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Active anticancer treatment during the final month of life in patients with non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature105023
Source
Anticancer Res. 2014 Feb;34(2):1015-20
Publication Type
Article
Date
Feb-2014
Author
Carsten Nieder
Terje Tollåli
Astrid Dalhaug
Ellinor Haukland
Gro Aandahl
Adam Pawinski
Jan Norum
Author Affiliation
Department of Oncology and Palliative Medicine, Nordland Hospital, P.O. Box 1480, 8092 Bodø, Norway. carsten.nieder@nlsh.no.
Source
Anticancer Res. 2014 Feb;34(2):1015-20
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Carcinoma, Non-Small-Cell Lung - economics - pathology - therapy
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Lung Neoplasms - economics - pathology - therapy
Male
Multivariate Analysis
Norway
Retrospective Studies
Terminal Care - economics - methods - utilization
Abstract
Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death and consumption of healthcare resources worldwide. Significant costs are generated shortly before death, partly because of continued oncological treatment during the terminal stage of disease. We analyzed factors predicting for the likelihood of active anticancer therapy during the final month of life. Patients who died from NSCLC (any stage and treatment) during the years 2006-2013 within a defined geographical region of northern Norway were included (n=266). Out of these, 28.6% received oncological treatment during the final month of life. Hospital death occurred in 70% of patients who received active treatment during their last month of life, compared to 41% of other patients (p=0.0001). Multivariate analysis showed that lack of documented resuscitation preference (p=0.001) and the presence of superior vena cava compression (p=0.039) were the most important predictors of active therapy during the last month of life. Trends were observed with regard to use of steroids for symptom palliation (p=0.067) and advanced T stage (p=0.071). Given that patients with documented resuscitation preference before their last month of life (typically a do not resuscitate order) were unlikely to receive active treatment during the final month (2% versus 35% in patients without documented preference), early discussion of prognosis, options for symptom control and resuscitation preference are crucial components in strategies for improving terminal care.
PubMed ID
24511048 View in PubMed
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Adjuvant fluorouracil, epirubicin and cyclophosphamide in early breast cancer: is it cost-effective?

https://arctichealth.org/en/permalink/ahliterature16695
Source
Acta Oncol. 2005;44(7):735-41
Publication Type
Article
Date
2005
Author
Jan Norum
Mari Holtmon
Author Affiliation
Department of Oncology, University Hospital of North Norway, Norway. jan.norum@unn.no
Source
Acta Oncol. 2005;44(7):735-41
Date
2005
Language
English
Publication Type
Article
Keywords
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Breast Neoplasms - drug therapy - economics
Chemotherapy, Adjuvant
Comparative Study
Cost-Benefit Analysis
Cyclophosphamide - economics - therapeutic use
Drug Costs
Epirubicin - economics - therapeutic use
Female
Fluorouracil - economics - therapeutic use
Humans
Medical Records
Methotrexate - economics - therapeutic use
Norway
Survival Rate
Abstract
Adjuvant chemotherapy (ACT) in breast cancer exposes patients to morbidity, but improves survival. The FEC (fluorouracil, epirubicin, cyclophosphamide) regimen has taken over the prior role of CMF (cyclophosphamide, methotrexate, fluorouracil). In this model, efficacy, tolerability and quality of life (QoL) data from the literature were incorporated with Norwegian practice and cost data in a cost-effectiveness approach. The FEC efficacy was calculated 3-7% superior CMF. There was no difference in quality of life. An 80-100% dose intensity range was employed, one Euro was calculated NOK 8.78 and a 3% discount rate was used. The total cost of FEC employing the friction cost method on production loss, including amount spent on drugs, administration and travelling ranged between 3,278-3,850 Euros (human capital approach 12,143-12,715 Euros). Money spent on drugs alone constituted 15-48%, depending on method chosen. A cost-effectiveness analysis revealed a cost per life year (LY) saved replacing FEC by CMF of 3,575-15,125 Euros. Adjuvant FEC is cost effective in Norway.
PubMed ID
16227165 View in PubMed
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Admission and stay in psychiatric hospitals in northern Norway among Sami and a control group: a registry-based study.

