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Rick O, Gerhardt A, Schilling G. Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice. Oncol Res Treat 2024; 47:218-223. [PMID: 38471462 DOI: 10.1159/000538277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options. SUMMARY In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD. KEY MESSAGES Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
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V Grafenstein K, Foerster FM, Haberstroh F, Campbell D, Irshad F, Salgado FC, Schilling G, Travac E, Weiße N, Zepf M, Döpp A, Karsch S. Laser-accelerated electron beams at 1 GeV using optically-induced shock injection. Sci Rep 2023; 13:11680. [PMID: 37468564 DOI: 10.1038/s41598-023-38805-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
In recent years, significant progress has been made in laser wakefield acceleration (LWFA), both regarding the increase in electron energy, charge and stability as well as the reduction of bandwidth of electron bunches. Simultaneous optimization of these parameters is, however, still the subject of an ongoing effort in the community to reach sufficient beam quality for next generation's compact accelerators. In this report, we show the design of slit-shaped gas nozzles providing centimeter-long supersonic gas jets that can be used as targets for the acceleration of electrons to the GeV regime. In LWFA experiments at the Centre for Advanced Laser Applications, we show that electron bunches are accelerated to [Formula: see text] using these nozzles. The electron bunches were injected into the laser wakefield via a laser-machined density down-ramp using hydrodynamic optical-field-ionization and subsequent plasma expansion on a ns-timescale. This injection method provides highly controllable quasi-monoenergetic electron beams with high charge around [Formula: see text], low divergence of [Formula: see text], and a relatively small energy spread of around [Formula: see text] at [Formula: see text]. In contrast to capillaries and gas cells, the scheme allows full plasma access for injection, probing or guiding in order to further improve the energy and quality of LWFA beams.
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Affiliation(s)
- K V Grafenstein
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany.
| | - F M Foerster
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - F Haberstroh
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - D Campbell
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
- Department of Physics, University of Strathclyde, Glasgow, G4 0NG, UK
| | - F Irshad
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - F C Salgado
- Friedrich-Schiller-Universität Jena, Institut für Optik und Quantenelektronik, 07743, Jena, Germany
- Helmholtz-Institut Jena, 07743, Jena, Germany
| | - G Schilling
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - E Travac
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - N Weiße
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
| | - M Zepf
- Friedrich-Schiller-Universität Jena, Institut für Optik und Quantenelektronik, 07743, Jena, Germany
- Helmholtz-Institut Jena, 07743, Jena, Germany
| | - A Döpp
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany
- Max Planck Institut für Quantenoptik, 85748, Garching, Germany
| | - S Karsch
- Ludwig-Maximilians-Universität München, Centre for Advanced Laser Applications, 85748, Garching, Germany.
- Max Planck Institut für Quantenoptik, 85748, Garching, Germany.
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Lingens SP, Schilling G, Schulz H, Bleich C. Effectiveness of brief psychosocial support for patients with cancer and their relatives: a quasi-experimental evaluation of cancer counselling centres. BMJ Open 2023; 13:e068963. [PMID: 36977537 PMCID: PMC10069588 DOI: 10.1136/bmjopen-2022-068963] [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] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of brief psychosocial support for patients with cancer and their relatives regarding their mental health. DESIGN Quasi-experimental controlled trial with measurements at three time points (baseline, after 2 weeks and after 12 weeks). SETTING The intervention group (IG) was recruited at two cancer counselling centres in Germany. The control group (CG) included patients with cancer or relatives who did not seek support. PARTICIPANTS In total, n=885 participants were recruited and n=459 were eligible for the analysis (IG, n=264; CG, n=195). INTERVENTION One to two psychosocial support sessions (approximately hour) provided by a psycho-oncologist or social worker. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was distress. The secondary outcomes were anxiety and depressive symptoms, well-being, cancer-specific and generic quality of life (QoL), self-efficacy and fatigue. RESULTS The linear mixed model analysis showed significant differences between IG and CG at follow-up for distress (d=0.36), p=0.001), depressive (d=0.22), p=0.005) and anxiety symptoms (d=0.22), p=0.003), well-being (d=0.26, p=0.002), QoL (QoL mental; d=0.26, p=0.003), self-efficacy (d=0.21, p=0.011) and QoL (global; d=0.27, p=0.009). The changes were not significant for QoL (physical; d=0.04, p=0.618), cancer-specific QoL (symptoms; d=0.13, p=0.093), cancer-specific QoL (functional; d=0.08, p=0.274) and fatigue (d=0.04, p=0.643). CONCLUSION The results suggest that brief psychosocial support is associated with the improvement of mental health of patients with cancer and their relatives after 3 months. TRIAL REGISTRATION NUMBER DRKS00015516.
