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Starkhammar, Hans
Publications (10 of 22) Show all publications
Drott, J., Starkhammar, H., Kjellgren, K. & Berterö, C. (2016). The trajectory of neurotoxic side effects' impact on daily life: a qualitative study. Supportive Care in Cancer, 24(8), 3455-3461.
Open this publication in new window or tab >>The trajectory of neurotoxic side effects' impact on daily life: a qualitative study
2016 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 8, 3455-3461 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

The purpose of this study was to explore the experiences of oxaliplatin-induced neurotoxic side effects among patients with colorectal cancer (CRC) and how these side effects influenced their daily lives over time.

METHODS:

To assess neurotoxic side effects, ten patients were repeatedly interviewed. The patients were recruited from two hospitals in south of Sweden, had stage II-III CRC, and had been treated with adjuvant oxaliplatin postoperatively, from November 2013 to October 2015. They had received FOLFOX and XELOX, with a mean total dose of 791 mg oxaliplatin. After completed chemotherapy, at 3, 6, and 12 months into the post-treatment phase, 25 interviews were conducted and thematic analysis was used according to Braun and Clarke.

RESULTS:

Oxaliplatin-induced neurotoxicity affects patients in several ways in the long term. Four themes were identified: Expectation of cure, Dubiety, Normalization, and Learn to live with neurotoxicity. The findings of this study describe the trajectory of neurotoxicity and its impact on these patients' life situation. The findings confirmed that neurotoxicity is multi-faceted and that the experience of it changes over time.

CONCLUSION:

The desire to survive stimulates adaptations and strategies to manage daily life, and patients learn to live with the neurotoxic side effects. This study provides evidence that these patients need individual attention and support during the trajectory of neurotoxic side effects. Current care provision is inadequate due to a lack of knowledge of the ways in which neurotoxicity impacts the patient's daily life. This study provides insights that could be used to develop a more person-centered care.

Keyword
Adjuvant chemotherapy; Colorectal cancer; Neurotoxicity; Oxaliplatin; Qualitative interviews; Thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-126626 (URN)10.1007/s00520-016-3179-1 (DOI)000378884400030 ()26992409 (PubMedID)
Note

Funding agencies:We thank all patients for their participation in this study. We also thank the Swedish Cancer Society, the Department of Oncology and Surgery, Linkoping University Hospital, and the Division of Nursing Science at the Department of Medical and Health Sciences for the financial support. Further thanks go to all the health professionals in the oncology clinics who were involved in the study in different ways.

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2017-11-30
Heedman, P. A., Canslatt, E., Henriks, G., Starkhammar, H., Fomichov, V. & Sjödahl, R. (2015). Variation at presentation among colon cancer patients with metastases: a population-based study. Colorectal Disease, 17(5), 403-408.
Open this publication in new window or tab >>Variation at presentation among colon cancer patients with metastases: a population-based study
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2015 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 17, no 5, 403-408 p.Article in journal (Refereed) Published
Abstract [en]

AimThe study aimed to describe and follow a 2year cohort of colon cancer patients with Stage IV disease from presentation to long-term outcome. MethodThe records of 177 colon cancer patients diagnosed in southeast Sweden during 2009-2010 with disseminated disease at presentation were reviewed retrospectively. ResultsThe patients were heterogeneous with respect to age, performance status and survival. Despite metastatic disease, local symptoms from the primary tumour dominated the initial clinical picture. Forty-one per cent had anaemia. The time from suspicion of colon cancer to established diagnosis of disseminated disease varied from 0 to 231days (emergency cases included, median 12days). The majority (77%) were diagnosed in hospital. In 53% the primary tumour and the metastases were not diagnosed on the same occasion which may increase the risk for misinformation or delays in the care process. The possibility of simultaneous diagnosis was doubled when the patient was investigated as an inpatient. Patients were seen by one to 12 physicians (median three) in the investigation phase, and one to 47 (median 11) from diagnosis until the last record in the hospital notes. The 1-year survival was 46%. ConclusionPatients with metastatic colon cancer at presentation are heterogeneous and warrant an adapted multidisciplinary approach to achieve the goal of individualized treatment for each patient in accordance with the Swedish national cancer strategy.

