Epidemiologie des Lungenkarzinoms

[The future incidence of colorectal and lung cancers: results of the calculation of different scenarios for the year 2020]

BACKGROUND

Cancer is a common disease that places a large burden on health-care systems. Although the rise of incident cancer cases over recent decades in Germany can largely be explained by demographic ageing, other factors also affect these numbers. The aim of this work was to calculate the incidence of colorectal and lung cancers, two of the most common cancer sites, for the year 2020 under different scenarios.

MATERIALS AND METHODS

The calculations were based on national incidence estimates by the Centre for Cancer Registry Data at the Robert Koch Institute. Two scenarios were calculated for each of the two cancer sites and by gender. The "status quo" scenario accounts only for demographic ageing, assuming constant age-specific incidence rates. The second scenario additionally assumes that trends in incidence rates observed from 2000 to 2009 continue up to the year 2020.

RESULTS

The "status quo" scenarios showed an increase in incident cancer cases of between 12 and 24%, depending on gender and cancer site. The "continuing trends" scenarios resulted in smaller increases for colorectal cancer (+3 to + 17%), while the results for lung cancer differed widely between women (+ 64%) and men (+ 2%). In general, large increases are expected for the highest age groups and the age groups of the baby boomer generation.

DISCUSSION

Changes in the age structure of the German population will lead to an increase in incident cancer cases and a higher portion of geriatric patients. Additionally, further increasing incidence rates would result in a dramatic growth in the number of female lung cancer patients.

Smoking prevention in school students: positive effects of a hospital-based intervention

BACKGROUND

Adolescents have smoked less in recent years, but 11.7% of 12-to-17-year-olds were still smokers in 2011. The prevalence of smoking has also remained high among 18-to-25-year-olds (36.8%). An intervention program called "Students in the Hospital" was developed in which the health aspects of smoking and its individual and societal consequences were presented in an interactive informational event. In this study, we determine the efficacy of the program.

METHODS

From September 2007 to July 2008, we performed an anonymous survey by questionnaire, with a quasi-experimental control-group design, two weeks before (t(1)) and six months after (t(2)) the intervention in a group of 760 participating school students in Berlin.

RESULTS

40.8% of the participants were smokers, among whom 79% stated that they smoked water pipe. Significantly fewer students in the intervention group than in the control group began smoking in the six months after the intervention (p<0.001). The chance of remaining a non-smoker was four times as high in the intervention group (OR, 4.14; CI, 1.66-10.36). Girls benefited from the intervention more than boys (OR 2.56, CI 1.06-6.19). 16.1% of smokers in the intervention group and 17.6% in the control group gave up smoking (p>0.05).

CONCLUSION

A clear primary preventive effect of the program was demonstrated, although it apparently did not induce persons who were already smokers to quit.

What is special about patients with lung cancer and pulmonary metastases in palliative care? Results from a nationwide survey

BACKGROUND

Patients with advanced lung cancer constitute a special focus in palliative care not only for epidemiological or prognostic reasons, but also because their symptom burden is felt to be widespread and difficult to treat. This study describes disease-specific characteristics and the symptom burden of patients with advanced incurable lung cancer, comparing them with patients suffering from other diseaseentities.

METHODS

A secondary analysis of the nationwide Hospice and Palliative Care Evaluation (HOPE) was performed, by focussing on inpatient hospice and palliative care unit patients and by using descriptive methods.

RESULTS

From 2006 to 2008, 5487 inpatients were registered, 874 of which were diagnosed with lung cancer and 1884 with pulmonary metastases. Symptoms such as weakness, tiredness, or pain were most prevalent in all subgroups. Dyspnea was significantly more prevalent in all patients with different kinds of pulmonary tumor manifestations; confusion was significantly more prevalent in patients with lung cancer. Dyspnea could not be treated as effectively as pain or nausea. Confusion and nursing problems worsened during the observation period. Dyspnea and confusion were associated with increased risk of death during the observational period.

