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  1. Article ; Online: Corrigendum to "Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer" [Eur J Cancer 199 (2024) 113572].

    Osterman, Erik / Syriopoulou, Elisavet / Martling, Anna / Andersson, Therese M-L / Nordenvall, Caroline

    European journal of cancer (Oxford, England : 1990)

    2024  Volume 201, Page(s) 113940

    Language English
    Publishing date 2024-02-20
    Publishing country England
    Document type Published Erratum
    ZDB-ID 82061-1
    ISSN 1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
    ISSN (online) 1879-0852
    ISSN 0277-5379 ; 0959-8049 ; 0964-1947
    DOI 10.1016/j.ejca.2024.113940
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    Zs.A 456: Show issues Location:
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  2. Article ; Online: Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer.

    Osterman, Erik / Syriopoulou, Elisavet / Martling, Anna / Andersson, Therese M-L / Nordenvall, Caroline

    European journal of cancer (Oxford, England : 1990)

    2024  Volume 199, Page(s) 113572

    Abstract: Background: The introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain.: Methods: ... ...

    Abstract Background: The introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain.
    Methods: CRCBaSe, a register-linkage originating from the Swedish Colorectal Cancer Registry, was used to identify information on patient and tumour characteristics, for 83,460 patients with stage I-III disease diagnosed 2008-2021. SES was measured as disposable income (quartiles) and the highest level of education. Outcomes of interest were emergency surgery, multidisciplinary team (MDT) conference discussion, and oncological treatment. Differences in treatment between SES groups were explored using multivariable logistic regression adjusted for year of diagnosis, age at diagnosis, sex, civil status, comorbidities, tumour location and stage.
    Results: Patients in the highest income quartile had a lower risk of emergency surgery (OR 0.73 95%CI 0.68-0.80), a higher chance of being discussed at the preoperative (OR 1.39 95%CI 1.28-1.51) and postoperative MDT (OR 1.41 95%CI 1.30-1.53), receiving neoadjuvant (OR 1.15 95%CI 1.06-1.25) and adjuvant treatment (OR 2.04 95%CI 1.88-2.20). Higher education level increased the odds of MDT discussion but was not associated with oncological treatment. The proportion of patients discussed at the MDT increased, with almost all patients discussed since 2016. Despite this, treatment differences remained when patients diagnosed since 2016 were analysed separately.
    Conclusion: There were significant differences in how patients with different SES were treated for colorectal cancer. Further action is required to investigate the drivers of these differences as well as their impact on mortality and, ultimately, eliminate the inequalities.
    MeSH term(s) Humans ; Socioeconomic Disparities in Health ; Social Class ; Registries ; Neoadjuvant Therapy ; Colorectal Neoplasms/pathology
    Language English
    Publishing date 2024-01-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 82061-1
    ISSN 1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
    ISSN (online) 1879-0852
    ISSN 0277-5379 ; 0959-8049 ; 0964-1947
    DOI 10.1016/j.ejca.2024.113572
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  3. Article ; Online: Complete response rates in rectal cancer: Temporal changes over a decade in a population-based nationwide cohort.

    Temmink, Sofieke J D / Martling, Anna / Angenete, Eva / Nilsson, Per J

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2023  Volume 49, Issue 11, Page(s) 106991

    Abstract: Introduction: In the past decade many changes in neoadjuvant treatment for patients with rectal cancer have taken place and are expected to impact complete response rates. The aim of this study was to investigate the impact on pathological, and overall, ...