Place, publisher, year, edition, pages
Wiley: 12 months, 2015
Keyword
Colon cancer; diagnostic approach; metastases; heterogeneity; decision making; integrated care
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-118033 (URN)10.1111/codi.12864 (DOI)000353565100014 ()25511984 (PubMedID)
Available from: 2015-05-21 Created: 2015-05-20 Last updated: 2017-12-04
Drott, J., Starkhammar, H., Börjeson, S. & Berterö, C. (2014). Identifying Oxaliplatin induced Neurotoxicity in Medical records - strengthening compassion. In: : . Paper presented at 18th ICCN (International Conference on Cancer Nursing), September 7-11, 2014, Panama City, Panama. .
Open this publication in new window or tab >>Identifying Oxaliplatin induced Neurotoxicity in Medical records - strengthening compassion
2014 (English)Conference paper, Oral presentation only (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110636 (URN)
Conference
18th ICCN (International Conference on Cancer Nursing), September 7-11, 2014, Panama City, Panama
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2016-09-26
Drott, J., Starkhammar, H., Börjeson, S. & Berterö, C. (2014). Oxaliplatin induced neurotoxicity among patients with colorectal cancer: documentation in medical records - a pilot study. Open Journal of Nursing, 4, 265-274.
Open this publication in new window or tab >>Oxaliplatin induced neurotoxicity among patients with colorectal cancer: documentation in medical records - a pilot study
2014 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, 265-274 p.Article in journal (Refereed) Published
Abstract [en]

Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively.Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxicside effects so they can be documented and action taken at an early stage. The study aimed toidentify and explore neurotoxic side effects documented in the medical records of patients withcolorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study weremedical records; presenting documentation about patients treated at the University Hospital inthe south of Sweden between 2009 and 2010. A summative content analysis approach was used toexplore the neurotoxic side effects. Identification and quantification of the content of medical recordswere carried out by using a study-specific protocol. “Cold sensitivity” and “tingling in thehands” were the most frequently documented neurotoxicity-related terms in the medical records.This identification was followed by interpretation. Three categories were identified in the interpretivepart of the study: acute, chronic, and degree of neurotoxicity. The results show the importanceof awareness of neurotoxic side effects so that they can be documented and action taken atan early stage. The documentation could be more reliable if patient-reported structured measurementswere used, combined with free descriptions in the medical records. Being able to followthe progression of the symptoms during and after treatment would improve patient’s safety andalso quality of life. The protocol that we developed and used in this review of medical records maybe helpful to structure the documentation in the electronic system for documentation of neurotoxicityside effects.

 

Place, publisher, year, edition, pages
Scientific Research Publishing, 2014
Keyword
Adjuvant Oxaliplatin Chemotherapy, Colorectal Cancer, Medical Record Review, Neurotoxicity
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-105867 (URN)10.4236/ojn.2014.44031 (DOI)
Available from: 2014-04-11 Created: 2014-04-11 Last updated: 2017-12-05Bibliographically approved
Sjödahl, R., Rosell, J. & Starkhammar, H. (2013). Causes of death after surgery for colon cancer-impact of other diseases, urgent admittance, and gender. Scandinavian Journal of Gastroenterology, 48(10), 1160-1165.
Open this publication in new window or tab >>Causes of death after surgery for colon cancer-impact of other diseases, urgent admittance, and gender
2013 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, no 10, 1160-1165 p.Article in journal (Refereed) Published
Abstract [en]

Objective. In patients with colon cancer, high age and comorbidity is common. In this population-based retrospective study we have investigated causes of death and the influence of urgent operation, and gender on survival. Material and methods. Medical records of 413 patients with verified colon cancer were reviewed. The diagnosis was made during 2000-2006 and operation was performed in 385 patients (93%). Results. The overall 5-year survival after surgery was 48.3%. At the end of the follow-up, 128 patients (54.9%) had verified colon cancer when they died but 105 patients (45.1%) had no signs of colon cancer. Their 5-year survival was 5.5% and 41.9%, respectively (p andlt; 0.0001). Median survival time was significantly shorter after urgent compared with elective admittance, 20.7 months versus 77.9 months, and the 5-year survival 32.4% versus 57.9% (p = 0.0001). The tumor stage at operation was more favorable in patients dying with no signs of colon cancer than in those dying with cancer regarding stage I-II (66.7% versus 16.4%), and stage IV (1.0% versus 53.1%), but not regarding stage III (30.5% versus 29.7%). The overall survival in women who were operated was longer than in men (p = 0.045) as well as survival after elective admittance (p = 0.013). Conclusion. After a median follow-up of 56.1 months almost half of the patients who were dead had died from other causes than colon cancer. Ten percent of those patients had an incorrectly reported diagnosis of colon cancer as cause of death. Urgent admittance was associated with reduced survival time. The median survival time was longer in women than in men.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keyword
colon cancer, comorbidity, neoplasm, survival, urgent admittance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-99407 (URN)10.3109/00365521.2013.828771 (DOI)000324761000008 ()
Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-12-06
Börjeson, S., Starkhammar, H., Unosson, M. & Berterö, C. (2012). Common Symptoms and Distress Experienced Among Patients with Colorectal Cancer: A Qualitative part of Mixed Method Design. Open Nursing Journal, 6(1), 100-107.
Open this publication in new window or tab >>Common Symptoms and Distress Experienced Among Patients with Colorectal Cancer: A Qualitative part of Mixed Method Design
2012 (English)In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 6, no 1, 100-107 p.Article in journal (Refereed) Published
Abstract [en]

Background :

Colorectal cancer is one of the most common types of tumour in the world. Treatment side effects, together with the tumour symptoms, can result in a ‘symptom burden’. To understand the patient’s burden during chemotherapy treatment and plan effective symptom relief there is a need for more knowledge about the experience of symptoms from the patients’ perspective.

