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Background
Due to the lifetime prevalence, patients with previous a psychological illness represent a significant group of oncologic patients. They have numerous particularities.Results
These special aspects include altered pain perception, a significantly increased risk of suicide, a sometimes drastically altered ability to communicate, and, finally the necessity of ongoing psychopharmacological treatment in patients with severe and chronic mental illness.Conclusion
This situation requires the oncologist to take special care during the anamnestic evaluation and necessitates close collaboration with the treating colleagues in psychiatry. Special attention is needed to prevent a deterioration or triggering of psychiatric symptomatology through the interaction of different (pain) medications.3.
Background
Non-small cell lung cancer (NSCLC) can cause a multitude of physical, psychological and social burdens to the patients. These can continue to have an impact on the quality of life of those affected for a long time after the disease and treatment.Objective
The aim of this article is to describe factors which are associated with the quality of life of NSCLC survivors and provide an overview on the necessary components of aftercare and prospects of survivorship care plans for NSCLC survivors.Method
A narrative literature review based on a PubMed search was conducted.Results
Survivors of NSCLC often have persisting symptoms and psychosocial implications from the disease and treatment. Domains of quality of life that are particularly frequently impaired are physical and role functioning. Factors which are associated with quality of life in NSCLC survivors comprise physical symptoms (e.g. dyspnea, fatigue, pain, cough, insomnia), treatment, recurrent disease or secondary malignancies, comorbidities, psychological distress (e.g. anxiety, depression) and sociodemographic factors (e.g. age, gender, living alone). Patient-centered aftercare planning should ensure early access to supportive therapy, palliative interventions, psychosocial support, support for life style changes and regular follow-up examinations. Particular importance is placed on the development and implementation of survivorship care plans aimed at ensuring continuity of care and preventing or alleviating long-term consequences and late effects.Conclusion
Survivors of NSCLC often have a variety of impairments of quality of life. Patient-centered, structured care models can make an important contribution to the long-term maintenance of the quality of life.4.
Background
Prognostic improvements for patients with small cell lung cancer (SCLC) have been achieved within the last decade especially due to the use of radiotherapeutic treatment options.Methods
In this article, an overview of the approved and current therapeutic approaches for the treatment of SCLC is presented.Results
Given the high potential for proliferation and metastatic spread in SCLC, systemic chemotherapy, preferably with a platinum/etoposide combination, is still the therapeutic basis. In limited stage disease this is performed, if possible, simultaneously with thoracic radiotherapy (TRT) followed by prophylactic cranial irradiation (PCI). In extended stage disease (ED), TRT also has therapeutic value for those patients who respond to chemotherapy. PCI generally shows a reduction in the risk for cerebral metastases, but is with regard to the improvement of overall survival in ED controversial.Conclusion
Chemotherapy together with radiooncology is of substantial relevance for survival of SCLC patients.5.
Background
Systemic treatment of non-small cell lung cancer (NSCLC) is currently undergoing a paradigmatic change with impressive dynamics. Patients with advanced disease are treated based on the analysis of biomarkers either with immunotherapy, a combination of immunotherapy with chemotherapy or with driver mutation-directed targeted drugs. Treatment of acquired resistance remains a particular challenge. An increasing knowledge of the molecular mechanisms underlying resistance enables the development of more potent inhibitors.Objective
This review focuses on the state of the art and current developments in targeted therapy of advanced stage NSCLC.Material and methods
This review is based on the summary and interpretation of publications on preclinical and clinical studies in the field of targeted treatment of advanced NSCLC.Results and conclusion
Targeted treatments against activating mutations in the EGFR and BRAF genes as well as ALK and ROS1 fusions define the standard first line treatment for approximately 15?% of patients with advanced NSCLC. In retrospective analyses this development has led to a substantially prolonged overall survival in these subgroups. Targeted therapies against further aberrations are in clinical evaluation and a targeted treatment is currently available for approximately 30% of patients. Next generation inhibitors are characterized by a high effectiveness against tumors with acquired resistance to tyrosine kinase inhibitors (TKI) and improved tolerability and are increasingly being used as first line treatment. In order to understand the molecular causes and to select the most effective treatment, rebiopsies play a special role in resistance.6.