    Abstract Introduction: In the past decade many changes in neoadjuvant treatment for patients with rectal cancer have taken place and are expected to impact complete response rates. The aim of this study was to investigate the impact on pathological, and overall, complete response rates in a nationwide population-based cohort, in relation to changes in neoadjuvant treatment and the start of a Watch & Wait (WoW) study.
    Materials and methods: A nationwide register study using prospectively collected data from the Swedish Colorectal Cancer Register between 2009 and 2020. Patients with rectal cancer stage I-III with a ypT0N0 in the resected specimen after neoadjuvant treatment and clinical complete responders from the yearly inclusion data of the national WoW study were included. Temporal changes in pathological and overall complete response rates were analysed, and differences in neoadjuvant treatment regimens over time and per region were studied.
    Results: Between 2009 and 2020 the pathological complete response rate for rectal cancer remained similar (Mann-Kendall tau of 0.091, p = 0.68) while the overall complete response rate increased significantly from 3.0% to 9.6% (Mann-Kendall tau of 0.818, p < 0.001). The pathological complete response rate for patients receiving short course radiotherapy followed by chemotherapy was reduced by 50% after the introduction of the WoW study.
    Conclusions: During the studied time period the overall complete response rate increased significantly presumably due to changes in national neoadjuvant treatment regimens. Since the start of the national WoW study clinical complete response seem to partly replace pathological complete response.
    MeSH term(s) Humans ; Treatment Outcome ; Chemoradiotherapy ; Neoplasm Staging ; Rectal Neoplasms/therapy ; Rectal Neoplasms/pathology ; Remission Induction ; Neoadjuvant Therapy ; Watchful Waiting
    Language English
    Publishing date 2023-07-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2023.106991
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  4. Article ; Online: Does Androgen Deprivation Therapy for Prostate Cancer Increase the Risk of Colorectal Cancer?

    Martling, Anna

    Cancer control : journal of the Moffitt Cancer Center

    2015  Volume 22, Issue 2, Page(s) 261–262

    MeSH term(s) Androgen Antagonists/adverse effects ; Androgen Antagonists/therapeutic use ; Colorectal Neoplasms/epidemiology ; Humans ; Male ; Prostatic Neoplasms/drug therapy ; Prostatic Neoplasms/epidemiology ; Sweden/epidemiology
    Chemical Substances Androgen Antagonists
    Language English
    Publishing date 2015-04
    Publishing country United States
    Document type Editorial
    ZDB-ID 1328503-8
    ISSN 1526-2359 ; 1073-2748
    ISSN (online) 1526-2359
    ISSN 1073-2748
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    Zs.A 4467: Show issues Location:
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  5. Article ; Online: Quality register-based research revisited.

    Martling, Anna

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2015  Volume 17, Issue 5, Page(s) 371

    MeSH term(s) Biomedical Research ; Humans ; Quality Assurance, Health Care/methods ; Registries
    Language English
    Publishing date 2015-05
    Publishing country England
    Document type Editorial
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.12957
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    Zs.A 5799: Show issues Location:
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  6. Article: Surgical Outcomes after Radiotherapy in Rectal Cancer.

    Temmink, Sofieke J D / Peeters, Koen C M J / Nilsson, Per J / Martling, Anna / van de Velde, Cornelis J H

    Cancers

    2024  Volume 16, Issue 8

    Abstract: Over the past decade, the treatment of rectal cancer has changed considerably. The implementation of TME surgery has, in addition to decreasing the number of local recurrences, improved surgical morbidity and mortality. At the same time, the optimisation ...

    Abstract Over the past decade, the treatment of rectal cancer has changed considerably. The implementation of TME surgery has, in addition to decreasing the number of local recurrences, improved surgical morbidity and mortality. At the same time, the optimisation of radiotherapy in the preoperative setting has improved oncological outcomes even further, although higher perineal infection rates have been reported. Radiotherapy regimens have evolved through the adjustment of radiotherapy techniques and fields, increased waiting intervals, and, for more advanced tumours, adding chemotherapy. Concurrently, imaging techniques have significantly improved staging accuracy, facilitating more precise selection of advanced tumours. Although chemoradiotherapy does lead to the downsizing and -staging of these tumours, a very clear effect on sphincter-preserving surgery and the negative resection margin has not been proven. Aiming to decrease distant metastasis and improve overall survival for locally advanced rectal cancer, systemic chemotherapy can be added to radiotherapy, known as total neoadjuvant treatment (TNT). High complete response rates, both pathological (pCR) and clinical (cCR), are reported after TNT. Patients who follow a Watch & Wait program after a cCR can potentially avoid surgical morbidity and colostomy. For both early and more advanced tumours, trials are now investigating optimal regimens in an attempt to offer organ preservation as much as possible. Multidisciplinary deliberation should include patient preference, treatment toxicity, and likelihood of end colostomy, but also the burden of intensive surveillance in a W&W program.
    Language English
    Publishing date 2024-04-18
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers16081539
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  7. Article ; Online: Long-term prescribed drug use in stage I-III rectal cancer patients in Sweden, with a focus on bowel-regulating drugs after surgical and oncological treatment.

