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  1. Article ; Online: Palliative oncology and palliative care.

    Strang, Peter

    Molecular oncology

    2022  Volume 16, Issue 19, Page(s) 3399–3409

    Abstract: New therapeutic approaches can produce promising results even in severely ill cancer patients. But they also pose new challenges with respect to prognostication, as patients who were once not eligible for treatment, due to age or comorbidities, now are. ... ...

    Abstract New therapeutic approaches can produce promising results even in severely ill cancer patients. But they also pose new challenges with respect to prognostication, as patients who were once not eligible for treatment, due to age or comorbidities, now are. Palliative oncology constitutes a major part of oncological care, with life prolongation and quality of life as its main goals. Palliative care specialists are experts in symptom control and psychosocial and existential support, and the integration of their expertise early on in patient care can prolong survival. In this article, I discuss the need to integrate specialist palliative care into early cancer treatment plans to achieve quality of life for patients. I also discuss the ways in which palliative care specialists balance the benefits of novel treatments against their adverse effects for patients, particularly for the elderly, the frail and those in advance stages of disease. I highlight the need to ensure equal access to palliative care to improve cancer patients' quality of life but also why futile, burdensome treatments should be avoided especially in the frail, elderly patients. Further, I discuss benefits and problems related to nutritional support in patients with cachexia and exemplify why translational research is needed to link basic research with clinical oncology and effective symptom control.
    MeSH term(s) Aged ; Humans ; Medical Oncology ; Neoplasms/therapy ; Palliative Care/methods ; Quality of Life
    Language English
    Publishing date 2022-08-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2415106-3
    ISSN 1878-0261 ; 1574-7891
    ISSN (online) 1878-0261
    ISSN 1574-7891
    DOI 10.1002/1878-0261.13278
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  2. Article ; Online: The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study.

    Strang, Peter / Schultz, Torbjörn

    Current oncology (Toronto, Ont.)

    2023  Volume 30, Issue 7, Page(s) 6623–6633

    Abstract: Background: Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on ... ...

    Abstract Background: Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients.
    Method: Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths.
    Results: A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%,
    Conclusion: Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
    MeSH term(s) Male ; Humans ; Female ; Palliative Care ; Frailty/therapy ; Retrospective Studies ; Neoplasms/therapy ; Emergency Service, Hospital ; Registries ; Death ; Hospitals
    Language English
    Publishing date 2023-07-11
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1236972-x
    ISSN 1718-7729 ; 1198-0052
    ISSN (online) 1718-7729
    ISSN 1198-0052
    DOI 10.3390/curroncol30070486
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    Zs.A 4305: Show issues Location:
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  3. Article ; Online: Partly unequal receipt of healthcare in last month of life in amyotrophic lateral sclerosis: a retrospective cohort study of the Stockholm region.

    Strang, Peter / Schultz, Torbjörn / Ozanne, Anneli

    Upsala journal of medical sciences

    2024  Volume 129

    Abstract: Context: In amyotrophic lateral sclerosis (ALS), equal care is important, given that the disease often has complex symptoms at the end of life.: Objectives: The aim was to study the possible associations between demographic and clinical factors, ... ...

    Abstract Context: In amyotrophic lateral sclerosis (ALS), equal care is important, given that the disease often has complex symptoms at the end of life.
    Objectives: The aim was to study the possible associations between demographic and clinical factors, including age, sex, and frailty, with acute healthcare utilization in the last month of life, measured by emergency room (ER) visits, admissions to acute hospitals and, acute hospitals as place of death, among patients with ALS. A second aim was to study whether receipt of specialized palliative care (SPC) affects above-mentioned healthcare utilization.
    Methods: Observational, retrospective study based on Region Stockholm's administrative data warehouse (VAL) in Sweden. Data were retrieved for 2015-2021 and analyzed with descriptive statistics and logistic regression models.
    Results: All deceased patients (
    Conclusions: The results indicate partly unequal distribution of palliative care, however the actual, individual preferences cannot be deducted from registry studies. All patients with ALS should be offered SPC when needed.
    Key message: This register study shows that receipt of SPC in patients with ALS is equal in relation to gender, socioeconomic standing, frailty, and age <75 years, while those ≥75 years, with dementia, or residing in NH were somewhat less likely to receive SPC. Receipt of SPC reduces ER visits and acute hospital admissions.
    MeSH term(s) Aged ; Female ; Humans ; Male ; Amyotrophic Lateral Sclerosis/therapy ; Delivery of Health Care ; Dementia/therapy ; Frailty ; Palliative Care ; Retrospective Studies
    Language English
    Publishing date 2024-02-07
    Publishing country Sweden
    Document type Journal Article ; Observational Study
    ZDB-ID 183949-4
    ISSN 2000-1967 ; 0300-9734
    ISSN (online) 2000-1967
    ISSN 0300-9734
    DOI 10.48101/ujms.v129.9856
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  4. Article ; Online: Age and co-morbidities as independent risk factors of infections leading to hospital admission in the last year of life among the elderly: A retrospective registry-based study.