Objectives :

The study was designed to qualitatively identify and describe the most common symptoms among patients treated for colorectal cancer, and discover whether there are barriers to reporting symptoms.

Methods :

Thirteen Swedish patients diagnosed with colorectal cancer and treated with chemotherapy were interviewed face-to-face. The interviews were audio-taped and transcribed verbatim. The transcripts were analysed by following the principles of qualitative content analysis.

Results :

Nine symptoms/forms of distress were identified. Those most frequently expressed were fatigue, changed bowel habits, and affected mental well-being, closely followed by nausea, loss of appetite and neurological problems. Of particular note were the affected mental well-being, the magnitude of the neurological problems described, the symptoms related to skin and mucous membrane problems, and the reports of distressing pain. Barriers to symptom control were only expressed by the patients in passing and very vaguely.

Conclusion :

This study confirms other reports on most common symptoms in colorectal cancer. It also highlights the early onset of symptoms and provides data on less well-studied issues that warrant further study, namely affected mental well-being, the magnitude of the neurological problems and symptoms related to the skin and mucous membranes. Nurses need to be sensitive to the patients’ need presented and not only noting symptoms/distresses they have guidelines for.

Place, publisher, year, edition, pages
Bentham Open, 2012
Keyword
Colorectal cancer, distress, qualitative content analysis, symptoms
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87145 (URN)10.2174/1874434601206010100 (DOI)
Available from: 2013-01-10 Created: 2013-01-10 Last updated: 2017-12-06
Drott, J., Berterö, C., Börjeson, S. & Starkhammar, H. (2012). Neurotoxiska symtom vid adjuvant cytostatikabehandling hos patienter med kolorektalcancer. Paper presented at Kirurgveckan i Linköping 2012,20-24 augusti. .
Open this publication in new window or tab >>Neurotoxiska symtom vid adjuvant cytostatikabehandling hos patienter med kolorektalcancer
2012 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90997 (URN)
Conference
Kirurgveckan i Linköping 2012,20-24 augusti
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2016-09-26
Tveit, K. M., Guren, T., Pfeiffer, P., Sorbye, H., Pyrhonen, S., Sigurdsson, F., . . . Christoffersen, T. (2012). Phase III Trial of Cetuximab With Continuous or Intermittent Fluorouracil, Leucovorin, and Oxaliplatin (Nordic FLOX) Versus FLOX Alone in First-Line Treatment of Metastatic Colorectal Cancer: The NORDIC-VII Study. Journal of Clinical Oncology, 30(15), 1755-1762.
Open this publication in new window or tab >>Phase III Trial of Cetuximab With Continuous or Intermittent Fluorouracil, Leucovorin, and Oxaliplatin (Nordic FLOX) Versus FLOX Alone in First-Line Treatment of Metastatic Colorectal Cancer: The NORDIC-VII Study
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2012 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 30, no 15, 1755-1762 p.Article in journal (Refereed) Published
Abstract [en]

Purpose less thanbrgreater than less thanbrgreater thanThe NORDIC-VII multicenter phase III trial investigated the efficacy of cetuximab when added to bolus fluorouracil/folinic acid and oxaliplatin (Nordic FLOX), administered continuously or intermittently, in previously untreated metastatic colorectal cancer (mCRC). The influence of KRAS mutation status on treatment outcome was also investigated. less thanbrgreater than less thanbrgreater thanPatients and Methods less thanbrgreater than less thanbrgreater thanPatients were randomly assigned to receive either standard Nordic FLOX (arm A), cetuximab and FLOX (arm B), or cetuximab combined with intermittent FLOX (arm C). Primary end point was progression-free survival (PFS). Overall survival (OS), response rate, R0 resection rate, and safety were secondary end points. less thanbrgreater than less thanbrgreater thanResults less thanbrgreater than less thanbrgreater thanOf the 571 patients randomly assigned, 566 were evaluable in intention-to-treat (ITT) analyses. KRAS and BRAF mutation analyses were obtained in 498 (88%) and 457 patients (81%), respectively. KRAS mutations were present in 39% of the tumors; 12% of tumors had BRAF mutations. The presence of BRAF mutations was a strong negative prognostic factor. In the ITT population, median PFS was 7.9, 8.3, and 7.3 months for the three arms, respectively (not significantly different). OS was almost identical for the three groups (20.4, 19.7, 20.3 months, respectively), and confirmed response rates were 41%, 49%, and 47%, respectively. In patients with KRAS wild-type tumors, cetuximab did not provide any additional benefit compared with FLOX alone. In patients with KRAS mutations, no significant difference was detected, although a trend toward improved PFS was observed in arm B. The regimens were well tolerated. less thanbrgreater than less thanbrgreater thanConclusion less thanbrgreater than less thanbrgreater thanCetuximab did not add significant benefit to the Nordic FLOX regimen in first-line treatment of mCRC.