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Affiliation(s)
- Solveigh Paola Lingens
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Springer F, Sautier L, Schilling G, Koch-Gromus U, Bokemeyer C, Friedrich M, Mehnert-Theuerkauf A, Esser P. Effect of depression, anxiety, and distress screeners on the need, intention, and utilization of psychosocial support services among cancer patients. Support Care Cancer 2023; 31:117. [PMID: 36645499 PMCID: PMC9842579 DOI: 10.1007/s00520-023-07580-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE In clinical cancer care, distress screening is recommended to identify highly burdened patients in objective need for psychosocial support to improve psychological distress and quality of life and to enhance patient empowerment. It is however unclear whether distress screeners are suitable for psychosocial care planning and thus whether they can predict the willingness that is need, intention, and utilization, to seek psychosocial support. METHODS In a secondary analysis of a cluster intervention study, we assessed cancer patients with three distress screeners (DT, PHQ-9, GAD-7) at baseline. The willingness to seek psychosocial support services was assessed binary for psychosocial services at 3 and 6 months. Logistic regression models were applied to examine the predictive effect of the screeners on need, intention, and utilization. We corrected all models for multiple testing. RESULTS The 660 patients included in the study were on average 60 years, 54% were male. At the 3- and 6-month follow-up, 353 and 259 patients participated, respectively. The screeners were best in predicting the need for support (OR reaching up to 1.15, 1.20, and 1.22 for the PHQ-9, GAD-7, and DT respectively). The intention was predicted by the PHQ-9 and GAD-7, whereas utilization of psychosocial support services was not predicted by the screeners. CONCLUSION The three distress screeners might be useful in psychosocial care planning, as they are able to predict the need and to some degree the intention to seek psychosocial support. Future research needs to examine potential barriers and supporting factors that may explain utilization of psychosocial support. TRIAL REGISTRATION The study was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).
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Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Leon Sautier
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Georgia Schilling
- Department of Clinical Oncology, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Uwe Koch-Gromus
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- grid.13648.380000 0001 2180 3484Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Friedrich
- grid.411339.d0000 0000 8517 9062Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- grid.411339.d0000 0000 8517 9062Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Peter Esser
- grid.411339.d0000 0000 8517 9062Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Haier J, Beller J, Adorjan K, Bleich S, de Greck M, Griesinger F, Heppt M, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schaefers J. Decision Conflicts in Clinical Care during COVID-19: A Multi-Perspective Inquiry. Healthcare (Basel) 2022; 10:healthcare10101914. [PMID: 36292361 PMCID: PMC9602416 DOI: 10.3390/healthcare10101914] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting “Decisional Uncertainty” provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for “Decisional Conflicts” included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals.
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Affiliation(s)
- Joerg Haier
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
- Correspondence:
| | - Johannes Beller
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Hospital, 80539 Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, 60590 Frankfurt am Main, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Markus Heppt
- Department of Dermatology, Erlangen University Hospital, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Soeren Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital, 53127 Bonn, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Tumorzentrum, 22763 Hamburg, Germany
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital, 01307 Dresden, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 Munich, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Juergen Schaefers
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
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Haier J, Beller J, Adorjan K, Bleich S, de Greck M, Griesinger F, Heppt MV, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schaefers J. Differences in Stakeholders' Perception of the Impact of COVID-19 on Clinical Care and Decision-Making. Cancers (Basel) 2022; 14:cancers14174317. [PMID: 36077852 PMCID: PMC9454870 DOI: 10.3390/cancers14174317] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.
