[Cancer treatment in Skane and in Sjaelland. Do differences concerning examination and treatment explain reduced survival among Danish cancer patients?]. / Kraeftbehandling i Skåne og på Sjaelland. Er forskelle i udredning og behandling med til at forklare danske kraeftpatienters dårligere overlevelse?

INTRODUCTION: Danish cancer patients generally have a poorer survival than Swedish cancer patients. The difference is most pronounced for certain tumour types, e.g. common types such as lung, breast, colorectal, and prostate cancer. The reasons are not clear. The present article examines if differences in the diagnostic workup and treatment can explain some of this variation. MATERIAL AND METHODS: Aspects of the diagnostic workup and treatment of the above mentioned four cancer types are examined using data from cancer registry analyses and official reports. These data are seen in the context of counts of trained personnel and equipment in cancer diagnostics and treatment in the two countries. RESULTS: With regard to lung and breast cancer, the data seem to indicate that Danish patients are diagnosed later, and that Denmark lags behind in treatment capacity. With regard to rectal cancer, the data seem to indicate that concentrating operations in fewer hospitals, and improvements in operation technique have been introduced earlier in Sweden than in Denmark. With regard to prostate cancer, however, the data seem to indicate that many more indolent cases that do not need treatment are diagnosed in Sweden than in Denmark. The total capacity for oncologic treatment, both in terms of trained personnel and equipment, seen in relation to the size of the population, is considerably larger in Southern Sweden than in Eastern Denmark. DISCUSSION: The data for some of the common cancer types seem to indicate that problems in the areas of sufficient capacity for diagnostic workup and treatment may explain some of the difference in survival between Danish and Swedish cancer patients.

[Centralized follow-up of patients treated for head and neck cancer]. / Centraliseret efterkontrol af patienter behandlet for hoved-halskraeft.

In a prospective study, the value of the clinical follow-up after treatment for head and neck cancer has been assessed. A total of 407 visits in 377 patients were recorded during a three month period in 1993 at the two major radiotherapy departments in Denmark. The results showed that 61% of follow-up visits included one or more problems either related to treatment morbidity or tumour recurrence. About 50% of all visits included treatment related normal tissue problems, and 30% had problems that required intervention. Although the majority of problems occurred within a few years after treatment, 47% of patients at three to four years observation time still had one or more problems. A total of 34 new tumour recurrences were found in the period, and of these 11 (32%) were asymptomatic. It is concluded that head and neck cancer patients have both tumour and normal tissue problems several years after the end of treatment. Since effective salvage treatment improves local control significantly, early detection of possible recurrence is important. A follow-up period of four to five years is recommended-preferably by qualified experts in the management of both recurrent disease and treatment morbidity.

[Treatment of early stage Hodgkin disease]. / Behandling ved tidlig Hodgkin's sygdom.

In early stage Hodgkin's disease the optimal choice of treatment is still an unresolved issue. Twenty-two randomized trials of radiotherapy alone versus radiotherapy plus combination chemotherapy have been carried out world-wide. The preliminary results of a global meta-analysis of these trials indicate that we still do not definitively know whether or not the early addition of prophylactic chemotherapy improves survival. Arguments in favour of early chemotherapy are: that laparotomy may be avoided, that radiation fields and doses may perhaps be reduced, and that the stress of experiencing a relapse is avoided in many patients. The major argument against early chemotherapy is: that by careful staging and selection of patients and by careful radiotherapy techniques the number of patients exposed to potentially toxic chemotherapy may be kept at a minimum. Recently, trials have been carried out testing chemotherapy alone, results are, however, conflicting. In order not to jeopardize the good results achieved with the standard treatments developed over the last three decades, newer treatment approaches should be carefully tested in large randomized trials before being implemented for general clinical use.

Changes over the course of time in histological subclassification of Hodgkin's disease in Denmark.

Primary diagnostic lymph node biopsies from 317 patients with Hodgkin's disease pathologic stage (PS) I or II in the prospective randomised trial of the Danish National Hodgkin Study and from 174 patients with Hodgkin's disease stage III or IV examined and treated at the Finsen Institute, Copenhagen, Denmark, were reviewed. The original diagnosis of Hodgkin's disease was made during the period 1971-1983 and was a result of a consensus among three members of a panel of pathologists. In the current study, the histological material was re-examined in order to critically consider and exclude cases which are not histologically diagnostic but microscopically bear resemblance to Hodgkin's disease, to obtain a uniform subclassification in accordance with recent new points of the Rye classification, to examine possible changes in incidence over the course of time and to examine the NS subclassification according to the BNLI proposals. Two cases (0.4%) were reclassified as not being Hodgkin's disease, and 489 cases (99.6%) were reclassified as Hodgkin's disease in the subgroups: LP 7.5% (16.7%), NS 65.1% (54.7%), MC 21.9% (26.4%) and LD 1.2% (1.2%) (the numerals in brackets state the original subgroups). In 9.7% of the cases, the subclass could not be assessed, because the biopsies were too small for subclassification. The difference between the original and the present subclassification could be explained partly by a change in the criteria for the different subgroups and partly by interobserver disagreement. In the histologically reclassified material, the Rye classification lost its prognostic significance. It was not possible to demonstrate a gradual change over the course of time in the relative number of cases in each subgroup.(ABSTRACT TRUNCATED AT 250 WORDS)