Late effects following breast cancer treatment.

Improved survival after breast cancer treatment comes at a cost in the form of increased risk of late effects. A number of these are summarised in this review. The late effects can be divided in 1) late effects after locoregional treatment, e.g., lymphoedema, impaired shoulder movement, and pain; 2) consequences of systemic treatment, e.g. polyneuropathy, problems related to premature menopause, and increased risk of cardio-vascular disease; and 3) general late effects, commonly seen across all cancer types, including fatigue, insomnia, and cognitive impairment. There is a need for more knowledge about risk factors, prognoses, and the most effective treatments.

The importance of sleep in memory, learning, and other cognitive functions.

Sleep is important for brain health, having both a restorative function and playing an important role in cognitive functions, e.g., attention, memory, learning, and planning. This review finds that sleep disturbances are prevalent and associated with poorer cognitive functioning in neurodegenerative disorders such as Parkinson's disease and in people with non-neurodegenerative diseases such as cancer and mood disorders. Screening for and treating sleep disturbances are potential supplementary approaches to preventing and treating cognitive impairment.

[Sleep impairment is a threat to good health].

Long-term sleep impairment is related to an increased risk of somatic health problems, e.g. overweight, Type 2 diabetes, cardiovascular disease and premature death. Avoidance of caffeine, alcohol, energy-rich or fatty foods and light from computer screens close to bedtime may counteract impaired sleep. A quiet, dark and well-tempered bedroom and physical activity during the day may have a positive impact on sleep. Impaired sleep may be related to stress and conditions at home or at work. Psychological sleep treatment is free of adverse side effects with effects comparable to effects of medical treatment.

[Pain audit as a tool to optimize pain treatment in hospital departments]. / Smerteaudit som et redskab til optimering af smertebehandlingen på hospitalsafdelinger.

On March 3 2011 the Department of Oncology, Aarhus University Hospital, conducted a cross-sectional pain audit. All patients present at the department were invited to complete a questionnaire about their pain experience, and their medical records were reviewed. The results indicated that patients with probable neuropathic pain reported the highest pain severity levels and experienced the greatest burden of their pain. Most patients with neuropathic pain did not receive any secondary analgesics and their general practitioners were infrequently involved in the treatment. The methods used in the present audit can be transferred to other departments for the benefit of the patients.

[Stress and insomnia]. / Stress og insomni.

Insomnia and stress are two conditions, which are strongly associated and appear to be pathophysiologically integrated: the occurrence of stress increases the risk of insomnia, insomnia exacerbates stress, and coexistence of both factors has a negative influence on their prognosis. Stress and insomnia thus share complex interactions and the mechanisms involved are insufficiently understood but involve both psychological and physiological processes. First choice interventions involve behavioural and cognitive strategies and, to a lesser extent, pharmacological treatment.

[Are old and young cancer patients being treated differently?]. / Gøres der forskel på aeldre og yngre kraeftpatienter?

INTRODUCTION: Research suggests that cancer patients' age may affect the quality of their treatment. Yet, there is little knowledge of how and why age affects treatment quality. This study explores staff attitudes and perceptions of age-related differences in treatment and care at a Danish oncology department. MATERIAL AND METHODS: Qualitative analyses of nine semi-structured interviews with strategically selected staff members were conducted using a grounded theory-inspired approach. The interviews were independently coded by four raters through a process of meaning condensation and meaning was structured into core-categories. RESULTS: Although eight of nine participants denied that age was a reason for differential treatment, all nine participants gave examples of age-related differences in treatment. Younger patients were generally offered: 1) more intensive treatment, 2) more consultation time with physicians, 3) allocation to physicians with higher seniority, and 4) increased continuity in the staff assigned to them. The differences were explained as due to: a) differences in patients' physical health and b) sympathy for younger patients' life situation and needs. DISCUSSION: Two co-dominant values were identified: 1) "equality in treatment and care" and 2) "normative life course expectations" of serious disease belonging to old age and thus being more tragic for young individuals (life script model). Values of equality are explicit and govern formal health care system guidelines, while values related to the staff's life course expectations are more implicit and may account for some age-related differences in treatment quality.

[Quality of life concept]. / Livskvalitet som begreb.

Although WHO defined health as a "state of complete physical, mental and social well-being'' in 1948, it is only in recent years that health-related "quality-of-life'' (HRQOL) has gained acceptance in medicine. Changes in clinical outcome measures do not necessarily correspond to the increased benefits in HRQOL perceived by patients, and their HRQOL-related preferences may differ from those of health professionals. HRQOL measures can guide treatment decisions and increase the possibility of involving patients in decisions concerning treatment, care and rehabilitation.

[The importance of spiritual well-being for cancer patients' quality of life]. / Betydning af religiøs tro og eksistentielt velbefindende for kraeftpatienters livskvalitet.

Research indicates unmet religious and spiritual needs among cancer patients both internationally and in a secular society like Denmark. Obtaining a patient's spiritual history is a way of identifying religious/spiritual needs. Spiritual well-being has been positively associated with global experience of quality of life and with increased psychological, social, and physiological well-being. Although religiosity/spirituality may represent a way of coping with cancer, at present no causality can be implied with respect to this relationship.

[Psychosocial problems and needs among cancer patients]. / Psykosociale problemer og behov hos kraeftpatienter.

INTRODUCTION: Cancer can have a serious impact on patient well-being and quality of life. The international literature reports a higher prevalence of psychosocial problems among cancer patients; primarily problems associated with difficulties in the family, duties in the household, work and leisure, sexuality and finances. The prevalence of these problems among Danish cancer patients is still unknown. MATERIALS AND METHODS: A questionnaire assessing psychosocial problems and needs was mailed out to all patients who had been at the Department of Oncology, Aarhus Hospital in week 35, 2004. A total of 71%, i.e. 515 patients (34% men and 66% women) in active treatment and control returned the questionnaire. RESULTS: High levels of emotional distress were reported by 39% of the patients. High levels of distress were primarily related to problems with worries about their spouses, household duties, financial problems and experiences of insufficient collaboration between health care and social services. Between 19% and 25% of the patients required further help to handle emotional problems, legal and financial problems and practical problems in the home. CONCLUSION: A considerable proportion of oncology patients experience significant levels of distress. This group of distressed patients also report unmet needs for psychosocial support.