of the disease‐specific mortality of conservatively managed incidentalcarcinoma in relation to T‐category, Gleason score, p53, Ki‐67, Chromogranin A and serotonin wasmade. From the same register we studied whether common predictive factors such as serum‐PSA, Tcategoryand biopsy tumour grade could be used to better assess the prognosis of men with nodepositiveprostate cancer. Using data from the clinical trial SPCG‐5 we studied the possibility of serialmeasurements of PSA and ALP being to predict survival early in the course of hormone‐treatedmetastatic prostate cancer. From the same trial, we also assessed the value of PSA kinetics inpredicting survival and related this to baseline variables in men with metastatic HRPC. Results: In the South–East Region, where screening was seldom done the median age at diagnosisand death was 75 and 80 years respectively, and 12% were diagnosed before the age of 65 years. Hightumour grade, high serum PSA and high T category were associated with poor outcome. The projected 15‐year disease‐specific survival rate was 44% for the whole population. In total, 18% ofpatients had metastases at diagnosis and their median survival was 2.5 years. In the cohort of men with incidental carcinoma, 17% died of prostate cancer. Of 86 patients withGleason score ≤5, three died of prostate cancer. Independent predictors of disease‐specific mortality inmultivariate analysis were category T1b prostate cancer, Gleason score >5 and high immunoreactivityof Ki‐67. Men with lymph‐node positive disease have a median cancer‐specific survival of 8 years.Preoperatively known factors such as PSA, T‐category, age, mode of treatment, failed to predictoutcome, but there was a weak, not statistically significant difference in cancer‐specific survival inrelation to tumour grade. Initial ALP, and ALP and PSA after 6 months of treatment were the serum markers that provided thebest prognostic information about the long‐term outcome of metastatic prostate cancer. In men withHRPC, PSA velocity alone gave a better prediction of survival than all other PSA kinetic variables. Conclusion: In an almost unscreened population, prostate cancer is the elderly mans disease but themortality is high. Ki‐67 may be of value in addition to stage and Gleason score for predicting theprognosis in men with incidental carcinoma.The impact of lymph node metastases on survival overrides all other commonly used prognosticfactors. By following ALP and PSA for 6 months it is possible to predict outcome in metastatic prostate cancer.This gives a much better prediction than baseline PSA and helps to select men with a poor prognosis.By combining PSAV with the variables available at baseline, a better ground for treatment decisionmakingin men with HRPC is achieved.

One-carbon metabolism, a network of enzymatic reactions involving the transfer of methyl groups, depends on B-vitamins as cofactors, folate as a methyl group carrier, and amino acids, betaine, and choline as methyl group donors. One-carbon metabolism influences many processes in cancer initiation and development such as DNA synthesis, genome stability, and histone and epigenetic methylation. To study markers of one-carbon metabolism and inflammation in relation to colorectal cancer (CRC) risk, we used prediagnostic plasma samples from over 600 case participants and 1200 matched control participants in the population-based Northern Sweden Health and Disease Study cohort. This thesis studies CRC risk with respect to the following metabolites measured in pre-diagnostic plasma samples: 1) folate, vitamin B12, and homocysteine; 2) components of one-carbon metabolism (choline, betaine, dimethylglycine, sarcosine, and methionine); and 3) three markers of different aspects of vitamin B6 status. In addition, this thesis examines three homocysteine ratios as determinants of total B-vitamin status and their relation to CRC risk. In two previous studies, we observed an association between low plasma concentrations of folate and a lower CRC risk, but we found no significant association between plasma concentrations of homocysteine and vitamin B12 with CRC risk. We have replicated these results in a study with a larger sample size and found that low folate can inhibit the growth of established pre-cancerous lesions. Using the full study cohort of over 1800 participants, we found inverse associations between plasma concentrations of the methionine cycle metabolites betaine and methionine and CRC risk. This risk was especially low for participants with the combination of low folate and high methionine versus the combination of low folate and low methionine. Well-functioning methionine cycle lowers risk, while impaired DNA synthesis partly explains the previous results for folate. We used the full study cohort to study associations between CRC risk and the most common marker of vitamin B6 status, pyridoxal' 5-phosphate (PLP), and two metabolite ratios, PAr (4-pyridoxic acid/(PLP + pyridoxal)) estimating vitamin B6 related inflammatory processes and the functional vitamin B6 marker 3-hydroxykynurenine to xanthurenic acid (HK:XA). Increased vitamin B6-related inflammation and vitamin B6 deficiency increase CRC risk. Inflammation was not observed to initiate tumorigenesis. Total B-vitamin status can be estimated by three different recently introduced homocysteine ratios. We used the full study cohort to relate the ratios as determinants of the total B-vitamin score in case and control participants and estimated the CRC risk for each marker. Sufficient B-vitamin status as estimated with homocysteine ratios was associated with a lower CRC risk. These studies provide a deeper biochemical knowledge of the complexities inherent in the relationship between one-carbon metabolism and colorectal tumorigenesis.

