BACKGROUND:Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed. AIM:MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer. DESIGN:MISTRAL was an investigator-initiated, phase III, randomized, double-blind, placebo-controlled, parallel-group, superiority, multicenter, clinical trial with a nested biomarker study. Registration EudraCT 2014-004552-64, NCT02948309. SETTING AND PARTICIPANTS:At 9 oncology centers, 290 participants were randomized to standard treatment (palliative chemotherapy or best supportive care) plus subcutaneous mistletoe extract or placebo. Main inclusion criteria were advanced pancreatic cancer, performance status 0-2, main exclusion criteria neuroendocrine pancreatic tumor. EORTC-QLQ-C30, EORTC-QLQ-PAN26, body weight, cost parameters and biomarkers were assessed from baseline up until 9 months. RESULTS:No statistically significant differences for quality of life and weight were evident between treatment arms. Parameters for observed costs for supportive and inpatient care (days at hospital, parenteral nutrition infusions, nutritional supplement drinks, number of visits of palliative home care teams, symptom-relieving medication) were similar in both arms. Thus, calculation of costs was not performed. No effect on explored biomarkers (differential blood count, lymphocyte subpopulations, C-reactive protein, albumin and Ca19-9) was found except for a statistically significant increase of eosinophils in the mistletoe arm without association to clinical effect. CONCLUSIONS:Since no benefit was observed, there is no clinical reason to recommend mistletoe extract in patients with advanced pancreatic cancer.

Background Contact nurses in cancer care play a key role in providing information about planned treatment and care. However, little is known about how their communication skills influence patients’ ability to participate actively in their care. There is also limited knowledge about contact nurses’ capacity to engage patients in decision-making related to information sharing and self-management. This study aimed to examine the level of agreement between patients and contact nurses regarding perceived patient participation during pre-treatment encounters and to identify factors influencing agreement or disagreement. Methods A cross-sectional assessment was conducted with 63 cancer patient–contact nurse pairs at an oncology outpatient clinic in a large university hospital. Patients and contact nurses completed the Dyadic OPTION scale immediately after a scheduled encounter prior to treatment initiation. Before the encounter, patients also completed the Patient Activation Measure (PAM-13®), the Hospital Anxiety and Depression Scale (HADS), and study-specific questions. Data were analyzed using percentage agreement and linear regression, along with content analysis of an open-ended question about agreement on the main issues discussed. Results Agreement between patients and contact nurses varied, although most patients (95%) reported high satisfaction with the encounter. Depression symptoms were the primary factor associated with lower agreement. Higher agreement occurred when both parties reported discussing the same main problem. Disagreement was most often related to patients not being asked about their prior knowledge or preferred level of involvement in treatment and care. Conclusions Low agreement between patients’ and contact nurses’ perceptions of patient participation and of the issues discussed before treatment may lead to misunderstandings and missed information, posing a potential risk to patient safety. Contact nurses therefore need to proactively assess patients’ prior knowledge and preferences for involvement. Understanding patients’ existing knowledge and experiences enables nurses to tailor information more effectively, improving comprehension and opportunities for participation. Contact nurses should also ensure they have accurately understood each patient’s concerns and that patients fully comprehend the information provided. Ongoing development of communication skills and a stronger focus on effective information exchange are essential.