https://arctichealth.org/en/permalink/ahliterature125806
Source
Nord J Psychiatry. 2012 Dec;66(6):422-7
Publication Type
Article
Date
Dec-2012
Author
Jan Norum
Fred Emil Bjerke
Inger Nybrodahl
Aina Olsen
Author Affiliation
Northern Norway Regional Health Authority, Bodø, Norway and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
Source
Nord J Psychiatry. 2012 Dec;66(6):422-7
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Case-Control Studies
Commitment of Mentally Ill
Ethnic Groups
Female
Hospitalization
Hospitals, Psychiatric - statistics & numerical data
Human Rights
Humans
Language
Length of Stay
Male
Mental Disorders - ethnology
Middle Aged
Norway - epidemiology
Patient Admission - statistics & numerical data
Population Groups
Registries - statistics & numerical data
Young Adult
Abstract
The aim of this study was analyze the admission and inpatient stay at psychiatric hospital in northern Norway among people from the Sami-speaking municipalities (Sami group) and a control group (non-Sami group). Are they treated equally?
All admissions and inpatient stay from the administration area of the Sami language law (eight municipalities) was matched with a control group of 11 municipalities. All adult patients treated during the 2-year time period 2009-2010 and registered by the Norwegian Patient Registry (NPR) were included in the study. Population data as of 2009 was accessed from Statistics Norway. The admission rate and the days in hospital (DiH) rate per 10,000 inhabitants/year were set as 1.0.
Both study groups had a significantly higher admission and DiH-rate than northern Norwegians in general. The median annual admission rate/10,000 inhabitants was 284 (Sami) and 307 (non-Sami), respectively (P =?0.23). Whereas there were no difference between groups with regard to DiH/10,000 inhabitants/year (P =?0.24), the males of the Sami group spent significantly fewer DiH when any form of coercion was used (RR =?0.41).
Sami did not experience significantly more or fewer admissions (voluntary and compulsory) to psychiatric hospitals than the control group. There were significant intergroup variations in both groups.
PubMed ID
22452323 View in PubMed
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Brain damage treated with non proven intensive training 2003-2011: a Norwegian cost analysis.

https://arctichealth.org/en/permalink/ahliterature119248
Source
Glob J Health Sci. 2012 Nov;4(6):179-84
Publication Type
Article
Date
Nov-2012
Author
Jan Norum
Arnborg Ramsvik
Knut Tjeldnes
Author Affiliation
Northern Norway Regional Health Authority trust , Bodo, Norway. jan.norum@helse-nord.no
Source
Glob J Health Sci. 2012 Nov;4(6):179-84
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain Injuries - economics - rehabilitation
Child
Child, Preschool
Costs and Cost Analysis
Female
Health Care Costs - statistics & numerical data
Humans
Infant
Male
Models, Economic
Norway - epidemiology
Physical Therapy Modalities - economics
Quality-Adjusted Life Years
Retrospective Studies
Young Adult
Abstract
There has been an increased request for intensive training and rehabilitation of patients with brain damage in Norway. These programs are demanding with regard to personnel, travelling, time and economic resources. We aimed to indicate cost and gain to make these programs cost-effective.
A retrospective study included all patients referred to the Northern Norway Regional Health Authority (NNRHA) trust during the nine years period 2003-2011. All referrals to the NNRHA trust for the economic coverage of foreign based rehabilitation or habilitation programs (The Advanced Bio-Mechanical Rehabilitation (ABR), Institutes of Achievement of Human Potential program (IAHP) (Doman Method), Family Hope Center (FHC) program and the Kozijavkin Method) were included. 17 patients were detected and 15 fulfilled the inclusion criteria for funding. Median age was 8 years (1-31 years). Cost from the specialist health care point of view was calculated. A cut-off limit of €57,000/quality adjusted life year (QALY) and a 4% discount rate was employed.
The undiscounted cost per patient enrolled was calculated €133,210 (discounted €121,348). To make these therapies cost effective, a total of at least 2.13 QALYs (2.34 undiscounted QALYs) must be gained per patient enrolled. Such a gain could not be indicated and we doubt it is achievable.
