[An Analysis of contributions to the main German chat forum for cancer patients regarding palliative care]

INTRODUCTION

Patients are looking for information regarding palliative care in different sources. Goal of this study is the analysis of the most important online forum for cancer patients, Cancer Compass, concerning palliative care.

METHODOLOGY

On the chosen date, 3.02.2012, all threads on the various topics (cancer types, cancer treatment, specific user groups, general topics, advice and addresses, countries and regions, Über den Krebs-Kompass & Vermischtes) were systematically analyzed. All entries relating to palliative care were recorded and subsequently analyzed and summarized.

RESULTS

From 231 threads relating to palliative care, 163 were relevant.The general practitioner is the main source of information, but the internet is gaining importance. The forum users often offer good explanations of cancer and palliative care and also refer to web pages with exact definitions. Reliability of web pages is a one issue discussed in the forum.Patients are afraid of pain and dying. Relatives fear for the patient, are overwhelmed and experience existential problems. Both groups use the Cancer Compass to share experiences and get psychological support. Thus Cancer Compass offers a possibility to discuss options for improving quality of life.Especially in the initial phase of care, many users are uncertain what palliative care means. The treatment of pain represents the main concern of patients and their families. Whereas dedicated palliative care wards are rated positively, users speak less positively about pain treatment in general wards in home care.In general, inpatient palliative care was rated positively. However information regarding outpatient care is lacking. Family care is mostly not possible on account of geographical distance. One point of criticism is the discrepancy between urban and rural areas. Patients place more trust in their general practitioner than in hospital doctors.

CONCLUSION

Cancer Compass is an important medium for patients and their families to share information, i. a. on palliative care. In order to improve the reliability of information from the internet, a certification of websites would be helpful. In web forums moderators may improve the quality of information.

[Stillbirths in Germany: Retrospective Analysis of 168 Cases between 2003 and 2011]

BACKGROUND

The decline in the incidence of stillbirths in Germany has remained static in recent years. This study aims to analyse the current situation of data documentation and examination of stillbirths. Furthermore, possible stillbirth prevention strategies should be developed.

METHODS

Searches in the international peer-reviewed literature, retrospective data collection of 168 stillbirths in 8 hospitals, (in the area of Bonn) with subsequent statistical evaluation (descriptive statistics, t-test and binominal test) were undertaken.

RESULTS

This study shows considerable deficits in data documentation, interdisciplinary communication and postmortal examination. Only in 51.8% (87/168) of the cases was a certain or uncertain cause of death found (42.3% placental, 1.2% foetal, 3.6% chromosomal, 4.8% umbilical cord abnormalities). Severe foetal growth restriction (<5(th) percentile) was observed in 29.2%; 44.9% (22/49) of them died at the age of ≥36+0 weeks of gestation.

CONCLUSION

The first step to reduce the rate of stillbirths in Germany is to increase the identified causes of foetal death: Therefore, an interdisciplinary case report form was compiled to improve data collection and interdisciplinary collaboration. To standardise and complete postmortal management, an algorithm was created. The long-term aim is the development of a central data register for statistical analysis, to identify goals of research and to organise conferences with interdisciplinary reports of diagnostic findings.

Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany

BACKGROUND

Prescription of third-generation cephalosporins and fluoroquinolones has been linked to an increasing incidence of gram-negative bacteria producing extended-spectrum beta-lactamases, methicillin-resistant Staphylococcus aureus and nosocomial infection with Clostridium difficile. Antibiotic stewardship (ABS) programmes offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programmes at community hospitals.

METHODS

We implemented an ABS programme at a 200-bed community hospital and aimed at a > 30 % reduction of cephalosporin and fluoroquinolone consumption within 1 year. Pharmacy data were obtained to estimate hospital-wide drug use density expressed in WHO-ATC-defined daily doses (DDD) or hospital-adapted recommended daily doses (RDD) per 1,000 patient days. The effect of the ABS intervention on drug use density was analysed using interrupted time-series analysis for the periods between January 2011 and March 2013 as pre-intervention, and between April 2013 and March 2014 as post-intervention period. The CDI incidence was calculated based on microbiology laboratory data.

RESULTS

Cephalosporin use (measured in RDD/1,000 patient days) decreased by 33 %, and fluoroquinolone use decreased by 31 %, respectively. Interrupted time-series analysis confirmed significant changes in the drug use density trends for both cephalosporins and fluoroquinolones after the intervention as well as for total antibiotic use that decreased by 11 % while no significant effect was noted for CDI incidence rates.

CONCLUSION

ABS programmes can be effective in community hospitals and may help establish ecologically advantageous antibiotic strategies when needed.

