Mats Lambe

Results from several studies indicate that continuous symptom monitoring in cancer patients can improve not only quality of life but also survival. In a French study where patients with advanced lung cancer were randomized to weekly symptom monitoring (intervention group) and standard follow-up (control group), the median survival in the intervention group was 22.5 months compared to 14.9 months in the control group. Using an IT platform that is already used in Swedish healthcare, we wish to investigate whether symptom monitoring has the same positive effects in Sweden. The project concerns patients with advanced lung cancer. The aim is to investigate whether changed routines with closer follow-up of the patient group can contribute to improving quality of life and prognosis. The area is procedures for the care of cancer patients

according to the current care program, lung cancer patients with advanced disease must be followed up approximately every three months after completion of treatment. The study examines the effects of closer contact where the patients answer questions every week about current symptoms that may be signs of complications or progress. The answers are continuously monitored by healthcare staff who, if necessary, call the patient to earlier appointments. If continuous, weekly symptom follow-up proves to have positive effects on quality of life and survival, the method can be introduced as part of the routines for standard treatment and included in the national care program for lung cancer, i.e. in the long run it will be offered to all patients with lung cancer. The project is run by pulmonary oncologists, representatives in the steering group for the Lung Cancer Registry, Karolinska Institutet and RCC Middle Sweden, a collaboration that facilitates the dissemination of the results into lung cancer care. The developed technical solution for reporting and monitoring symptoms can also be adapted for other patient groups with cancer.

The increasing quantity of detailed cancer related data with access to large, linked electronic databases has stimulated novel applied research. Advances in statistical methodology and software are not so rapid. With more detailed data combined with greater understanding of when effects can be considered causal, there needs to be reconsideration of the most appropriate ways to analyse and report comparisons from population-based cancer studies. This project will concentrate on survival analysis methods using large registry-based data.AIM 1: Rethinking how survival is estimated within population-based cancer studies through appropriate integration of causal inference methods.AIM 2: Improving the understanding and communication of risk in population-based cancer studies through further development of reference-adjusted measuresAIM 3: Transferal of methods into applied work through collaboration, software development, and education material.Aims 1 and 2 concentrate on methodological development. Aim1 will develop causal inference methods within the relative survival framework for use in population-based cancer survival studies. Aim 2 will further develop reference adjusted measures, an alternative approach to quantifying survival differences making all-cause and crude probabilities comparable between population groups. Aim 3 will ensure that the novel methods are used in practice through leading and collaborating on applied studies, software development, and education material.

Despite the launch of more precise diagnostic methods and new drugs, the prognosis for lung cancer patients remains pessimistic. We have previously shown unjustified differences in the received care and the importance of co-morbidity for survival. Big progress for the patient group could be made if diagnosis was brought forward, waiting times for treatment shortened and individualized care according to the latest findings offered to all patients. Utilization of the research database "LCBaSE" enables to highlight clinically relevant issues about early symptoms, co-morbidity, investigation, treatment, waiting times, equal care, heredity, quality of life, long-term course and prognosis. The research project is about lung cancer, which is the fifth and fourth most common cancer among Swedish men and women, respectively, and the most common cause of cancer death. There are still shortcomings in our knowledge of natural processes and optimal treatment of the disease in its various stages. By using information available in the research database "LCBaSE" we will highlight issues regarding early symptoms, co-morbidity, investigation, treatment, waiting times, equal care, heredity, quality of life, long-term course and prognosis. By utilizing a research database of unique size and content, we hope that the overall results from this research study will contribute to an increased knowledge of lung cancer disease and improve lung cancer care for the benefit of all patients, including through early diagnosis, shortened waiting times and an individualized care according to latest findings.