    Boman, Sol Erika / Fuentes, Stina / Nordenvall, Caroline / Martling, Anna / Chen, Lingjing / Glimelius, Ingrid / Neovius, Martin / Smedby, Karin E / Eloranta, Sandra

    Journal of cancer survivorship : research and practice

    2024  

    Abstract: Purpose: To describe long-term prescribed drug use after rectal cancer treatment.: Methods: We identified 12,871 rectal cancer patients without distant metastasis between 2005 and 2016 and 64,341 matched population comparators using CRCBaSe (a ... ...

    Abstract Purpose: To describe long-term prescribed drug use after rectal cancer treatment.
    Methods: We identified 12,871 rectal cancer patients without distant metastasis between 2005 and 2016 and 64,341 matched population comparators using CRCBaSe (a Swedish nationwide register linkage of colorectal cancer patients). Mean defined daily doses (DDDs) of drug dispensing during relapse-free follow-up were calculated by Anatomical Therapeutic Chemical drug categories. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) from negative binomial regression were used to compare drug dispensing between patients and comparators.
    Results: The overall pattern of drug dispensing was similar among cancer survivors and comparators, although patients had higher mean DDDs of drugs regulating the digestive system. Excess dispensing of drugs for constipation (IRR, 3.35; 95% CI, 3.12-3.61), diarrhea (IRR, 6.43; 95% CI, 5.72-7.22), functional gastrointestinal disorders (IRR, 3.78; 95% CI, 3.15-4.54), and vitamin and mineral supplements (IRR, 1.37; 95% CI, 1.24-1.50) was observed up to 10 years after surgery. Treatment with Hartmann's procedure was associated with higher dispensing rates of digestive drugs compared to surgery with anterior resection and abdominoperineal resection but the association was attributed to higher use of diabetic drugs. Additionally, excess digestive drug dispensing was associated with more advanced cancer stage but not with (chemo)radiotherapy treatment.
    Conclusions: Excess drug use after rectal cancer is primarily driven by bowel-regulating drugs and is not modified by surgical or oncological treatment.
    Implications for cancer survivors: The excess use of bowel-regulating drugs after rectal cancer indicated long-standing postsurgical gastrointestinal morbidity and need of prophylaxis. Reassuringly, no excess use of other drug classes was noted long term.
    Language English
    Publishing date 2024-02-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-024-01548-9
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  8. Article ; Online: Disinfection by-products in drinking water and risk of colorectal cancer: a population-based cohort study.

    Helte, Emilie / Säve-Söderbergh, Melle / Larsson, Susanna C / Martling, Anna / Åkesson, Agneta

    Journal of the National Cancer Institute

    2023  Volume 115, Issue 12, Page(s) 1597–1604

    Abstract: Background: Colorectal cancer is the third most common malignancy worldwide and is strongly linked to lifestyle and environmental risk factors. Although several drinking-water disinfection by-products are confirmed rodent carcinogens, the evidence in ... ...