[Screening for colorectal, skin, breast and prostate cancer. Essential knowledge for counseling]

The major goal of cancer screening programs is the reduction of disease-specific mortality by detecting malignant tumors in an early and still curable stage. Sensitive screening tests are used in apparently healthy people and conspicuous findings are referred for further investigations. Taking the personal disease risk into account, persons considering participation in a screening program should be informed about the methods, benefits and disadvantages of the screening program. This information, together with personal preferences, is the basis for a well-informed decision for or against participation in a screening program. This article imparts essential knowledge that is needed for individual medical counseling on screening for colorectal, skin, breast and prostate cancer.

Complementary and alternative medicine (CAM) in obstetrics and gynaecology: a survey of office-based obstetricians and gynaecologists regarding attitudes towards CAM, its provision and cooperation with other CAM providers in the state of Hesse, Germany

PURPOSE

Whereas we have some information on complementary medicine in the field of oncology, little is known about complementary medicine in the field of obstetrics and gynaecology especially outside of hospitals.

METHODS

All office-based obstetricians and gynaecologists in the state of Hesse, Germany, were contacted and asked to fill in an assessment form regarding cooperation in the field of complementary and alternative medicine (CAM), as well as the perceived efficacy of various CAM methods for a number of pathological conditions in the field of obstetrics and gynaecology.

RESULTS

It was found that more than half of Hessian office-based obstetricians and gynaecologists had existing cooperation regarding CAM, especially with colleagues, but also midwives, pharmacists, physiotherapists, and health practitioners. The probability of cooperation was significantly inversely associated with age. It was found that the probability for advising CAM differed between various health problems. The following CAM methods were considered reasonable for the treatment of different conditions: phytotherapy for climacteric complaints and premenstrual syndrome; homoeopathy for puerperal problems; acupuncture and traditional Chinese medicine for complaints during pregnancy; and dietary supplements for the side effects of cancer therapy.

CONCLUSIONS

The analysis shows that there is much cooperation in the field of CAM. Comparison between physicians' perceived efficacy of CAM methods and objective findings shows that there is a need for the provision of valid information in the field.

Synthese und Kristallstruktur der Benzyltriphenylphosphonium-bromide: [C6H5-CH2P(C6H5)3]+Br-CH2Cl2 und [C6H5-CH2P(C6H5)3]+Br3 - / Synthesis and Crystal Structures of (Benzyl)triphenylphosphonium Bromides, [C6H5-CH2P(C6H5)3]+Br-CH2Cl2 and [C6H5-CH2P(C6H5)3]+Br3 -

(Benzyl)triphenylphosphonium bromide, [C6H5-CH2P(C6H5)3]+Br- (CH2Cl2) (1) has been prepared by the reaction of triphenylphosphine with benzylbromide and its structure determined. The colorless crystals are triclinic, space group P1̄, Z = 2, a = 976.0(3), b = 1069.0(3), c = 1226.1(4) pm, α = 94.13(3), β = 104.70(3), γ = 100.14(3)°. The lattice contains Br- anions and [C6H5-CH2P(C6H5)3]+ cations. [C6H5-CH2P(C6H5)3]Br3 (2) has been obtained by treating compound 1 with equimolar quantities of elemental bromine in methylene chloride solution. The red crystals of 2 are monoclinic, space group P21/c, Z = 4, a = 917.9(2), b = 1022.6(2), c = 2573.6(5) pm, β = 99.11(2)°, and comprise[C6H5-CH2P(C6H5)3]+ cations and linear, slightly asymmetrical Br3 - anions with bromine-bromine distances of 246.19(11) and 263.69(11) pm.

[Complementary and alternative medicine in oncology]

Complementary and alternative medicine are frequently used by cancer patients. The main benefit of complementary medicine is that it gives patients the chance to become active. Complementary therapy can reduce the side effects of conventional therapy. However, we have to give due consideration to side effects and interactions: the latter being able to reduce the effectiveness of cancer therapy and so to jeopardise the success of therapy. Therefore, complementary therapy should be managed by the oncologist. It is based on a common concept of cancerogenesis with conventional therapy. Complement therapy can be assessed in studies. Alternative medicine in contrast rejects common rules of evidence-based medicine. It starts from its own concepts of cancerogenesis, which is often in line with the thinking of lay persons. Alternative medicine is offered as either "alternative" to recommended cancer treatment or is used at the same time but without due regard for the interactions. Alternative medicine is a high risk to patients. In the following two parts of the article, the most important complementary and alternative therapies cancer patients use nowadays are presented and assessed according to published evidence.

[Information on complementary and alternative medicine at homepages of German cancer self-help]

INTRODUCTION

Complementary and alternative medicine (CAM) is important for cancer patients. The internet has a rising relevance of source of health information. Patient set strong confidence in websites from patient advocacy groups. The websites of German patient advocacy groups were analysed regarding information on CAM.

