(Summary in Swedish)
Stora förbättringar har skett när det gäller minskningen av biverkningar hos patienter med tidig lokaliserad prostatacancer som fått strålbehandling under den senaste 10-årsperioden. Resultaten visar ett fåtal allvarliga biverkningar. Studien visar att det inte finns någon skillnad i livskvalitet mellan patienter som strålbehandlats och de med avvaktande behandling (exspektans) och är likvärdig med en åldersmatchad kontrollgrupp. Syftet med studien har varit att utveckla en patientenkät för att mäta patienternas subjektiva symtom och bieffekter av behandling. Patienternas besvär har jämförts med de som fått exspektans samt jämförts med män i samma ålder utan en prostatacancersjukdom (kontroller).
Prostatacancer (PC) är idag den vanligaste cancerformen bland män i Sverige och medelålder vid diagnos är 74 år. Hos 60-70 % av dessa patienter är sjukdomen lokaliserad till prostata utan spridning till andra organ. Vid tidig lokaliserad PC finns det inga säkra vetenskapliga resultat som talar för att dagens behandlingsmetoder, strålbehandling eller operation ger bättre överlevnad än exspektans. Det är viktigt att den behandling som erbjuds inte orsakar biverkningar och försämrar livskvaliteten mer än vad själva grundsjukdomen gör. Förekomsten av biverkningar och framför allt hur patienterna själva upplever dessa kan då få en avgörande betydelse för val av behandlingsform, vilket då gör det viktigt att studera detta problem.
Enkäten har skickats till patienter med PC som strålbehandlats samt till en åldersmatchad kontrollpopulation utan PC för att få information om urinvägs och avföringsproblem samt sexualfunktion. Patienterna har följts i upp till 8 år efter avslutad strålbehandling. Studien visar att de som fått strålbehandling i slutet av 80-talet hade mera urin- och avföringsbesvär i jämförelse med kontrollgruppen samt en försämrad sexualfunktion. Detta är mest uppenbart hos patienter som är under 70 år och som även fått hormonbehandling. Två tredjedelar hos kontrollgruppen under 70 år är sexuellt aktiva, vilket är jämförbart med de som enbart strålbehandlats.
Avhandlingen omfattar även en randomiserad studie med en jämförelse av livskvaliteten och symtom hos patienter som fått strålbehandling eller exspektans. Studien visar att det inte finns någon skillnad i livskvalitet mellan patienter som fått strålbehandling eller exspektans, ej heller i jämförelse mot kontrollgruppen. De patienter som fått strålbehandling påvisar en högre grad av biverkningar, speciellt från tarmarna, men dessa upplevdes som lindriga. Sammanfattningsvis visar avhandlingen att enkäten kan mäta skillnader i biverkningar och symtom hos både patienter som fått strålbehandling eller exspektans. Utvärdering av symtom och livskvalitet är viktigt när den optimala behandlingsmetoden skall väljas.
ACKNOWLEDGEMENTS
This study was performed at the Department of Radiation Sciences, Oncology, Umeå University. During my research, first as an oncology nurse and than as a doctoral student I have received much support from many persons.
I wish to express my sincere gratitude to:
Anders Widmark, my supervisor. For introducing me into the field of cancer research and for never stop pushing me forward when I sometime thought that I have reached the "blind alley" and there was no way out of it.
Lars Franzén, my assistant supervisor, Head of the Radiotherapy Department. For always supporting me in my work, both at the department of radiotherapy and as research nurse.
Roger Henriksson, Head of the Department of Radiation Sciences, Oncology. For nice discussions and giving me the opportunity to go further on with my research work at the Clinical Research Unit (KFE). "Alf' thanks you!
Bo Littbrand, earlier Head of the Department of Oncology. He has always giving me support in my work with interest and giving me the opportunity to work both at the Radiotherapy Department and as a research nurse at the department of oncology.
Björn Tavelin, my co-author, for all statistical support and nice discussions about everything (and sometimes about nothing).
Barbra Frankel, for correcting the English in several manuscripts.
James Turner, radiotherapist from England, for correcting the English in this dissertation.
Pia Granlund, and Monica Sandström, for skilful secretarial assistance with all the administrative work.
Jan-Erik Damber, earlier Head of the Department of Urology and co-author, for good cooperation and knowledge in the urological oncology.
Hans Modig, co-author, for good cooperation and knowledge in the urological oncology.
All colleagues at the Radiotherapy Department, for endless support during the years and always being helpfully. However, especially thanks for giving me technical assistance in my work has to be given to these colleagues at the Radiotherapy Department:
Barbro Widmark, head nurse, for always supporting me and giving me all possible assistance to have the opportunity to go on with my research.
Britt Lindström, for helping me to collect data and feeding the data in to the computer. Perhaps these words will give you pleasure "The daily diary era is soon over".
Birgitta Bern, for helping me to collect patient data from the treatment planning system.
Eva Nyström and Karin Brännström, for helping me with the patient information and delivering of the questionnaires.
Lions' Cancer Research foundation at Umeå University, the Swedish Cancer Society, The Swedish Association for Cancer and Traffic Victims (CTRF), Gunnar, Arvid, and Elisabeth Nilssons Cancer Foundation, Elsa and Folke Sahlbergs Foundation at Umeå University, JC Kempes Foundation at Umeå University, and The Swedish Foundation for Health Care and Allergy Research (Vårdalstiftelsen) for all financial support.
Finally but not least, my family Sonja, Linda, and Hanna, for the support and understanding during this period of the work with this dissertation (mostly in the office in the "garage")
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