KEP: Cancer Epidemiology Group
We aim to improve the understanding of determinants of risk and prognosis of cancer, with a special focus on malignant lymphomas and cancers arising after organ transplantation, as well as to characterize issues of cancer survivorship. The overall goal is to provide a better basis for primary prevention of cancer, prediction of risk and prognosis, and cancer rehabilitation.
What we do
We aim to improve the understanding of cancer risk and survival, prognostic prediction and survivorship, with a focus on malignant lymphomas, prostate, breast and colorectal cancer and malignant melanomas. Our research is based on linkages of population-based health register data, often enriched with clinical data from national cancer quality registers and medical records, and we strive to address research questions of high clinical relevance. Examples of areas of specific interest are survival and relapse risk in Hodgkin lymphoma, diffuse large B-cell and follicular lymphoma, late adverse effects from cancer treatments such as risk of second malignancies or heart disease, and child birth potential among cancer survivors.
We collaborate closely with other research groups at KEP, other units at the Karolinska Institutet (MMK, CCK, MEB, IMM), researchers at other Swedish universities (Uppsala, Lund) and the Swedish Lymphoma group as well as internationally within the Nordic Lymphoma group and within the InterLymph consortium. In the ongoing clinical prospective Biolymph study, we work closely with the medical units of Hematology, Genetics and Pathology at the Karolinska hospital to improve diagnostics, prognostics and follow-up of patients with newly diagnosed lymphoma. This work also forms part of a pilot study within the Genomic Medicine Sweden.
Our research is conducted thanks to financial support from the following funding bodies: Swedish Cancer Society, Nordic Cancer Union, Cancerföreningen, Åke Wibergs Stiftelse, Barncancerfonden and Stockholm County Council.
We have also received support by grant funding from Janssen Pharmaceutica NV through a research collaboration with Karolinska Institutet on B-cell malignancies.
Updates from our group are also available via our twitter account @CancerepiK.
A summary of our publications (years 2016 through 2021) can be found here.
Lymphoma and myeloma
Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response
Failure to complete planned R-CHOP treatment among diffuse large B-cell lymphoma patients is an important clinical issue associated with inferior survival. Therefore, we investigated the extent of failure to complete such treatment for reasons unrelated to non-response. We found that old age, extranodal disese and poor performance status most strongly predicted failure to complete treatment. The results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.
American Journal of Haematology, July 2020
Comorbidities and sex differences in causes of death among mantle cell lymphoma patients
This study is the first of three ongoing studies addressing the shift from traditional chemotherapy-based treatments to novel targeted drugs in mantle cell lymphoma, a possible paradigm shift in the care for mantle cell lymphoma patients. Comorbidities at the time of diagnosis is present in 44% of patients, and 28% have severe comorbidity. Severe comorbidity was independently associated with worse all-cause and lymphoma-specific mortality. The majority eventually dies from lymphoma, indicating the need of more efficient, but especially more tolerable lymphoma treatments, in these elderly comorbid patients.
The British Journal of Hematology, April 2020
Concordance in survival time among first-degree relatives with lymphoid malignancies
This study explores survival patterns among first-degree relatives with a lymphoid malignancy among 66,430 patients diagnosed between 1958-2016. We found no concordance in survival among first-degree relatives with lymphoid malignancies (unspecified subtype) overall. Among individuals with indolent lymphoma, including chronic lymphocytic leukemia, those with a first-degree relative with an average or poor survival had worse outcome compared to those with a relative with good survival. In counseling patients with an indolent lymphoma, the survival of relatives affected by indolent lymphoma may add information about the predicted clinical course.
European Journal of Haematology, Sept 2020
Is family history of colorectal cancer associated with prognosis?
In this study we found that young patients with a positive family history had less advanced cancers and lower excess mortality than those with no family history even after adjusting for cancer stage. Possible explanations for the observed association include greater health awareness, likelihood to attend opportunistic screening and adopt lifestyle changes.
Journal of Internal Medicine, February 2020
Organ transplantation and cancer risk
This study investigated cancer risk among all Kidney transplant recipients in Sweden, Norway, Denmark and Finland between 1995-2011. Overall, 1 in 6 patients developed cancer within ten years. The highest excess risks were observed for non-melanoma skin cancer, non-Hodgkin lymphoma, lung cancer and kidney cancer. The results call for supporting extensive post-transplantation cancer vigilance.
Transplant international, Sept 2020
Cancer survival statistics for patients and health care professionals
In this review article we explain two statistical measures that are often used for describing the prognosis of cancer patients; survival in the presence of competing risks and expected life years lost due to the cancer. The concepts are relevant when producing statistics for risk communication between physicians and patients and for planning for use of healthcare resources. Several examples from prostate cancer, breast cancer, colon cancer and Chronic myeloid leukemia are provided to illustrate the methods. The article is relevant for producers or readers of articles on population-based cancer survival.
Journal of Internal Medicine, July 2020