The annual Swedish number of newly diagnosed cancer cases will double between 2014 and 2040, an increase that is most evident in the oldest age groups. It will be a challenge for cancer care to provide adequate treatment for elderly, often multi-disease patients. Unlike other countries, the care of older cancer patients has received little interest in Sweden. Foreign studies have highlighted unjustified differences in treatment intensity between younger and elderly patients, including breast, lung, colorectal and prostate cancer. Few studies with a clear focus on dealing with older cancer patients have so far been made in Sweden. The overall purpose of the project is twofold: to • comparing patterns for investigation and treatment as well as cancer mortality between younger and older patients on the basis of quality register data.   • identify any medically unjustified deviations from guidelines when dealing with the elderly who can lead to sub-optimal results. The overall aim of the study is to improve knowledge of cancer treatment patterns in the elderly. By identifying any medically unjustified deviations, guidelines and care programs can be developed to optimize treatment decisions among the elderly in order to avoid under-treatment that can lead to sub-optimal results. The results of the study are communicated via care process groups and care programs and can be of direct clinical importance by improving treatment and results for a large and growing patient group.

With just over 3,500 new cases a year, lung cancer is the fifth and fourth most common cancer among Swedish men and women, respectively, and the most common cause of cancer death. The prognosis for patients with lung cancer remains gloomy with an average relative three and five-year survival of 14.6% and 8.2% respectively. Although lung cancer is a common tumor disease with severe prognosis, the knowledge is insufficient about the influence of co-morbidity on treatment and survival. The project aims to increase knowledge about patterns of other disease burden, special care needs and expected care weight among lung cancer patients. The results help to increase the knowledge of the causes behind previous findings regarding socio-economic, gender and age differences in lung cancer mortality. The data material also makes it possible to produce data for survival prognoses for subgroups of lung cancer patients with varying degrees of complicity. We hope that increased knowledge of the importance of co-morbidity in lung cancer can contribute to a more adapted care of the patient group both before and after cancer treatment. We also intend to produce documentation where the prognosis for survival can be based on the patient's entire disease picture.

With just over 3,500 new cases a year, lung cancer is the fifth and fourth most common cancer among Swedish men and women, respectively, and the most common cause of cancer death. The prognosis for patients with lung cancer remains gloomy with an average relative three and five-year survival of 14.6% and 8.2% respectively. Although lung cancer is a common tumor disease with severe prognosis, the knowledge is insufficient about the influence of co-morbidity on treatment and survival. The project aims to increase knowledge about patterns of other disease burden, special care needs and expected care weight among lung cancer patients. The results help to increase the knowledge of the causes behind previous findings regarding socio-economic, gender and age differences in lung cancer mortality. The data material also makes it possible to produce data for survival prognoses for subgroups of lung cancer patients with varying degrees of complicity. We hope that increased knowledge of the importance of co-morbidity in lung cancer can contribute to a more adapted care of the patient group both before and after cancer treatment. We also intend to produce documentation where the prognosis for survival can be based on the patient's entire disease picture.

Breast, prostate, thick and rectal cancer accounts for just over 45% of total cancer disease in Sweden, and each year affects more than 8,000 Swedes in working age. Thanks to improved early detection opportunities and new treatment methods, the prognosis in these cancers has dramatically improved in recent decades. The proportion of patients with cancer who wish to return to an active life is therefore expected to increase. However, both the cancer disease itself and the treatment can have physical and psychological consequences that make it difficult to return to work. The project highlights various aspects of the life situation after a cancer diagnosis. Based on information in quality registers for cancer and other data sources, work-related and social consequences of a diagnosis with malignant melanoma, breast, prostate or colorectal cancer are studied among patients who have fallen ill before the age of 60. The study charts for each type of cancer the reason given for sick leave / early retirement, patterns of care utilization, sick leave, early retirement, income and marital status in relation to the severity of the tumor, treatment and the patient's socio-economic status. The study can help identify subgroups of cancer patients in need of special support. The project's results can also provide knowledge base for the development of programs for cancer rehabilitation to facilitate return to work, and is of importance for both healthcare, health insurance systems and the social partners.