    Björkhem-Bergman, Linda / Schultz, Torbjörn / Strang, Peter

    Upsala journal of medical sciences

    2024  Volume 129

    Abstract: Background: The immune system declines with age, but the impact of chronological age may be affected by sex, co-morbidities, and sociodemographic factors.: Objective: The article aims to study infections associated with hospital admission in the ... ...

    Abstract Background: The immune system declines with age, but the impact of chronological age may be affected by sex, co-morbidities, and sociodemographic factors.
    Objective: The article aims to study infections associated with hospital admission in the elderly in their last year of life and the impact of age, sex, co-morbidities, and sociodemographic factors.
    Method: A retrospective study based on registry data covering all care visits in Stockholm Region, Sweden, for 7 years was conducted. All deceased subjects with at least one hospital admission with infection as the main diagnosis in the last year of life were compared with subjects with no such admission. Subjects were categorized into three different age-groups 65-79, 80-89, and 90 years and above. Co-morbidity was measured by the Charlson Comorbidity Index (CCI) and sociodemographic factors were assessed using the 'Mosaic-system'. Subjects living in nursing homes were analyzed separately. Uni- and multivariable logistic regressions were conducted.
    Results: Of the 55,238 subjects in the study population, 14,192 (26%) had at least one hospital admission due to infection in the last year of life. The risk of having a severe infection increased with age, adjusted odds ratio (OR): 1.30 (1.25-1.36), and 1.60 (1.52-1.69) for the age-groups 80-89 and ≥ 90 compared to the age-group 65-79. The most important factor for infection was a high co-morbidity score; adjusted OR: 1.75 (1.68-1.82). Male sex and living in a less affluent area were weaker risk factors for infections.
    Conclusion: Chronological age and co-morbidities are independent risk factors of infections associated with hospital admission in the last year in life while male sex and sociodemographic factors have less impact.
    MeSH term(s) Humans ; Male ; Aged ; Retrospective Studies ; Comorbidity ; Risk Factors ; Registries ; Morbidity ; Hospitals
    Language English
    Publishing date 2024-03-13
    Publishing country Sweden
    Document type Journal Article
    ZDB-ID 183949-4
    ISSN 2000-1967 ; 0300-9734
    ISSN (online) 2000-1967
    ISSN 0300-9734
    DOI 10.48101/ujms.v129.10504
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  5. Article ; Online: Parenteral Hydration in Dying Patients With Cancer: A National Registry Study.

    Martinsson, Lisa / Strang, Peter / Lundström, Staffan / Hedman, Christel

    Journal of pain and symptom management

    2024  Volume 67, Issue 5, Page(s) 384–392

    Abstract: Context: Clinically assisted hydration during end-of-life care among patients with cancer is controversial; practice varies between clinical settings and countries, and there is a lack of evidence.: Objectives: To examine whether breathlessness, ... ...

