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Bergqvist J, Hedskog S, Hedman C, Schultz T, Strang P. Patients with both cancer and psychosis-to what extent do they receive specialized palliative care. Acta Psychiatr Scand 2024; 149:313-322. [PMID: 38369614 DOI: 10.1111/acps.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC. PATIENTS AND METHODS This retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis. RESULTS Patients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, p < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, p < 0.0001), more likely to reside in nursing homes (25% vs. 11%, p < 0.0001), and had a higher prevalence of low area-based socioeconomic status (46% vs. 32%, p < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital. CONCLUSIONS Patients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.
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Affiliation(s)
- Jenny Bergqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Department of Surgery and Oncology, Capio St Gorans Sjukhus, Stockholm, Sweden
| | - Stina Hedskog
- Breast Center, Department of Surgery and Oncology, Capio St Gorans Sjukhus, Stockholm, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Torbjörn Schultz
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden
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Tong L, Kremer V, Neo SY, Liu Y, Chen Y, Wagner AK, Yang Y, Chen Z, Seitz C, Tobin NP, Ligtenberg MA, Alici E, Chen X, Haglund F, Seliger B, Harmenberg U, Colón E, Plogell AHS, Liu LL, Lundqvist A. Renal cell carcinoma escapes NK cell-mediated immune surveillance through the downregulation of DNAM-1. Cancer Commun (Lond) 2023. [PMID: 37314951 PMCID: PMC10354414 DOI: 10.1002/cac2.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Le Tong
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Veronika Kremer
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Shi Yong Neo
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yaxuan Liu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Yi Chen
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | | | - Ying Yang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ziqing Chen
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Biology, Princeton University, New Jersey, USA
| | - Christina Seitz
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Maarten Alexander Ligtenberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Evren Alici
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Xinsong Chen
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Seliger
- Institute for Medical Immunology, Martin-Luther University Halle-Wittenberg, Halle, Germany
- Institute of Translational Immunology, Medical School Theodor Fontane, Brandenburg an der Havel, 14770, and Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Ulrika Harmenberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eugenia Colón
- Department of Women's and Children's Health, Karolinska Institutet and S:t Göran's Hospital-Unilabs, Stockholm, Sweden
| | | | - Lisa Lei Liu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Piersiala K, Farrajota Neves da Silva P, Hjalmarsson E, Kolev A, Kågedal Å, Starkhammar M, Elliot A, Marklund L, Margolin G, Munck‐Wikland E, Kumlien Georén S, Cardell L. CD4 + and CD8 + T cells in sentinel nodes exhibit distinct pattern of PD-1, CD69, and HLA-DR expression compared to tumor tissue in oral squamous cell carcinoma. Cancer Sci 2021; 112:1048-1059. [PMID: 33462898 PMCID: PMC7935788 DOI: 10.1111/cas.14816] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/27/2022] Open
Abstract
Anticancer immunotherapies have revolutionized cancer management, yet the effect of systemic anti-programmed cell death protein 1 (PD-1) treatment is predominantly studied in tumor-infiltrating lymphocytes (TILs). Its impact on PD-1 expressing cells in tumor-draining lymph nodes (TDLNs) is not well understood and yet to be explored. Thus, further research aiming for better understanding of the PD-1 pathway not only in tumor tissue but also in TDLNs is warranted. In this study, we investigated the expression of PD-1, CD69, and HLA-DR on CD4+ and CD8+ T cells by flow cytometry analysis of peripheral blood mononuclear cells (PBMCs), TDLNs, and tumor samples from patients with oral squamous cell carcinoma (OSCC). Our data showed that both helper and cytotoxic T lymphocytes in OSCC tissue were highly activated and expressed high level of PD-1 (over 70% positivity). Lymphocytes in TDLNs and peripheral blood expressed significantly lower levels of PD-1 and other activation markers compared to TILs. Moreover, we demonstrated that a significant fraction of PD-1 negative TILs expressed high levels of human leukocyte antigen - DR isotype and CD69. In contrast, PD-1 negative cells in TDLNs and PBMCs scarcely expressed the aforementioned activation markers. Furthermore, we proved that patients with a high percentage of CD3+ PD-1+ cells in tumor-draining lymph nodes had significantly lower disease-free and overall survival rates (log-rank test P = .0272 and P = .0276, respectively). Taken together, we proved that flow cytometry of lymph nodes in OSCC is feasible and may be used to investigate whether PD-1 levels in TDLNs correspond with survival and potentially with response to anti-PD-1 therapy. Such knowledge may ultimately help guide anti-PD-1 treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Antigens, CD/metabolism
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Differentiation, T-Lymphocyte/metabolism
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Female
- Flow Cytometry
- HLA-DR Antigens/analysis
- HLA-DR Antigens/metabolism
- Humans
- Lectins, C-Type/analysis
- Lectins, C-Type/metabolism
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Middle Aged
- Mouth Neoplasms/immunology
- Mouth Neoplasms/pathology
- Programmed Cell Death 1 Receptor/analysis
- Programmed Cell Death 1 Receptor/metabolism
- Sentinel Lymph Node/cytology
- Sentinel Lymph Node/immunology
- Sentinel Lymph Node/pathology
- Squamous Cell Carcinoma of Head and Neck/immunology
- Squamous Cell Carcinoma of Head and Neck/pathology
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Affiliation(s)
- Krzysztof Piersiala
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | | | - Eric Hjalmarsson
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | - Aeneas Kolev
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Åsa Kågedal
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Magnus Starkhammar
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Alexandra Elliot
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Medical Unit Head Neck, Lung and Skin CancerKarolinska University HospitalStokcholmSweden
| | - Linda Marklund
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Gregori Margolin
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
- Medical Unit Head Neck, Lung and Skin CancerKarolinska University HospitalStokcholmSweden
| | - Eva Munck‐Wikland
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Medical Unit Head Neck, Lung and Skin CancerKarolinska University HospitalStokcholmSweden
| | - Susanna Kumlien Georén
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Lars‐Olaf Cardell
- Division of ENT DiseasesDepartment of Clinical Sciences, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
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