Non-proven intensive training programs for patients with brain damage are costly. As long as their effect has not been documented, health care services should not spend resources on these programs outside clinical trials.
PubMed ID
23121754 View in PubMed
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Cardiovascular disease (CVD) in the Norwegian Arctic. Air ambulance operations 1999-2009 and future challenges in the region.

https://arctichealth.org/en/permalink/ahliterature99870
Source
Int Marit Health. 2010;62(3):117-22
Publication Type
Article
Date
2010
Author
Jan Norum
Source
Int Marit Health. 2010;62(3):117-22
Date
2010
Language
English
Publication Type
Article
Abstract
Background. Air ambulance operations in the Arctic have to deal with remote locations, long distances, rough weather conditions, seasonable darkness, and almost no alternative for landing. Despite these challenges, people expect high quality, specialist health care. Objective. This study aimed to analyse air ambulance operations due to cardiovascular disease (CVD) in the Arctic and employ the result as an instrument for future suggestions. Melting ice in the Arctic Sea opens new prospects for shipping, adventures, and oil/gas industry. Material and methods. In February 2010 all air ambulance operations performed in the Arctic during the period 1999 to 2009 were analysed. The population of this study covered patients with CVD. The state of emergency, state of seriousness (the National Advisory Committee on Aeronautics (NACA) scale was used), flight time, destination, and flying time were the main outcome measures. A total of 45 patients (myocardial infarction 31, angina pectoris 11, and heart failure 4 patients) were identified. There were 39 Norwegians and 6 people of other nationalities. The mean age was 57 years (range 43-83 years) Results. Thirteen cardiac incidents occurred in June and July. Most cases (26 patients) were considered urgent or emergent, and the mean NACA score was 4 (range 3-6). The adjusted female/male ratio was 0.222, and the median flying time (one way) was 3 h 25 min (range 1 h-6 h 40 min). Four flights were delayed, and one fifth of patients were transported during the night (midnight to 8.00 AM). Conclusions. Air ambulance operations in the Arctic experience significant challenges. In the near future more shipping and polar adventure operations together with new oil and gas installations will increase the demand for health care support. Telemedical installations onboard vessels and rigs will be important for remote consultation and treatment.
PubMed ID
21154297 View in PubMed
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Compulsory and voluntary admission in psychiatric hospitals in northern Norway 2009-2010. A national registry-based analysis.

https://arctichealth.org/en/permalink/ahliterature124054
Source
Nord J Psychiatry. 2013 Feb;67(1):47-52
Publication Type
Article
Date
Feb-2013
Author
Jan Norum
Aina Olsen
Inger Nybrodahl
Knut W Sørgaard
Author Affiliation
Northern Norway Regional Health Authority, Bodø, Norway. jan.norum@helse-nord.no
Source
Nord J Psychiatry. 2013 Feb;67(1):47-52
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Coercion
Commitment of Mentally Ill - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Length of Stay
Male
Middle Aged
Norway
Patient Admission - statistics & numerical data
Registries - statistics & numerical data
Retrospective Studies
Young Adult
Abstract
During the last decade, Norwegian healthcare authorities have been concerned about the frequent use of coercive measures in psychiatric care. On this background, we aimed to explore the voluntary and compulsory admissions in psychiatric hospitals in northern Norway, the University Hospital of North Norway in Troms? (UNN-T) and the Nordland Hospital in Bod? (NH-B).
All voluntary and compulsory admissions (2009-2010) among patients aged =18 years registered by the Norwegian Patient Registry (NPR) were analyzed retrospectively. Compulsory admission was registered according to the general practitioner's (GP's) decision and the patients were hospitalized in Bod? or Troms?. A total of 12,237 admissions and 242,148 days in hospital were identified. The female/male ratio of admission and stay was 1.17 and 1.15, respectively.