Abstract Background Research indicates that about 40% of all cancer cases within the European Union (EU) are preventable. Public awareness of modifiable risk factors is essential for informed health-related decision-making. Systematic assessments of public awareness are crucial for identifying awareness gaps and guiding targeted public health interventions. This study aimed to examine awareness of cancer risk factors among the Swedish general public, and to examine the attitude towards lifestyle changes for cancer prevention. Methods This cross-sectional study used a pre-existing data set with a randomly selected sample of 1520 participants (18–84 years old) recruited from a Swedish online survey panel in April 2024. Statistical analyses utilized post-stratification weights to make the results representative for the general Swedish population. Pearson’s χ2-test and weighted adjusted logistic regression were used to test for associations between demographic characteristics, believing that changed lifestyle habits could reduce one’s cancer risk, and awareness of 20 established risk factors for cancer. Results A majority (63.6%) of the respondents believed that one’s cancer risk could be reduced through changed lifestyle habits. Most were aware of smoking (97.1%), sun exposure (92.4%), hereditary factors (91.0%), sunbeds (90.2%), and air pollution (90.2%), while fewer were aware of alcohol (64.9%), obesity (61.6%), overweight (58.1%), and processed meat (53.3%) as cancer risk factors. A minority of the responders were aware of low levels of physical activity (48.1%), red meat (38.9%), low intake of fruit and vegetables (32.9%), low intake of whole grains (23.7%) and not breast-feeding one’s child (9.3%) as risk factors. For most risk factors, the awareness was significantly higher among college/university educated respondents. Conclusions Beside significant awareness gaps among the Swedish general public regarding several established cancer risk factors, this study found an educational gradient, illuminating important differences in cancer prevention awareness. Achieving meaningful improvements in cancer prevention awareness requires coordinated system-level and policy-level actions to reduce the educational gradient and ensure equitable access to information. This could in turn increase people’s ability to make well-informed decisions regarding their lifestyle habits and preventive measures.

BACKGROUND:The European Code Against Cancer (ECAC) aims to increase the awareness of modifiable cancer risk factors among the general public. A goal set by the European Commission was that 80% of European citizens should be aware of this code by 2025. This study aims to examine the awareness and attitudes towards the ECAC among the general public in Sweden. METHODS:A randomly selected sample of 1520 Swedes (18-84 years old) were recruited from a survey panel and invited to respond to an online study-specific questionnaire. The questionnaire included general questions regarding cancer prevention, as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, using post-stratification weights based on gender, age, education, and expressed political party orientation. RESULTS:In total, 3.7% of the respondents had heard about the ECAC before taking this survey. Respondents with a college/university education were more likely to have heard about the ECAC (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.23-4.06). Males (OR 0.56; 95% CI 0.32-0.99), and those living alone (OR 0.47; 95% CI 0.23-0.95) were less likely to have heard about the ECAC. In total, 60.6% of the respondents agreed with the ECAC recommendations, while 27.4% reported that their motivation to improve their lifestyle increased after reading the ECAC. CONCLUSIONS:Awareness of the ECAC among the general public in Sweden is very low. Still, a majority seem to agree with its recommendations. The results also indicate that the ECAC motivates some, but far from all, to improve their lifestyle habits to reduce their cancer risk. Consequently, further research is warranted on how the ECAC best could and should be used in order to improve cancer prevention awareness and motivation.

The Multinational Association for Supportive Care (MASCC) recently published its Supportive Care 2030 Movement with the aims of developing consensus about shared, equitable and translatable ambitions to drive excellence in and outline the desired state of supportive cancer care by 2030. In response to the publication of the ambition statements, the major oncology nursing organizations launched a collaboration in June 2024 with the aim of achieving global nursing excellence and leadership within the wider interdisciplinary model of supportive cancer care. This editorial presents our collective response to the ambitions set by the Supportive Care 2030 Movement. We believe that the 13 ambitions can realistically be achieved only if five prerequisites are in place that put oncology nursing at the forefront of any relevant endeavor.