    Abstract Context: Clinically assisted hydration during end-of-life care among patients with cancer is controversial; practice varies between clinical settings and countries, and there is a lack of evidence.
    Objectives: To examine whether breathlessness, respiratory secretion, or confusion correlates with receiving parenteral hydration during end of life, adjusted for sex, age, and place of death.
    Methods: The Swedish Register of Palliative Care database was used to collect data about the usage of parenteral hydration during the last day of life, and the occurrence of three symptoms during the last week. Adults dying from cancer during 2011-2021 in hospitals, in residential care homes, and within specialized palliative care were included. Correlation between parenteral hydration and symptoms was examined using χ
    Results: A total of 147,488 patients were included in the study. Parenteral hydration was more often prescribed to younger persons, to men, and in acute hospitals (compared to other settings), p < 0.001 in all three comparisons. Patients with hematological malignancies (20%) and ovarian cancer (16%) were most likely to receive parenteral hydration, while those with brain tumors (6%) were least likely. The presence of all three analyzed symptoms during the last week (breathlessness, respiratory secretion, and confusion) were significantly correlated with having received parenteral hydration during the last day of life (p < 0.001). In the final logistic regression model adjusted for age, sex, and place of death, the only symptom with remaining correlation to parenteral hydration was breathlessness (OR 1.56, 95% CI 1.50-1.6).
    Conclusion: There is an association between parenteral hydration and increased breathlessness in patients with cancer. Provision of parenteral hydration is more prevalent in men, younger patients, and those with hematological malignancies or ovarian cancer, and most widespread in acute hospital settings.
    MeSH term(s) Male ; Adult ; Humans ; Female ; Terminal Care ; Palliative Care ; Dyspnea/epidemiology ; Registries ; Ovarian Neoplasms ; Hematologic Neoplasms
    Language English
    Publishing date 2024-02-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2024.01.036
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    Zs.A 2252: Show issues Location:
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  6. Article: Dying with Cancer and COVID-19, with Special Reference to Lung Cancer: Frailty as a Risk Factor.

    Strang, Peter / Schultz, Torbjörn

    Cancers

    2022  Volume 14, Issue 23

    Abstract: Older age and frailty have been associated with COVID-19 deaths, but frailty has seldom been studied in the context of cancer. The aim of this paper was therefore to study frailty (measured using the Hospital Frailty Risk Score) and other risk factors in ...

    Abstract Older age and frailty have been associated with COVID-19 deaths, but frailty has seldom been studied in the context of cancer. The aim of this paper was therefore to study frailty (measured using the Hospital Frailty Risk Score) and other risk factors in patients who died with advanced cancer and a concomitant COVID-19 infection, with special reference to lung cancer. Of 4312 patients who died with cancer, 282 had concomitant COVID-19 (within the last 30 days), and these patients were significantly older, more often men, and residents of nursing homes. They often had less access to specialized palliative care, and they died more often in acute hospital settings. Patients with cancer who died with COVID-19 were more often frail (57% vs. 45%,
    Language English
    Publishing date 2022-12-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers14236002
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  7. Article ; Online: Patients with both cancer and psychosis-to what extent do they receive specialized palliative care.

    Bergqvist, Jenny / Hedskog, Stina / Hedman, Christel / Schultz, Torbjörn / Strang, Peter

    Acta psychiatrica Scandinavica

    2024  Volume 149, Issue 4, Page(s) 313–322

    Abstract: Background: Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis ... ...

    Abstract Background: Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC.
    Patients and methods: This retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis.
    Results: Patients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, p < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, p < 0.0001), more likely to reside in nursing homes (25% vs. 11%, p < 0.0001), and had a higher prevalence of low area-based socioeconomic status (46% vs. 32%, p < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital.
    Conclusions: Patients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.
    MeSH term(s) Humans ; Life Expectancy ; Neoplasms/epidemiology ; Neoplasms/therapy ; Palliative Care ; Psychotic Disorders/epidemiology ; Psychotic Disorders/therapy ; Retrospective Studies ; Adult
    Language English
    Publishing date 2024-02-18
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 103-x
    ISSN 1600-0447 ; 0001-690X
    ISSN (online) 1600-0447
    ISSN 0001-690X
    DOI 10.1111/acps.13666
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  8. Article ; Online: Nursing Home Residents With Dementia at End of Life: Emergency Department Visits, Hospitalizations, and Acute Hospital Deaths.

    Salaj, Dag / Schultz, Torbjörn / Strang, Peter

    Journal of palliative medicine

    2023  Volume 27, Issue 1, Page(s) 24–30

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Humans ; Male ; Female ; Nursing Homes ; Retrospective Studies ; Emergency Room Visits ; Frailty ; Dementia ; Hospitalization ; Hospitals ; Death ; Emergency Service, Hospital
    Language English
    Publishing date 2023-07-27
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2023.0201
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    Zs.A 5440: Show issues Location:
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  9. Article ; Online: Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19-A Register-Based Study.