The admission rate (northern Norway =1.0) varied significantly from south to north (0.60-1.52). Whereas patients living close to the hospitals had the same admission rate as others, the mean hospital stay was significantly longer (ratio =1.32). Furthermore, the UNN-T had a higher re-admission rate (2% vs. 5%). Municipalities with District Psychiatric Centers (DPC) did not differ from others. A significant difference in the use of coercive measures was revealed between hospitals. Forced medication was the most frequent measure employed.
The study documented a south-north gradient in admission rate and indicated differences in the use of coercion. Variation may partly be due to different reporting procedures. This finding and why patients living in the neighborhood of hospitals stay longer should be explored in future studies.
PubMed ID
22631219 View in PubMed
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A cost-minimising analysis of standard radiotherapy and two experimental therapies in glioblastoma.

https://arctichealth.org/en/permalink/ahliterature19200
Source
Radiother Oncol. 2002 Feb;62(2):227-31
Publication Type
Article
Date
Feb-2002
Author
Tom B Johannesen
Jan Norum
Knut Lote
David Scheie
Henry Hirschberg
Author Affiliation
Department of Radiotherapy and Oncology, The Norwegian Radium Hospital, Oslo, Norway.
Source
Radiother Oncol. 2002 Feb;62(2):227-31
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Brachytherapy - economics
Comparative Study
Cost-Benefit Analysis
Female
Glioblastoma - radiotherapy - surgery
Health Care Costs
Humans
Length of Stay - economics
Male
Middle Aged
Norway
Quality-Adjusted Life Years
Radiotherapy, High-Energy - economics
Research Support, Non-U.S. Gov't
Retrospective Studies
Treatment Outcome
Abstract
BACKGROUND AND PURPOSE: Accelerated radiotherapy (ART) and intracavity brachytherapy (ICBT) have been introduced in the primary treatment of glioblastoma. Our objective was to determine total treatment costs, hospitalisation time, and treatment outcome in these two experimental therapies compared to standard treatment. MATERIALS AND METHODS: In the time period 1985 to 1st May 1999, a total of 174 patients with histologically confirmed glioblastoma multiforme were given postoperative radiotherapy according to three different treatment schedules at three different time intervals. A conventional regime of external radiotherapy (54Gy/30 fractions) was given to 58 patients (group I), 75 patients were treated with ART (48Gy/twice daily 30 fractions) (group II), and 41 patients were given ICBT (60Gy/ten fractions) (group III). Treatment costs including surgery, hospital stay, hospital hotel stay, and radiotherapy were calculated. RESULTS: The total mean costs employing the three treatment alternatives were calculated to $25,618 (group I), $23,442 (group II), and $14,534 (group III). Total mean stay in hospital for the whole primary treatment was 48.8, 41.6, and 19 days for groups I, II, and III respectively. Median survival figures were 16, 14, and 13 months for groups I, II, and III, respectively. CONCLUSIONS: The total cost of postoperative radiotherapy in glioblastoma is comparable to other health care services. ART did not improve the total treatment cost or influence the need for hospitalisation compared to standard treatment. ICBT seemed to have economic benefits with less need for hospitalisation.
PubMed ID
11937250 View in PubMed
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Current guidelines for BRCA testing of breast cancer patients are insufficient to detect all mutation carriers.

https://arctichealth.org/en/permalink/ahliterature290860
Source
BMC Cancer. 2017 Jun 21; 17(1):438
Publication Type
Journal Article
Date
Jun-21-2017
Author
Eli Marie Grindedal
Cecilie Heramb
Inga Karsrud
Sarah Louise Ariansen
Lovise Mæhle
Dag Erik Undlien
Jan Norum
Ellen Schlichting
Author Affiliation
Department of Medical Genetics, Oslo University Hospital, Oslo, Norway. ELIGR@ous-hf.no.
Source
BMC Cancer. 2017 Jun 21; 17(1):438
Date
Jun-21-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
BRCA1 Protein - genetics
BRCA2 Protein - genetics
Breast Neoplasms - epidemiology - genetics - pathology
Female
Genetic Testing
Heterozygote
Humans
Middle Aged
Mutation
Norway
Abstract
Identification of BRCA mutations in breast cancer (BC) patients influences treatment and survival and may be of importance for their relatives. Testing is often restricted to women fulfilling high-risk criteria. However, there is limited knowledge of the sensitivity of such a strategy, and of the clinical aspects of BC caused by BRCA mutations in less selected BC cohorts. The aim of this report was to address these issues by evaluating the results of BRCA testing of BC patients in South-Eastern Norway.