Background
The concept of sentinel removal is a safe procedure in the field of gynecological oncology and is an integral part of staging in early vulvar and cervical cancer. Moreover resent studies have shown that this type of nodal staging has promising results even in endometrial cancer. Only in ovarian cancer is this concept still far from clinical routine.Diagnosis
There are at least three different tracers for staining the lymph nodes: blue dye, indocyanine green, and radioactive technetium. The blue tracer is visualized with conventional cameras, while indocyanine green needs a special fluorescent camera. Technetium is detectable only with a special probe and an acoustic signal in the proximity of a stained lymph node.Conclusion
The increasing data available in the field of sentinel node technology shows that this concept will be used in an ever broader area in the future—with the same oncological safety but with lower peri- and postoperative morbidity.7.
Tobias Kampfenkel Anna Arning Oliver Heidinger Heribert Jürgens Raphael Koch 《Der Onkologe》2016,22(12):984-991
Background
In 2014, 41?% of all colorectal cancer patients in North Rhine-Westphalia (NRW) were treated in a certified cancer center, with rising tendency. While positive outcomes have been shown for surrogate parameters in certified bowel cancer centers, the influence of center certification on patient-relevant outcomes has so far remained unclear. In general, the classic endpoint with the highest patient relevance in oncology is overall survival.Objective
The present study investigated whether there is a difference in overall survival between colorectal cancer patients who have been treated in a certified cancer center versus those treated in a non-certified center.Methods
A non-interventional retrospective observational study using routine data from a statutory health insurance fund (AOK Nordwest) supplemented by data from the Epidemiological Cancer Register NRW was performed. Statistical analyses of overall survival were performed using multivariate methods.Results
Tumor stage, age at initial diagnosis, care level, end-stage renal disease, and dementia were associated with statistically noticeable effects on overall survival. However, no significant difference in overall survival could be observed between patients treated in certified cancer centers versus patients treated in non-certified centers (hazard ratio = 1.043, 95?% CI 0.893–1.219; p = 0.592).Conclusion
This analysis revealed no statistically noticeable difference in overall survival between patients treated in a certified cancer center versus patients treated in a non-certified cancer center. However, due to study limitations, this outcome must be interpreted with caution. The applied methodology cannot replace comprehensive evaluations based on data generated from clinical cancer registries.8.
Background
External beam radiotherapy (EBRT) is a curative therapeutic option in prostate cancer.Percutaneous radiotherapy with curative intent
Patients with low risk can be cured with EBRT. For patients at intermediate risk, EBRT may be combined with androgen deprivation therapy (ADT) for 4 months. For patients at high risk, ADT should be administered for 2–3 years and the EBRT dose should be escalated. Hypofractionation is currently under intensive clinical investigation, but is currently not a clinical standard.Recurrence
A recurrence after EBRT is defined as two prostate-specific antigen (PSA) values higher than nadir +2 ng/ml.Adjuvant radiotherapy
Adjuvant EBRT is recommended after pT3 and/or R1 resection. In patients with lower stages or with more comorbidities, a PSA follow-up can be recommended with initiation of salvage EBRT only after increase of PSA (but preferably < 0.5 ng/ml).9.
Background
Primary malignant sarcomas in children, adolescents and young adults are rare and represent a major challenge for the treating physician.Aim
The aim of this article is to provide a comprehensive overview on sarcomas in children, adolescents and young adults. This article provides an overview of the epidemiology, clinical presentation, diagnoses, tumor biology, international therapy strategies and currently active phase I, II and III clinical trials.Material and methods
The article is based on a selective literature search and also provides data from the authors’ own national and international clinical trials.Results
The treatment must follow a multimodal concept, which ultimately requires close cooperation between many disciplines. As a result of modern interdisciplinary treatment approaches consisting of chemotherapy, surgery and/or radiotherapy, two thirds of patients can be cured if they undergo early and appropriate therapy. This requires a precise and early diagnosis and treatment in selected medical centers with an interdisciplinary team of specialized oncologists, surgeons and radiotherapists is highly recommended.10.