    Hedman, Christel / Strang, Peter / Lundström, Staffan / Martinsson, Lisa

    Journal of palliative care

    2023  Volume 38, Issue 3, Page(s) 261–267

    Abstract: Objective: Little is known to what extent access to specialist palliative care (SPC) for cancer patients dying with coronavirus disease-2019 (COVID-19) affects the occurrence of breakthrough symptoms, symptom relief, and overall care, compared to ... ...

    Abstract Objective: Little is known to what extent access to specialist palliative care (SPC) for cancer patients dying with coronavirus disease-2019 (COVID-19) affects the occurrence of breakthrough symptoms, symptom relief, and overall care, compared to hospital deaths. Our aim was to include patients with both COVID-19 and cancer and compare those dying in hospitals with those dying in SPC with reference to the quality of end-of-life care.
    Methods: Patients with both cancer and COVID-19 who died in hospitals (
    Results: Breakthrough of breathlessness was more common in the hospital patients compared to the SPC patients (61% and 39%, respectively;
    Conclusion: More systematic palliative care routines may be an important factor for better symptom control and higher quality of end-of-life care in hospitals.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; COVID-19/complications ; COVID-19/mortality ; COVID-19/therapy ; Hospital Mortality ; Neoplasms/complications ; Neoplasms/mortality ; Neoplasms/therapy ; Palliative Care ; Quality of Health Care ; Registries ; Specialization ; Sweden/epidemiology ; Terminal Care
    Language English
    Publishing date 2023-02-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639326-3
    ISSN 2369-5293 ; 0825-8597
    ISSN (online) 2369-5293
    ISSN 0825-8597
    DOI 10.1177/08258597231157622
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  10. Article ; Online: The oral microbiome of a family including Papillon-Lefèvre-syndrome patients and clinically healthy members.

    Vályi, Péter / Wirth, Roland / Minárovits, János / Strang, Orsolya / Maróti, Gergely / Kovács, Kornél L

    BMC oral health

    2024  Volume 24, Issue 1, Page(s) 158

    Abstract: Aims: The oral microbiota composition of patients diagnosed with Papillon-Lefèvre-syndrome and treated for several years were compared to those existing in the oral cavity of the clinically healthy family members and a cohort of patients having various ... ...

    Abstract Aims: The oral microbiota composition of patients diagnosed with Papillon-Lefèvre-syndrome and treated for several years were compared to those existing in the oral cavity of the clinically healthy family members and a cohort of patients having various stages of chronic periodontitis.
    Materials and methods: A family with two sisters affected with severe periodontitis and with the typical skin symptoms of Papillon-Lefèvre-syndrome, and symptomless parents and third sibling were investigated. The Patients received periodontal treatment for several years and their oral microbiome was analysed by amplicon sequencing. Data were evaluated by microbial cluster analysis.
    Results: The microbiome of the patients with Papillon-Lefèvre-syndrome was predominated with Aggregatibacter actinomycetemcomitans and associated oral periodontopathogens. Although the clinically healthy family members showed no oral disorder, their microbiome resembled that of subjects having mild periodontitis.
    Conclusions: Predominance of A. actinomycetemcomitans in the subgingival microbiome of patients with Papillon-Lefèvre-syndrome suggests that specific treatment strategies directed against this pathobiont may improve the oral health status of the affected individuals.
    Trial registration: The study was conducted in accordance with the Declaration of Helsinki and the ethical permission has been issued by the Human Investigation Review Board of the University of Szeged, Albert Szent-Györgyi Clinical Centre (Permission No. 63/2017-SZTE). September 19, 2017.  https://u-szeged.hu/klinikaikutatas/rkeb-altal-jovahagyott/rkeb-2017 .
    MeSH term(s) Humans ; Papillon-Lefevre Disease ; Periodontitis/therapy ; Health Status
    Language English
    Publishing date 2024-01-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2091511-1
    ISSN 1472-6831 ; 1472-6831
    ISSN (online) 1472-6831
    ISSN 1472-6831
    DOI 10.1186/s12903-024-03856-z
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