Bakgrund: I Sverige dog cirka 90 000 människor 2018 varav 25 procent avdödsfallen rörde sig om tumörsjukdomar enligt Socialstyrelsen. De psykosocialakonsekvenserna av att drabbas av cancer kan vara lika allvarliga som de fysiskaoch kan påverka den upplevda livskvaliteten. Inom det salutogena forskningsfältetsöker man förklaringar till hur hälsan kan stärkas genom att göra livet begripligt,hanterbart och meningsfullt. Syfte: sammanställa tidigare forskning om vilkenbetydelse känsla av sammanhang kan ha för upplevelsen av livskvaliteten hospatienter med cancer. Metod: Resultat: Fyra kategorier har identifierats. Underbegriplighet identifierades anpassad information kan förbättra livskvalitet.Information skapar förståelse för sin sjukdom vilket leder till att deltagarna lättarekan fatta egna beslut vilket kan bidra till upplevelse av god livskvalitet. Underbegreppet hanterbarhet identifierades att acceptera sin livskvalitet och försökaleva som vanligt. Genom att acceptera sin livssituation, ha fritidsintressen ochupprätthålla dagliga rutiner kan människan uppleva välbefinnande trots sinsjukdom. Under meningsfullhet identifierades relationer och delaktighet samtexistentiella tankar om liv och död. Konklusion: Känsla av sammanhang harbetydelse för deltagarnas upplevelse av livskvalitet, det som har visat sig vara avstörst betydelse är att ha nära relationer till andra. I vilken fas av sin sjukdomdeltagarna befann sig, verkade inte vara avgörande för vilken livskvalitetdeltagarna upplevde. / Background: In Sweden approximately 90 000 people died in 2018 and 25 percentof the deaths were tumor diseases according to the National Board of Health andWelfare. The psychosocial consequences of suffering from cancer can be asserious as the physical ones and can affect the quality of life. Within thesalutogenic field of research, one seeks explanations for how health can bestrengthened by making life understandable, manageable and meaningful. Aim: Tocompile and investigate what significance sense of coherence can have for thequality of life of patients with cancer. Method: A systematic literature review thathas compiled ten scientific studies with a qualitative approach has been executed.The articles have been read on the basis of Aaron Antonovsky's theory of sense ofcoherence. The contents of the articles are categorized based on the concepts ofcomprehensibility, manageability and meaningfulness. Result: Four categorieshave been identified: Within comprehensibility customized information canimprove the quality of life were identified. Information increases theunderstanding of the situation which in its turn can lead to a sense of good qualityof life. Within manageability accepting their quality of life and try to live as usualwere identified. By accepting one's life situation, having leisure interests, andmaintaining daily routines, one can experience well-being despite his/her illness.Under meaningfulness, the categories relationships, participation and existentialthought about life and death were identified. Having close and deep relationshipsturned out to give a meaningful life. Hoping, believing and planning ahead isimportant and increases the quality of life for the participants. Conclusion: Whathas proven to be the most importance in maintaining quality of life is to haveclose relationships with others. The participants were at different stages of theirillness, although it did not seem to determine what quality of life theyexperienced.

Bakgrund: Populationen individer som når hög ålder ökar stadigt i världen, och därmed även behovet av palliativ vård och sjuksköterskor med god kunskap inom området då de har en central roll i omvårdnaden av de palliativa patienterna. Tidi-gare studier visar att sjuksköterskor inom palliativ vård ofta upplever att de inte har tillräckliga kunskaper inom området. Arbetet inom palliativ vård är kopplat till starka känslor hos den som utför vården, och därför kan det vara av vikt att belysa dessa upplevelser ur ett sjuksköterskeperspektiv för att som nyutexaminerad sjuk-sköterska ha kunskaper inom området.Syfte: Att beskriva undersöka sjuksköterskors upplevelser av att vårda cancersjuka patienter inom palliativ vård.Metod: Litteraturstudie med kvalitativ ansats. Litteratursökningar gjordes i data-baserna CINAHL, PubMed och PsycInfo. Studier som valdes ut kvalitets-granskades utifrån SBU:s granskningsmall för kvalitativa studier och slutligen kvarstod tio studier som analyserades utifrån Graneheim och Lundmans modell för innehållsanalys.Resultat: Resultaten presenteras genom tre teman; Patienterna i fokus, Sjukskö-terskans roll och Organisationens utmaningar med totalt sex underteman; Livskva-litet, Anhöriga, Kommunikation, Existentiella frågor, Brist på tid och Behov av ökad kunskapKonklusion: Sjuksköterskor upplever att palliativ vård av cancersjuka patienter i livets slut styrs av gynnande och missgynnande faktorer, var av vissa är påverk-bara och andra inte. Detta samtidigt som egna, existentiella tankar och frågor be-höver hanteras och bearbetas för att kunna utföra arbetet på ett tillfredsställande vis. / Background: The population of individuals reaching high age is firmly increasing around the world. In line with this, the need for palliative care and for healthcare nurses with knowledge on this area also increases. One can assume that working with palliative care evokes strong feelings for the person performing the care. Re-garding to this it seems important to illustrate these experiences from the nurses perspectives, to be able to prepare as a newly examinated nurse in both practical and emotional preparation.Aim: To examine nurse’s experiences of caring for patients dying in cancer in a palliative care-setting.Method: A litterature review with qualitative approach. The litterature search was conducted in the databases CINAHL, PubMed and PsycInfo. Selected articles were examined using SBU:s review template. The content of the articles were ana-lyzed with the support of Graneheim and Lundmans (2004) template for content analyzis.Results: The result is presented using three themes; Focusing on the Patients, the Nursing role and Organization including in total six subthemes; Quality of life, Relatives, Communication, Existential issues, Lack of time and Need of further knowledge. Conclusion: Nurses experiences that caring for patients with cancer at the end of life in a palliative care setting is depended on both favouring and disfavouring circumstances, some of them possible to infuence and some of them not. At the same time, they describe having to handle and process their own, personal exist-ential thoughts and feelings to be able to perform a good work.