Background
Pain in persons with intellectual disabilities is diagnosed too rarely und too late. Despite their higher disease burden, these patients receive less painkillers than persons without a disability.Results
Considering the possibility of pain is just as important as an adequate and sensitive diagnostic approach. In addition to employing all means to improve communication (explanations in simple language, pictures, and symbols), use of other forms of information (consultation of relatives/caregivers, special assessment instruments) to supplement or substitute for patient-reported information is frequently unavoidable. Every change in behavior is possible a cause of pain (or other symptoms), and must be registered and further investigated.Conclusion
Pain therapy can and should be carried out as in persons without disability, with nonpharmacological interventions being at the forefront of treatment. Pharmacological therapy should be initiated at a low dose and increased slowly, as in elderly persons. With more frequent pain therapy—perhaps for a test period—many so-called behavioral disorders can be treated adequately and more effectively than with psychopharmaceuticals.11.
Background
Ethical dilemmas that arise during the treatment of patients in oncology are self-evident to any clinician or lay person who has cared for individuals battling cancer. Issues related to autonomy, advance directives, surrogate decision making, communication barriers, goals of care, treatment decisions, end of life decisions and admission to the intensive care unit of advanced cancer patients are emotionally laden and complex; therefore, circumstances can arise in which moral dilemmas or conflicting values are not so easily resolved. Clinical ethics consultation is a structured approach to assist in mitigating ethical questions and conflicts through careful deliberation and guidance among the parties involved, particularly in a setting of standardized team or family conferences.Method
Research and analysis of the current literature.Objective and conclusion
The resolution process involves a reasoned approach to the ethical or moral dilemma or conflict in which multiple perspectives and points of view are integrated into an ethically justifiable and workable solution that is driven by a shared decision-making process. In respect to emergency conflict interventions by an ethics consultation it is hoped that advance care planning will be able to minimize requested ethics consultations.12.
Background
Pain is a frequent and highly distressing burden in cancer patients. Resource-oriented use of hypnotherapeutic subjective trance phenomena lends itself well to treatment.Objective
This work aims to describe hypnotherapeutic treatment options for pain in cancer patients, illustrate the basic procedures, and provide for evidence on their effectivity.Materials and methods
A literature search on the different treatment aspects was performed and clinical experiences were procured.Results
Hypnosis and hypnotherapy enable treatment and effective control of a wide spectrum of acute and chronic pain. There are a number of evidence-based interventions from which the majority of patients may benefit. Education in the use of self-hypnosis is considered a basic skill for regaining control over pain and enhancing self-efficacy, which should therefore be provided at an early stage of therapy. The various available techniques should be used in combination as much as possible, paying particular respect to the patients’ individual subjective resource experiences. Neuroscientific evidence on the central neurocognitive hubs involved in pain regulation imply use of processing-specific hypnotic suggestions that specifically address the different pain components.Conclusion
Hypnotherapeutic interventions are ideally suited for the treatment of acute and chronic pain in tumor patients due to both their rapid effectivity and the indirect permissive course of action. A particular advantage of these interventions is resource-oriented use of subjective trance phenomena and simultaneous treatment of different components of the pain complex.13.