PURPOSE:The European Cancer Nursing Index (ECNI) 2022 survey identified critical challenges in cancer nursing across Europe. One part of the survey, presented here, aimed at describing European cancer nursing staffing and exploring factors associated with bed closures and cancer treatment delays due to nursing shortages. METHODS:A secondary analysis of the European Cancer Nursing Index 2022 dataset was conducted, including responses from 436 cancer nurses across 29 European countries. Two multivariable logistic regression models were performed to assess the association between workforce-related variables and (1) bed closures and (2) delays in cancer treatment. Independent variables included nurse-to-patient ratio, advanced cancer nursing roles, inpatient setting, preparation of hazardous drugs, and nurse-led care. RESULTS:Nearly 18 % (n = 80) of respondents reported bed closures and treatment delays in the previous year due to nursing shortages. Logistic regression showed that nurses preparing hazardous drugs at their workplaces, rather than at a pharmacy/lab, were over twice as likely to report treatment delays (OR = 2.16, 95 % CI: 1.24-3.82, p = 0.007). Moreover, each additional patient per nurse increased the likelihood of reporting cancer treatment delay by 9 % (OR = 1.09, 95 % CI: 1.01-1.17, p = 0.026). CONCLUSIONS:Findings highlight the impact of excessive workload and unsafe drug preparation practices on timely cancer care delivery. Centralizing hazardous drug preparation and optimizing staffing may reduce delays and improve patient safety. Further research is needed to understand systemic factors behind bed closures and to inform workforce planning strategies across oncology settings.

PURPOSE:In Swedish cancer care, Contact Nurses (CNs), have a role to enhance the patients' opportunities for participation through improved communication and information. The aim of this study was to explore how patients describe their opportunities for participation during the first encounter with the CN, prior to starting the cancer treatment. METHODS:Semi-structured interviews with 14 patients with cancer, planned for curative treatment, were performed. Purposeful sampling, based on estimated high or low activation level measured with PAM-13®, as well as gender and age, were used. The interviews were analysed, using a qualitative inductive approach. RESULTS:The overarching theme "Dealing with an entirely new life situation" encompass three categories; "Establish relationships", "Gaining understanding of the illness" and "Taking part in treatment planning". The relationships with the CNs as well as the understanding of what was being planned, was considered important. Having the opportunity to communicate essential matters and the adaption of the information, was also found to be of great importance. The perceived possibilities to participate in the planning of treatment and care varied, with some patients describing the plan to be predetermined, while others had a more accommodating experience. CONCLUSION:The result highlights the importance for CNs of establishing relationships with their patients. It also points out the importance of the patients understanding of their situation. These insights emphasize the need for CNs to prioritize empathic communication, the need to adapt information to the patient's preunderstanding and to actively involve patients in their care planning, enhancing overall patient satisfaction and outcomes.

BACKGROUND:Patients with advanced pancreatic cancer have limited survival and few treatment options. We studied whether mistletoe extract (ME), in addition to comprehensive oncological treatment and palliative care, prolongs overall survival (OS) and improves health-related quality of life (HRQoL). METHODS:The double-blind, placebo-controlled MISTRAL trial was conducted in Swedish oncology centers. The main inclusion criteria were advanced exocrine pancreatic cancer and Eastern Cooperative Oncology Group (ECOG) performance status 0-2. The subjects were randomly assigned to ME (n=143) or placebo (n=147) and were stratified by study site and by eligibility (yes/no) for palliative chemotherapy (June 2016-December 2021). ME or placebo was injected subcutaneously three times a week for nine months. The primary endpoint was overall survival (OS); one of the secondary endpoints was the HRQoL dimension global health/QoL (EORTC-QLQ-C30), as assessed at seven time points over nine months. Trial registration: EudraCT 2014-004552-64, NCT02948309. RESULTS:No statistically significant benefit of adding ME to standard treatment was seen with respect to either OS or global health/ QoL. The adjusted hazard ratio for OS was 1.13 [0.89; 1.44], with a median survival time of 7.8 and 8.3 months for ME and placebo, respectively. The figures for the HRQoL dimension "global health/QoL" were similar in the two groups (p=0.86). The number, severity, and outcome of the reported adverse events were similar as well, except for more common local skin reactions at ME injection sites (66% vs. 1%). CONCLUSION:ME is unlikely to have a clinically significant effect on OS or the HRQoL dimension global health/QoL when administered in patients with advanced pancreatic cancer in addition to comprehensive cancer care.