METHODS

An analysis on the homepages of the most important self-help organizations for cancer patients in Germany was performed. A descriptive analysis of the contents at a cutoff date (20.12.2011) listing the contents was done using an instrument based on the HonCode criteria.

RESULTS

The homepages of the self-help groups are heterogeneous concerning CAM. Only few sites provide more information. The differences between the self-help groups do not correlate with the known user rate of patients with different kinds of cancer. Most homepages dealing with the topic also point to the associated problems of side effects and interactions. All homepages make a clear difference between information and opinion. Influences from outside were not detected.

CONCLUSION

In spite of a high number of patients using CAM the topic is only infrequently represented on the homepages. This could be due to difficult and contradictory data on KAM. As websites of patient advocacy are well suited to provide information on CAM the patient version of a S3 guideline in the German national guideline program in oncology could provide a fundament.

[How useful are diets against cancer?]

BACKGROUND

Diets against cancer are attractive for patients who try to influence disease progression.

METHODS

In order to determine the most influential cancer diets in Germany, we analyzed the chatroom for cancer patients "Krebs-Kompass", the search machines Google and Bing and our own counseling experience as experts. We conducted a systematic literature review of clinical data in Medline also considering preclinical data on safety.

RESULTS

The most often mentioned "cancer diets" are Budwig diet, Gerson's regimen, lowcarb diet, cancer cure of Breuß and macrobiotic diet. These diets can be classified according to the principle idea of carcinogenesis as follows: cancer as a lack or abundance of a substance or as a consequence of pathological metabolism of cancer cells. Staying in line with a specific diet the patients are thought to be able to cure themselves or at least substantially contribute to cure. However, we did not find any scientific publication of a clinical study which describes positive results regarding survival. On the contrary, data show malnutrition and side effects.

CONCLUSION

There is no indication to consume a "cancer diet". In some cases adverse effects can occur. Cancer patients who are discussing nutrition should be warned about taking up a "cancer diet".

How are Interactions Taken into Account in Studies on Conventional and Complementary Therapies for Breast Cancer Patients with Menopausal Complaints?

Introduction: Postmenopausal symptoms in breast cancer patients undergoing antihormone treatment lead to high drop-out rates from the therapy. From the therapeutic point of view, methods of both conventional and complementary medicine are concerned. Interactions are being discussed in cases of natural substances. However, they are also relevant for conventional medical substances. The aim of this analysis is to answer the question as to what extent potential interactions are taken into account in clinical studies and reviews on supportive therapies. Materials and Methods: Clinical studies and reviews were identified by means of a systematic search and analysed with regard to the consideration of potential interactions. Results: Altogether 46 clinical studies and one Cochrane review were found. Among the 35 studies on conventional drug therapies, 5 (14 %) took possible interactions into account. Among the 17 studies on complementary medicine, there were 2 (11.7 %) such publications. The Cochrane review did not mention interactions. Discussion: For future studies in which interactions cannot be excluded, a strategy to control for their clinically relevant consequences should be developed. The present authors suggest that the use of survival and recurrence data as secondary endpoints, also for studies on purely supportive therapies, is a reasonable approach. The resulting considerations for study routines are listed thematically.

[Hepatitis B reactivation following immunosuppressive therapy and screening adherence: a neglected problem?]

BACKGROUND

Current guidelines of the "Centers for Disease Control and Prevention [CDC]" recommend routine screening for Hepatitis B before cytotoxic or immunosuppressive therapies are initiated. The national German guideline "Prophylaxis, diagnosis and therapy of hepatitis B virus infection" is in line with the CDC recommendations and underscores general HBV screening before immunosuppression is induced. However, screening adherence and acceptance of these guidelines vary in different oncological specialities. To assess the HBV screening adherence a retrospective study was performed.

PATIENTS AND METHODS

Data of 140 patients were analyzed retrospectively. 37 case-records did not meet inclusion criteria. Patients diagnosed with breast-cancer (n = 43) and Hodgkin's disease (n = 14) requiring chemotherapy were included, as well as patients receiving allogenic stem cell transplantation (SCTx) therapy (n = 22) or transarterial chemoembolization (TACE) therapy of the liver (n = 24). All included case-records were reviewed regarding HBV and HCV serology.

RESULTS

In the TACE group three patients were screened for HBsAg. Four patients with breast cancer and five patients in the Hodgkin disease group were screened for HBsAg. In contrast, screening adherence was 100 % in the group of patients receiving allogenic stem cell transplantation therapy (n = 22).

CONCLUSION

Apart from patients with allogenic stem cell transplantation, only some patients receiving immunosuppressive therapies had been screened for HBV infection. Our data indicate that standardized checklists may improve HBV screening previous to immunosuppressive therapies. These clinical structures have led to an almost optimal screening adherence in the high-risk group of allogenic SCTx patients.