CONCLUSION

The symptom pattern of patients with lung cancer is characterized by dyspnea and confusion--symptoms that are difficult to treat until discharge and that imply a worse prognosis. Therefore, increased research on the pathophysiology and treatment of dyspnea and confusion is required, and efforts in advance care planning and anticipation of dyspnea and confusion as a critical symptom in patients with lung cancer should be reinforced.

Population aging and hospitalization for chronic disease in Germany

BACKGROUND

The population of Germany is aging, i.e., the elderly currently make up an increasing percentage of the population from year to year. Furthermore, many common chronic diseases mainly affect the elderly. For these two reasons, the overall cost of health care in Germany is expected to increase. We studied the effect that population aging has had on the number of hospitalizations for major types of chronic disease in Germany since the year 2000.

METHODS

This study is based on nationwide hospitalization statistics, classified by diagnosis, that were published by the German Federal Statistical Office. We analyzed data for three classes of diagnoses--malignant neoplasia, cardiovascular diseases, and diseases of the musculoskeletal system and connective tissue--which were further broken down into nine diagnostic subgroups. Changes in inpatient case numbers might be due either to population aging or to changing rates of hospitalization for individual diagnoses. We used index decomposition analysis to determine the relative influence of these two factors on changing case numbers.

RESULTS

The author found that the aging of the population increased the number of hospitalizations for all of the diagnoses studied. This was particularly evident with respect to the large birth cohorts born in the 1920s (with the diagnosis of congestive heart failure) and in the period 1934-1944 (with the diagnoses ischemic heart disease, lung cancer, colorectal cancer, and osteoarthritis). On the other hand, changing rates of hospitalization for individual diagnoses increased the number of hospitalizations for some diagnoses (congestive heart failure, diseases of the spine and back) and decreased it for others (ischemic heart disease, cerebrovascular diseases, colorectal cancer, breast cancer).

CONCLUSION

The aging of the population and the changing rates of hospitalization for various diagnoses are exerting separate effects on the number of hospitalizations for chronic diseases in Germany. Predictions of hospital case numbers in the future must take both factors into account.

The association between active participation in a sports club, physical activity and social network on the development of lung cancer in smokers: a case-control study

BACKGROUND

This study analyses the effect of active participation in a sports club, physical activity and social networks on the development of lung cancer in patients who smoke. Our hypothesis is that study participants who lack social networks and do not actively participate in a sports club are at a greater risk for lung cancer than those who do.

METHODS

Data for the study were taken from the Cologne Smoking Study (CoSmoS), a retrospective case-control study examining potential psychosocial risk factors for the development of lung cancer. Our sample consisted of n = 158 participants who had suffered lung cancer (diagnosis in the patient document) and n = 144 control group participants. Both groups had a history of smoking.Data on social networks were collected by asking participants whether they participated in a sports club and about the number of friends and relatives in their social environment. In addition, sociodemographic data (gender, age, education, marital status, residence and religion), physical activity and data on pack years (the cumulative number of cigarettes smoked by an individual, calculated by multiplying the number of cigarettes smoked per day by the number of years the person has smoked divided by 20) were collected to control for potential confounders. Logistic regression was used for the statistical analysis.

RESULTS

The results reveal that participants who are physically active are at a lower risk of lung cancer than those who are not (adjusted OR = 0.53*; CI = 0.29-0.97). Older age and lower education seem also to be risk factors for the development of lung cancer. The extent of smoking, furthermore, measured by pack years is statistically significant. Active participation in a sports club, number of friends and relatives had no statistically significant influence on the development of the cancer.

CONCLUSIONS

The results of the study suggest that there is a lower risk for physically active participants to develop lung cancer. In the study sample, physical activity seemed to have a greater protective effect than participation in a sports club or social network of friends and relatives. Further studies have to investigate in more detail physical activity and other club participations.