PurposeNurses are particularly at risk for occupational exposure to hazardous cancer drugs, risking both acute and chronic health effects. Knowledge on the implemented safety precautions into minimizing these risks is limited.MethodsThe European Cancer Nursing Index (ECNI) was developed by the European Oncology Nursing Society (EONS) to illustrate the development and status of this profession. In this study, anonymous online survey data on occupational safety reported by European cancer nurses as part of the ECNI 2022, was analysed.ResultsA total of 630 cancer nurses from 29 countries responded to the survey. A majority reported that written guidelines (n= 553, 88%) on safe handling and administration of hazardous drugs, personal protection equipment (PPE) and cytotoxic spillage kits (n=514, 82%) were available at their workplaces. 130 (21%) nurses reported that wipe testing to assess any residual hazardous drugs on workplace surfaces were conducted systematically at their workplaces. 185 (29%) nurses reported that nurses sometimes or always continued with their regular tasks (including handling hazardous cancer drugs) during pregnancy and breast feeding. 185 (29%) also responded that nurses at their workplaces did not receive an introductory education program before handling hazardous drugs. In total, 346 (55%) of the nurses reported that their workplace had a freedom to speak-up guardian or whistle blower policy for members of staff.ConclusionsEven if most nurses report that there are safety routines in place at their workplaces, the results reveal several serious occupational risks for European nurses handling hazardous cancer drugs. Actions are needed to improve and optimize occupational safety for nursing staff.

It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.

Purpose To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors. Methods The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal–Wallis test and linear regression. Results The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items. Conclusion HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.

Background More knowledge is needed regarding the perceptions of healthcare professionals when encountering empowered patients and informal caregivers in clinical settings. This study aimed to investigate healthcare professionals’ attitudes towards and experiences of working with empowered patients and informal caregivers, and perception of workplace support in these situations. Methods A multi-centre web survey was conducted using a non-probability sampling of both primary and specialized healthcare professionals across Sweden. A total of 279 healthcare professionals completed the survey. Data was analysed using descriptive statistics and Thematic analysis. Results Most respondents perceived empowered patients and informal caregivers as positive and had to some extent experience of learning new knowledge and skills from them. However, few respondents stated that these experiences were regularly followed-up at their workplace. Potentially negative consequences such as increased inequality and additional workload were, however, mentioned. Patients’ engagement in the development of clinical workplaces was seen as positive by the respondents, but few had own experience of such engagement and considered it difficult to be achieved . Conclusion Overall positive attitudes of healthcare professionals are a fundamental prerequisite to the transition of the healthcare system recognizing empowered patients and informal caregivers as partners.

BACKGROUND/AIM:The role of single nucleotide polymorphisms (SNPs) in the frequency and intensity of chemotherapy-induced nausea and vomiting (CINV) in women with breast cancer (BC) is unclear. The primary purpose of this study was to compare/evaluate the effect of SNP-guided antiemetic treatment versus standard CINV treatment.PATIENTS AND METHODS:A randomised, factorial, phase II multicentre study design was used. Women planned for neoadjuvant or adjuvant chemotherapy with epirubicin, cyclophosphamide and fluorouracil (FEC /EC, with or without fluorouracil) for BC were randomised to SNP-guided antiemetic treatment (based on the results of SNP analyses) versus standard CINV treatment. Blood samples were taken before the treatment was initiated. Patient-reported data on CINV (during 10 days from onset of cancer treatment) and health-related quality of life (HRQoL), were collected before and after the first cancer treatment.RESULTS:A total of 188 women were included. Overall, nausea was reported by 86% (n=129) of the patients during the ten-day period from the start of cancer treatment. The SNP genotype studied varied. In FAS-CD95, the genotypes AG and GG were overrepresented; in RB1-LPAR6, GG was overrepresented, and in CCL2, both AA and GG were overrepresented. We found no statistically significant difference in CINV between SNP-guided antiemetic treatment versus standard CINV treatment.CONCLUSION:SNP-guided antiemetic treatment could be as effective as standard treatment. SNP-guided antiemetic treatment of CINV is possibly useful in detecting patients with a higher or lower risk for CINV and thus may help in avoiding over-treatment with toxic components. CINV negatively affects the HRQL.

Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care may be challenging, and there is no golden standard model for integration. Fragmented care is associated with sub-optimal communication, collaboration, and ineffective care. This may lead to unnecessary care transitions, and impact patient safety. We performed a study with the aim to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home. Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Six online focus-group interviews were performed. Few signs of systematic integration between acute and palliative care teams were found, risking fragmented care and putting the patients in vulnerable situations. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors and uncertainty related to responsibilities impacted clinical decisions. We found barriers to timely end-of-life conversations and clinical decisions on optimal care. In addition, the appropriateness of transfer to acute care, seemed to be related to lack of knowing which team was responsible. Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources). Clinical implications: We started two main integration projects based on this study, one piloting direct admission to specialized palliative inpatient ward directly from the emergency room. The other on-going project will try digital visits with patient, the oncology, and the palliative team, aiming to discuss goals-of-care. The results and what we learned from those integration projects will be presented.

Abstract Background Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients’ and physicians’ experiences from situations when patients decline recommended cancer treatment and consider using CAM. Materials and Methods Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used. Results Regarding treatment choices, there was a dissonance between physicians’ focus on medical reasoning and patients’ expression of complex values. Physicians’ difficulty in understanding patients’ treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial. Conclusions This study highlights the difficulty of shared decision-making in practice when patients’ and physicians’ views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients’ values, and improve knowledge among physicians about CAM.

Cancer nursing has evolved to meet the demands of rising cancer incidence, newer and more complex treatment options, and the emergence of specialist roles supporting patients from pre-diagnosis, through treatment, survivorship and end of life care. Nurses are involved in direct and in-direct care of people at risk of, and living with and after cancer in diverse contexts. As a result, nurses are positioned to have a significant influence on the processes and outcomes of cancer care, through education, research, policy, practice and leadership. However, nursing and cancer care face challenges, arising from workforce shortages, under-investment in services and under-representation in decision-making. This paper discusses the evolution of cancer nursing across education, policy, research, profession and practice, and sets an agenda for innovation and disruption across these domains to ensure sustainability of cancer care services and care for people living with and after cancer. We argue for the continued advancement of cancer nursing with critical focus on identifying and addressing inequities in role recognition and access to specialist cancer nursing education throughout Europe. Partnership, exchange of learning, and co-design will be central to progressing education, evidence and policy to support future growth in the cancer nursing workforce and embed cancer nurses in research and policy setting at local, national and international levels.

Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home.METHODS:Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis.RESULTS:Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care.CONCLUSIONS:Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).

Research suggests varied possibilities for Swedish patients to participate in their own care, with many expressing lacking possibilities to participate to the preferred extent. Identifying individual preferences on how, to what degree, and in what situations the patients want to participate in their cancer care, are crucial in person-centred care. Patients' activation level (measured with PAM-13) has been found to be associated with perceived patient participation. The cancer contact nurses (CNs) perceptions of patients' needs and preferences for participation are important to optimise the communication between themselves and the patients. The overall aim for the project is to describe patients' experiences of participation. For this study we wanted to investigate levels of agreement/disagreements between patients' and CNs' of estimated opportunities for participation at the care encounter before starting cancer treatment and to explore how patients with "low" or "high" activation level, described their opportunities for participation in the meeting with the CN. Agreement of patient-nurse dyads, is assessed by dyadicOption, a 12-item scale with five-point response options and one open question. The instrument includes the same items, however, phrased differently for patients and CNs respectively and is completed immediately after each care encounter. Semi-structured interviews, regarding experiences of possibilities for participation in the encounter with the CN, are performed with patients using purposeful sampling, with low-high PAM score respectively. Data collection is on-going and the presentation will include preliminary results from the study. Data from on-going study will be presented.