Background
High rates of long-term survival can be achieved in patients with germ cell tumors even in metastatic stages. Early detection of potential relapses by close surveillance but without causing further toxicity by unnecessarily frequent use of imaging is crucial. Patients are usually young when diagnosed with germ cell tumors; therefore, prophylaxis and treatment of long-term toxicity are important for the quality of life.Objectives
We present an overview of the current literature and studies on follow-up and surveillance of germ cell tumor patients. We focus on a timely diagnosis of a potential relapse and especially on physical and psychosocial long-term toxicities.Results
Evidence-based recommendations on follow-up depending on the stage of disease and therapy options are available for germ cell tumor patients. These recommendations include life-long follow-up concerning fertility issues and diseases assigned to a metabolic syndrome. Furthermore, the risk for second malignancies, pulmonary or nephrological toxicity as well as polyneuropathy is increased. Patients also frequently complain of fatigue and cognitive impairments. Studies have also demonstrated higher rates of psychological problems, e.?g. anxiety, depression and posttraumatic stress disorder. The complex interactions between delayed physical toxicities, psychological problems and social as well as occupational long-term effects are also becoming clear. Survivorship programs aim to address the complex needs of germ cell tumor survivors in order to achieve the highest possible quality of life and health.Conclusion
Evidence-based follow-up strategies aim to achieve a high rate of long-term survival with good health after germ cell tumors. Prevention and therapy of delayed physical as well as psychosocial toxicities are crucial to achieve the highest possible quality of life in long-term survival.14.
Michael Ried Michael Rechenmacher Barbara Dietl Alexander Marx Okka W. Hamer Berthold Schalke Lukas Kirzinger Hans-Stefan Hofmann 《Best Practice Onkologie》2017,12(5):206-214
Background
Thymoma and thymic carcinoma (TC) are the most common primary malignancies in the anterior mediastinum.Objectives
In this review article, modern diagnostic tools and innovative treatments are described.Materials and methods
Selective literature research in Medline (key words: thymoma, thymic carcinoma, advanced thymoma) and interdisciplinary, clinical experience.Results
Treatment decisions and the prognosis of thymomas and TCs depend on tumor stage (currently described in parallel by the Masaoka-Koga and the new TNM system), histological subtype (according to the World Health Organization [WHO] classification) and resection status. R0 resection (that traditionally includes thymectomy) counts among the most important prognostic factors and is the standard therapeutic approach for resectable tumors. A multimodality treatment regime consisting of chemotherapy, surgical resection and in some cases radiotherapy is recommended for advanced or primarily unresectable tumors. Clinical trials evaluating immune checkpoint inhibitors in refractory thymomas and TCs are underway.Discussion
Modern diagnostics comprise computertomography scans, magnetic resonance imaging and precise histological investigation. An interdisciplinary evaluation and a multimodal treatment regime might improve the prognosis of locoregional and pleural advanced thymoma and thymic carcinoma as well as the prognosis of recurrent thymoma.15.
Background
Bone metastases are the most common cause of pain in oncologic patients.Objective
This article aims to describe the use of external-beam radiotherapy for pain control in patients with bone metastases.Materials and methods
The relevant literature in PubMed was reviewed.Results
Pain in patients with bone metastases can be effectively and safely treated by modern radiotherapy. Partial response rates range between 50 and 90%, while 10 to 50% of patients achieve total response. For analgesic effects single, hypo-, and normofractionated concepts are described. Current meta-analyses show that a single fraction of 8?Gy results in similar pain relief as fractionated regimes. Better remineralization is achieved 3–6 months after conventional fractionated radiotherapy with 2–3 Gy than after single-fraction radiation; furthermore, less pain relapses occur, thus re-irradiation is required less frequently after multifraction radiation. A single fraction of 8?Gy is recommended as the standard of care for uncomplicated symptomatic bone metastases without fractures or spinal cord compression worldwide. Patients with a good performance status and a survival prognosis of at least 3 months should receive normofractionated radiotherapy. Since a temporary increase in pain can occur several days after the first fraction (“pain flare”), patients require adequate pain management before starting radiotherapy and, potentially, antiedematous prophylaxis.Conclusion
Since different radiotherapeutic options for alleviating pain in patients with bone metastases exist, the optimal regimen for radiotherapy should be determined in an interdisciplinary approach together with the patient (“shared decision making”).16.