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Affiliation(s)
- Joerg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Correspondence:
| | - Johannes Beller
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, 60590 Frankfurt am Main, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Markus V. Heppt
- Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Karl-Jaspers-Hospital, 26160 Oldenburg, Germany
| | - Soeren Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital, 53127 Bonn, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, 60590 Frankfurt am Main, Germany
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Tumorzentrum, 22763 Hamburg, Germany
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital, 01307 Dresden, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Juergen Schaefers
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Haier J, Beller J, Adorjan K, Bleich S, De Greck M, Griesinger F, Hein A, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schäfers J. Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective. Healthcare (Basel) 2022; 10:healthcare10061019. [PMID: 35742070 PMCID: PMC9222354 DOI: 10.3390/healthcare10061019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/16/2022] Open
Abstract
(1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pandemic-related problems likely determine this decisional dilemma for patients and can characterize vulnerable groups with special susceptibility for decisional problems and related consequences. (2) Methods: Cross-sectional data from the OnCoVID questionnaire study were used involving 540 patients from 11 participating institutions covering all major regions in Germany. Participants were actively involved in clinical treatment in oncology or psychiatry during the COVID-19 pandemic. Questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, perception of consequences for patients) and very basic demographic data (age, gender, stage of treatment and educational background). Decision uncertainties and distress were operationalized using equidistant five-point scales. Data analysis was performed using descriptive and various multivariate approaches. (3) Results: A total of 11.5% of all patients described intensive uncertainty in their clinical decisions that was significantly correlated with anxiety, depression, loneliness and stress. Younger and female patients and those of higher educational status and treatment stage had the highest values for these stressors (p < 0.001). Only 15.3% of the patients (14.9% oncology, 16.2% psychiatry; p = 0.021) considered the additional risk of COVID-19 infections as very important for their disease-related decisions. Regression analysis identified determinants for patients at risk of a decisional dilemma, including information availability, educational level, age group and requirement of treatment decision making. (4) Conclusions: In patients, the COVID-19 pandemic induced specific decisional uncertainty and distress accompanied by intensified stress and psychological disturbances. Determinants of specific vulnerability were related to female sex, younger age, education level, disease stages and perception of pandemic-related treatment modifications, whereas availability of sufficient pandemic-related information prevented these problems. The most important decisional criteria for patients under these conditions were expected side effects/complications and treatment responses.
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Affiliation(s)
- Jörg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
- Correspondence:
| | - Johannes Beller
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany;
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany;
| | - Moritz De Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt am Main, 60528 Frankfurt, Germany;
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26129 Oldenburg, Germany;
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, 91054 Erlangen, Germany;
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Carl von Ossietzky University, 26129 Oldenburg, Germany;
| | - Sören Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany;
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, 53105 Bonn, Germany;
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Hospital Altona, Asklepios Tumorzentrum, 22763 Hamburg, Germany;
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Jürgen Schäfers
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
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Ernst L, Schilling G. [Physical long-term consequences of cancer]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:420-430. [PMID: 35312813 DOI: 10.1007/s00103-022-03504-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/31/2022] [Indexed: 11/02/2022]
Abstract
The number of long-term survivors of malignant diseases is steadily increasing, which is due to the further development and optimization of multimodal therapy strategies and the mechanisms of new substance classes. These can now be combined with classical treatment methods or used sequentially. At the same time the number of patients who suffer from physical and psychosocial long-term consequences of cancer therapies or have to live with chronic side effects under the long-term therapies increases. Every therapy, whether radiation, chemotherapy, targeted therapy, or operation, has undesirable long-term side effects that contribute to the decrease of one's quality of life. These affect all parts of the body. As a result, patients can be heavily burdened. In oncology and in other disciplines involved in aftercare, these consequences must therefore be increasingly addressed and clarified and treatment strategies further developed. Unfortunately, there is still a considerable need for research in this area; moreover, there is a lack of clinical studies examining the evidence of a wide variety of holistic therapy methods.
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Affiliation(s)
- Lisa Ernst
- Medizinische Fakultät: Asklepios Campus Hamburg, Semmelweis Universität Budapest, Lohmühlenstr. 5, Haus P, 20099, Hamburg, Deutschland.
| | - Georgia Schilling
- Internistisch-onkologische Rehabilitation, Asklepios Nordseeklinik Westerland/Sylt, Westerland/Sylt, Deutschland.,Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Deutschland
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Esser P, Sautier L, Sarkar S, Schilling G, Bokemeyer C, Koch U, Rose M, Friedrich M, Nolte S, Walter O, Mehnert-Theuerkauf A. Correction to: Evaluation of an electronic psycho-oncological adaptive screening program (EPAS) with immediate patient feedback: findings from a German cluster intervention study. J Cancer Surviv 2021; 17:859. [PMID: 34862959 DOI: 10.1007/s11764-021-01148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Esser