    Abstract Background: Colorectal cancer is the third most common malignancy worldwide and is strongly linked to lifestyle and environmental risk factors. Although several drinking-water disinfection by-products are confirmed rodent carcinogens, the evidence in humans for carcinogenicity associated with these by-products, including colorectal cancer, is still inconclusive.
    Methods: We assessed the association of long-term exposure to trihalomethanes (THMs), the most prevalent disinfection by-products in chlorinated drinking water, with incidence of colorectal cancer in 58 672 men and women in 2 population-based cohorts. Exposure was assessed by combining long-term information of residential history with drinking water-monitoring data. Participants were categorized according to no exposure, low exposure (<15 µg/L), and high exposure (≥15 µg/L). Incident cases of colorectal cancer were ascertained by use of the Swedish National Cancer Register.
    Results: During an average follow-up of 16.8 years (988 144 person-years), 1913 cases of colorectal cancer were ascertained (1176 cases in men and 746 in women, respectively). High THM concentrations in drinking water (≥15 µg/L) were associated with increased risk of colorectal cancer in men (hazard ratio = 1.26, 95% confidence interval = 1.05-1.51) compared with no exposure. When subsites were assessed, the association was statistically significant for proximal colon cancer (hazard ratio = 1.59, 95% confidence interval = 1.11 to 2.27) but not for distal colon cancer or rectal cancer. In women, we observed overall no association of THMs with colorectal cancer.
    Conclusion: These results add further evidence that disinfection by-products in drinking water may be a possible risk factor for proximal colon cancer in men. This observation was made at THM concentrations lower than those in most previous studies.
    MeSH term(s) Male ; Humans ; Female ; Drinking Water/adverse effects ; Disinfection/methods ; Cohort Studies ; Environmental Exposure/adverse effects ; Water Purification/methods ; Colonic Neoplasms/epidemiology ; Trihalomethanes/toxicity ; Trihalomethanes/analysis
    Chemical Substances Drinking Water ; Trihalomethanes
    Language English
    Publishing date 2023-08-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2992-0
    ISSN 1460-2105 ; 0027-8874 ; 0198-0157
    ISSN (online) 1460-2105
    ISSN 0027-8874 ; 0198-0157
    DOI 10.1093/jnci/djad145
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    Uh III Zs.131: Show issues Location:
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  9. Article ; Online: Reply to: Management of locally recurrent rectal cancer.

    Westberg, Karin / Martling, Anna

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2018  Volume 44, Issue 8, Page(s) 1282

    MeSH term(s) Humans ; Neoplasm Recurrence, Local ; Rectal Neoplasms ; Rectum ; Treatment Outcome
    Language English
    Publishing date 2018
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2018.05.028
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  10. Article ; Online: Overall and diagnosis-specific sickness absence and disability pension in colorectal cancer survivors and references in Sweden.

    Beermann, Luisa Christine / Alexanderson, Kristina / Martling, Anna / Chen, Lingjing

    Journal of cancer survivorship : research and practice

    2021  Volume 16, Issue 2, Page(s) 269–278

    Abstract: Purpose: To longitudinally investigate overall and diagnosis-specific sickness absence (SA) and disability pension (DP) in colorectal cancer (CRC) survivors and references and to identify potential risk factors.: Methods: This longitudinal register- ... ...

    Abstract Purpose: To longitudinally investigate overall and diagnosis-specific sickness absence (SA) and disability pension (DP) in colorectal cancer (CRC) survivors and references and to identify potential risk factors.
    Methods: This longitudinal register-based cohort study included all patients living in Sweden, diagnosed with a first primary CRC in 2008-2011 when aged 18-62 (n=6679), and their matched references (n=26 716). Net days of SA (in SA spells >14 days) and DP were analyzed from 2 years before through 5 years after diagnosis, overall and by specific diagnoses. Among survivors, risk factors for future SADP were explored using logistic regression.
    Results: In survivors, SA peaked in year 1 postdiagnosis, with 62.5% having at least some SA, and then gradually decreased to 20.1% in year 5. In the 2 years after diagnosis, CRC was the most common SA diagnosis in survivors, while SA due to mental diagnoses remained similar to the references. Notable risk factors for postdiagnostic SA or DP were rectal cancer diagnosis, advanced cancer stage at diagnosis, lower educational level, born outside of Sweden, and pre-diagnostic SA, mental morbidity, and comorbidities.
    Conclusion: During 5 years after a CRC diagnosis, CRC survivors had higher levels of postdiagnostic SA and DP than the references, which was mostly due to CRC diagnoses. Although their SA lowered gradually, it did not return to pre-diagnostic levels.
    Implications for cancer survivors: Our results provide valuable information for patients with CRC diagnosis, especially that most have none or low levels of SA/DP after a few years.
    MeSH term(s) Cohort Studies ; Disabled Persons ; Humans ; Pensions ; Rectal Neoplasms ; Risk Factors ; Sick Leave ; Survivors ; Sweden/epidemiology
    Language English
    Publishing date 2021-03-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-021-01017-7
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