Place, publisher, year, edition, pages
American Society of Clinical Oncology: JCO, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-78817 (URN)10.1200/JCO.2011.38.0915 (DOI)000304427600008 ()
Note
Funding Agencies|Kjell Magne Tveit||Merck Serono||sanofi-aventis||Bengt Glimelius||Eli Lilly||Per Pfeiffer||Roche||Halfdan Sorbye||Seppo Pyrhonen||Anders Johnsson||Fridbjorn Sigurdsson||Merck Serono (Darmstadt, Germany)||sanofi-aventis (Oslo, Norway)||Norwegian Cancer Society||Swedish Cancer Society (Cancerfonden)||Available from: 2012-06-21 Created: 2012-06-21 Last updated: 2017-12-07
Börjeson, S., Starkhammar, H. & Berterö, C. (2011). Common symptoms experienced among patients with colorectal cancer, and barriers to reporting symptoms or distress; the staff perspective. Austral-Asian Journal of Cancer, 10(1), 12-20.
Open this publication in new window or tab >>Common symptoms experienced among patients with colorectal cancer, and barriers to reporting symptoms or distress; the staff perspective
2011 (English)In: Austral-Asian Journal of Cancer, ISSN 0972-2556, Vol. 10, no 1, 12-20 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68398 (URN)
Available from: 2011-05-23 Created: 2011-05-23 Last updated: 2013-09-12
Loof, J., Rosell, J., Bratthall, C., Doré, S., Starkhammar, H., Zhang, H. & Sun, X.-F. (2011). Impact of PINCH expression on survival in colorectal cancer patients. BMC CANCER, 11(103).
Open this publication in new window or tab >>Impact of PINCH expression on survival in colorectal cancer patients
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2011 (English)In: BMC CANCER, ISSN 1471-2407, Vol. 11, no 103Article in journal (Refereed) Published
Abstract [en]

Background: The adaptor protein PINCH is overexpressed in the stroma of several types of cancer, and is an independent prognostic marker in colorectal cancer. In this study we further investigate the relationship of PINCH and survival regarding the response to chemotherapy in colorectal cancer. Results: Paraffin-embedded tissue sections from 251 primary adenocarcinomas, 149 samples of adjacent normal mucosa, 57 samples of distant normal mucosa and 75 lymph node metastases were used for immunohistochemical staining. Stromal staining for PINCH increased from normal mucosa to primary tumour to metastasis. Strong staining in adjacent normal mucosa was related to worse survival independently of sex, age, tumour location, differentiation and stage (p = 0.044, HR, 1.60, 95% Cl, 1.01-2.52). PINCH staining at the invasive margin tended to be related to survival (p = 0.051). In poorly differentiated tumours PINCH staining at the invasive margin was related to survival independently of sex, age and stage (p = 0.013, HR, 1.90, 95% Cl, 1.14-3.16), while in better differentiated tumours it was not. In patients with weak staining, adjuvant chemotherapy was related to survival (p = 0.010, 0.013 and 0.013 in entire tumour area, invasive margin and inner tumour area, respectively), but not in patients with strong staining. However, in the multivariate analysis no such relationship was seen. Conclusions: PINCH staining in normal adjacent mucosa was related to survival. Further, PINCH staining at the tumour invasive margin was related to survival in poorly differentiated tumours but not in better differentiated tumours, indicating that the impact of PINCH on prognosis was dependent on differentiation status.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67565 (URN)10.1186/1471-2407-11-103 (DOI)000289146300001 ()
Note
Original Publication: Jasmine Loof, Johan Rosell, Charlotte Bratthall, Siv Doré, Hans Starkhammar, Hong Zhang and Xiao-Feng Sun, Impact of PINCH expression on survival in colorectal cancer patients, 2011, BMC CANCER, (11), 103, . http://dx.doi.org/10.1186/1471-2407-11-103 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2011-04-18 Created: 2011-04-18 Last updated: 2011-05-09
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