Andreas Rosenblad

Anal squamous cell carcinoma (ASCC) is a rare but increasingly prevalent disease [1]. In 2020, over 50,000 individuals were diagnosed with anal cancer globally, with approximately 19,000 deaths rep...

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 χ ² -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 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.

Purpose: To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR). Methods: In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains. Results: In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 ( P < 0.001), and for physical ( P < 0.001) and emotional ( P < 0.001) disease-related symptoms, as well as treatment side effects ( P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 ( P < 0.001) and the FKSI-19 ( P < 0.001). Conclusions: HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

Objective: Anaemia is common in healthcare and may indicate undiagnosed cancer. Despite this, evidence regarding risk estimates informing clinical decision-making remains limited, particularly regarding haemoglobin dynamics and the role of mean corpuscular volume (MCV). We aimed to quantify the 18-month risks of incident cancer (IC) and all-cause mortality (ACM) following incident anaemia (IA), and to examine how MCV modifies these risks. Methods and analysis: Population-based, age- and sex-matched cohort study. The study used the Stockholm Early Detection of Cancer Study (STEADY-CAN), covering almost all adults residing in Stockholm County, Sweden, during 2011–2021. STEADY-CAN links laboratory tests with national registers, capturing healthcare use, diagnoses, cancer outcomes and prescribed medications. We included 190 057 adults with IA and 190 057 age- and sex-matched non-anaemic controls from the STEADY-CAN cohort. Eligible individuals were ≥18 years old, cancer-free, had ≥2 Hb measurements during 2011–2020 and a concurrent MCV value at the IA date. IA was defined as the first Hb value from 2012 onwards below 130 g/L in men or 120 g/L in women after prior normal values. Sex-stratified adjusted piecewise competing-risks multi-state Cox regression models were used, with separate HRs for IA during 0–3, 3–6, 6–12 and 12–18 months of follow-up. The main outcome measures were IC and ACM during the 18-month follow-up. Results: IC occurred in 6.2% of male and 2.8% of female IA cases, compared with 2.4% and 1.1% of controls. Corresponding ACM rates were 7.4% and 4.0% in IA cases versus 2.5% and 1.7% in controls. IA implied a 9.17-fold higher IC risk and 8.50-fold higher ACM risk among men during 0–3 months of follow-up, with 8.25- and 6.14-fold higher risks among women (all p<0.001). These risks decreased over time but were still significant for both sexes at 6–12 months of follow-up for IC and 12–18 months of follow-up for ACM. Microcytosis was linked to the highest IC risk, particularly for digestive and haematological cancers, whereas macrocytosis was more strongly associated with ACM. Conclusions: IA is a strong marker of both IC and ACM in routine care. Microcytic anaemia should prompt timely gastrointestinal evaluation, while macrocytic anaemia warrants broader assessments for comorbid conditions and systemic disease. Persistently elevated risks underscore the need for structured safety-netting and continued follow-up after IA, even without a cancer identification. Our findings highlight the value of using anaemia patterns and MCV in early risk stratification.

Classification of observations into one of several distinct categories is a common task in applied statistics, traditionally performed using parametric statistical models such as logistic regression. These parametric models are, however, often outperformed in terms of prediction accuracy by black box supervised learning models (BBSLMs). A drawback of BBSLMs is the lack of easy-to-interpret feature effect measures similar to the odds ratio (OR) for logistic regression models. The present paper derives two novel feature effect measures based on partial dependence plots for binary classification using BBSLMs: the relative risk of marginal effects (RRME) and the odds ratio of marginal effects (ORME). The performance and interpretation of these new measures are illustrated in an application studying the risk of death within 48 hours of admission among individuals admitted to hospital with a myocardial infarction. The BBSLMs are shown to have better predictive ability than the logistic regression models, with the RRME:s and ORME:s of death for the main risk factor anterior infarct both being 1.8, comparable to the OR of 1.9 for the logistic regression model. The RRMEs and ORMEs are also shown to be more robust in terms of being applicable also for observations with missing values for some features.

This study examines the association between violence exposure and psychological distress among women experiencing homelessness ( n = 41). Using a cross-sectional survey design, we assessed emotional, physical, and sexual violence perpetrated by both close (e.g., intimate partners, family members) and non-close (e.g., acquaintances, strangers) individuals and their impact on mental well-being. Findings indicate high levels of violence, with greater exposure linked to increased distress. Each form of violence in close relationships was independently associated with distress, highlighting its broad health consequences. Addressing the significant burden of violence among women experiencing homelessness requires both healthcare recognition and structural interventions. Comprehensive, trauma-informed approaches are essential to mitigate the impact of violence on psychological well-being.

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.