1371 newly diagnosed BC patients were tested with sequencing and Multi Ligation Probe Amplification (MLPA). Prevalence of mutations was calculated, and BC characteristics among carriers and non-carriers compared. Sensitivity and specificity of common guidelines for BRCA testing to identify carriers was analyzed. Number of identified female mutation positive relatives was evaluated.
A pathogenic BRCA mutation was identified in 3.1%. Carriers differed from non-carriers in terms of age at diagnosis, family history, grade, ER/PR-status, triple negativity (TNBC) and Ki67, but not in HER2 and TNM status. One mutation positive female relative was identified per mutation positive BC patient. Using age of onset below 40 or TNBC as criteria for testing identified 32-34% of carriers. Common guidelines for testing identified 45-90%, and testing all below 60 years identified 90%. Thirty-seven percent of carriers had a family history of cancer that would have qualified for predictive BRCA testing. A Variant of Uncertain Significance (VUS) was identified in 4.9%.
Mutation positive BC patients differed as a group from mutation negative. However, the commonly used guidelines for testing were insufficient to detect all mutation carriers in the BC cohort. Thirty-seven percent had a family history of cancer that would have qualified for predictive testing before they were diagnosed with BC. Based on our combined observations, we suggest it is time to discuss whether all BC patients should be offered BRCA testing, both to optimize treatment and improve survival for these women, but also to enable identification of healthy mutation carriers within their families. Health services need to be aware of referral possibility for healthy women with cancer in their family.
Notes
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PubMed ID
28637432 View in PubMed
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Do cancer patients benefit from short-term contact with a general practitioner following cancer treatment? A randomised, controlled study.

https://arctichealth.org/en/permalink/ahliterature16881
Source
Support Care Cancer. 2005 Nov;13(11):949-56
Publication Type
Article
Date
Nov-2005
Author
Knut Holtedahl
Jan Norum
Tor Anvik
Elin Richardsen
Author Affiliation
Institute of Community Medicine, University of Tromsø, 9037 Tromsø, Norway. knutarne.holtedahl@ism.uit.no
Source
Support Care Cancer. 2005 Nov;13(11):949-56
Date
Nov-2005
Language
English
Publication Type
Article
Keywords
Aged
Continuity of Patient Care
Family Practice
Female
Humans
Male
Middle Aged
Neoplasms - psychology - therapy
Norway
Patient satisfaction
Physician-Patient Relations
Quality of Life
Questionnaires
Referral and Consultation
Research Support, Non-U.S. Gov't
Time Factors
Abstract
GOALS OF WORK: To investigate whether increased contact with the patient's general practitioner (GP) soon after cancer treatment can increase patient quality of life (QoL) and satisfaction with follow-up. PATIENTS AND METHODS: A randomised controlled study with 91 patients from one Norwegian municipality. The intervention group got a 30-min invited consultation with the patient's GP and an invitation to further GP follow-up. Quality of life and patient satisfaction with diagnosis, treatment and overall care were measured with validated instruments. MAIN RESULTS: Relatives' satisfaction with care increased over 6 months in the intervention group (P = 0.018), but otherwise, there was no difference between the intervention and control groups concerning QoL, satisfaction with care or number of consultations. Patient satisfaction with care showed a tendency to increase when treatment intent was curative. Some functional QoL measures and satisfaction tended to increase during the first 6 months after treatment. Free text comments suggested that some patients appreciated the contact with their GP. CONCLUSION: Some cancer patients benefit from follow-up by their GP. The way to perform this kind of follow-up in primary care, and who these cancer patients are, should be further studied. Short follow-up time and an urban setting may have contributed to the lack of group differences in our study, but patients treated for cancer may have limited need for follow-up as long as they feel well and the situation remains stable.
PubMed ID
16025260 View in PubMed
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33 records – page 1 of 4.