William Paul SkeltonIV Hiral Parekh Jason S. Starr Jose Trevino Jessica Cioffi Steven Hughes Thomas J. GeorgeJr 《Journal of gastrointestinal cancer》2018,49(1):1-8
Introduction
Pancreatic cancer is often diagnosed at late stages, where disease is either locally advanced unresectable or metastatic. Despite advances, long-term survival is relatively non-existent.Discussion
This review article discusses clinical factors commonly encountered in practice that should be incorporated into the decision-making process to optimize patient outcomes, including performance status, nutrition and cachexia, pain, psychological distress, medical comorbidities, advanced age, and treatment selection.Conclusion
Identification and optimization of these clinical factors could make a meaningful impact on the patient’s quality of life.17.
B. Seekatz E. Jentschke M. Lukasczik S. Neuderth M. Schuler B. van Oorschot 《Der Onkologe》2016,22(11):870-877
Background
The German S3 guideline on palliative care requires that symptoms and needs of patients with incurable cancerous diseases should be regularly assessed, irrespective of the tumor-specific treatment. Self-report questionnaires for palliative medicine are available for screening, such as the Edmonton Symptom Assessment Scale (ESAS), which is used in oncology centers in Canada in the context of a quality management initiative.Aims and method
Implemention of the ESAS as a screening method for patients with metastases in lung cancer centers, colorectal cancer centers, in centers for neuro-oncological cancer and in the skin cancer center at the Mainfranken Comprehensive Cancer Center.Results
From a total of 839 patient sceened, 79.6?% patients reported at least 1 out of 10 symptoms with moderate or severe intensity (ESAS item score ≥4), which indicates the need for a more detailed clinical assessment or intervention. The most prevalent symptoms were impairment of general well-being, fatigue and exhaustion, loss of appetite and dyspnea. Of the patients 40.4?% showed at least 1 symptom with severe intensity (ESAS score ≥7) with an ensuing need for an intervention.Conclusions
A large proportion of patients reported a significant symptom burden. It should be further discussed whether clinical assessment and subsequent interventions can be provided by general palliative care teams and at what stage the inclusion of specialized teams is necessary.18.
Rachel Sommer Jörg Dirmaier Dennis Fechtelpeter Klaus Koch Martin Härter Corinna Bergelt 《Der Onkologe》2016,22(8):578-585
Background
Women between the ages of 50 and 69 are invited in Germany every two years to participate in the mammography screening program. The German Institute for Quality and Efficiency in Health Care (IQWiG), together with experts, was assigned by the Federal Joint Committee (G-BA) to modify the existing informational material into a new decision aid.Objective
The new decision aid was qualitatively tested with regard to comprehensibility and acceptance of users.Material and methods
Testing of the decision aid was done through a multi-step procedure with 37 women in six focus groups. The results were qualitatively analyzed.Results
The results show that the new material was regarded as helpful information on mammography screening. Many women were surprised about the information regarding overdiagnosis. All women had difficulties understanding the concept of overdiagnosis. In their understanding, most did not differentiate between overdiagnosis and false-positive results.The newly developed value clarification tool was helpful for 18 women with regard to their personal decision-making. Those who experienced no further benefit by the value clarification tool (n = 15), reasoned that they had already made their decision and did not need further support.Discussion
Communicating the existence of overdiagnosis is a challenge when developing decision aids on screening decisions. The new value clarification tool was considered to be helpful for coming to an individual decision for or against screening participation. Health literacy plays an important role regarding the comprehensiveness of the material and should be considered in the development of decision aids.19.
Ebtihag O. Alenzi S. Suresh Madhavan Xi Tan 《Breast cancer research and treatment》2018,167(1):183-193
Purpose
This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC.Methods
Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004–2011 and pre-existing diabetes (N = 7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis.Results
Overall, women with a DCSI = 2 and a DCSI ≥ 3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with a DCSI = 2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03–1.53).Conclusion
The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.20.