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Leon Sautier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sarkar
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Hamburg, Germany
| | - Georgia Schilling
- "Hubertus Wald" Tumor Center, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Clinical Oncology, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Rose
- Medical Clinic, Department of Psychosomatic Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Sandra Nolte
- Medical Clinic, Department of Psychosomatic Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - Otto Walter
- Medical Clinic, Department of Psychosomatic Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
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Esser P, Sautier L, Sarkar S, Schilling G, Bokemeyer C, Koch U, Friedrich M, Defossez G, Mehnert-Theuerkauf A. Development and preliminary psychometric investigation of the German Satisfaction with Comprehensive Cancer Care (SCCC) Questionnaire. Health Qual Life Outcomes 2021; 19:147. [PMID: 34001165 PMCID: PMC8130117 DOI: 10.1186/s12955-021-01784-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The assessment of patient satisfaction during treatment is essential to provide patient-centered high-quality cancer care. Nevertheless, no German instrument assesses patient satisfaction with comprehensive cancer care, which not only includes oncological treatment, but also interpersonal quality of care as well as psychosocial support services. Based on the French REPERES-60, we developed the German Patient Satisfaction with Comprehensive Cancer Care (SCCC) questionnaire. METHODS The REPERES-60 was translated and the items were adapted to make it applicable to the German healthcare system and across different tumor entities. Scales of the resulting instrument were extracted via principal axis factoring (PAF). Subsequently, we investigated the reliability (Cronbach's Alpha, CA), discriminatory power (corrected item-scale correlations) and convergent validity (pre-specified correlations of the SCCC with different outcomes). RESULTS The SCCC consisted of 32 items which were subsequently tested among a sample of 333 patients across different tumor entities (response rate: 47%). Average age was 59 years (standard deviation: 14), 63% were male. PAF revealed four multi-item scales named Competence, Information, Access and Support accounting for 71% of the variance. Two single-items scales assess global satisfaction with medical and psychosocial care, respectively. CA across the multi-item scales ranged from .84 to .96. Discriminatory power was sufficiently high, with all r ≥ .5. Convergent validity was largely verified by negative associations of the four multi-item scales with depressive/anxious symptomatology (r ≥ - .18, p < .01) and fatigue/overall symptom burden (r ≥ - .14, p < .01). CONCLUSION We developed a tool to assess patient satisfaction with comprehensive cancer care in Germany. The SCCC showed satisfactory psychometric properties. Further studies are needed to verify these preliminary findings.
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Affiliation(s)
- Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
| | - Leon Sautier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sarkar
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Hamburg, Germany
| | - Georgia Schilling
- "Hubertus Wald" Tumor Centre, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Clinical Oncology, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Gautier Defossez
- UFR Médecine Et Pharmacie, Université de Poitiers, Poitiers, France
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Wedekind C, Schilling G, Grüttmüller M, Becker K. Marine environmental radioactivity monitoring by “in-situ” γ-radiation detection / Überwachung der Umweltradioaktivität im Meer durch Messung der γ-Strahlung „in situ“. KERNTECHNIK 2021. [DOI: 10.1515/kern-2000-650419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schilling G. Onkologische Rehabilitation gewinnt zunehmend an Bedeutung. InFo Hämatol Onkol 2020. [PMCID: PMC7474309 DOI: 10.1007/s15004-020-8207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Georgia Schilling
- Asklepios Nordseeklinik Westerland GmbH, Norderstrasse 81, 25980 Sylt / OT Westerland, Germany
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Abstract
INTRODUCTION In recent years, medical treatment for cancer has improved, thereby increasing the life expectancy of patients with cancer. Hence, the focus in healthcare shifted towards analysing treatments that offer to decrease distress and improve the quality of life of patients with cancer. The psychological burden of patients with cancer originates from all kinds of psychosocial challenges related to diagnosis and treatment. Cancer counselling centres (CCounCs) try to address these concerns. However, the current literature lacks research on the effectiveness of CCounCs. This study aims to assess the effectiveness of CCounCs with regard to distress and other relevant psychosocial variables (quality of life, anxietyand so on). METHODS AND ANALYSIS This prospective observational study with a non-randomised control group has three measurement points: before the first counselling session (baseline, t0) and at 2 weeks and 3 months after baseline (t1, t2). Patients and their relatives who seek counselling between December 2018 and November 2020 and have sufficient German language skills will be included. The control group will be recruited at clinics and oncological outpatient centres in Hamburg. Propensity scoring will be applied to adjust for differences between the control and intervention groups at baseline. Sociodemographic data, medical data and counselling concerns are measured at baseline. Distress (distress thermometer), quality of life (Short Form-8 Health Survey, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-Core 30), anxiety (Generalized AnxietyDisorder-7), depression (Patient HealthQuestionnaire-9) and further psychosocial variables are assessed at all time points. With a total of 787 participants, differences between the intervention and control groups of a small effect size (f=0.10) can be detected with a power of 80%. ETHICS AND DISSEMINATION The study was registered prior to data collection with the German Registration of Clinical Trials in September 2018. Ethical approval was received by the local psychological ethical committee of the Center for Psychosocial Medicine at the University Medical Centre Hamburg-Eppendorf in August 2018. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00015516; Pre-results.
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Affiliation(s)
- Solveigh Paola Lingens
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Julia Harms
- Department of Psychology, University of Osnabruck, Osnabruck, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hawryluk R, Barnes CW, Batha S, Beer M, Bell M, Bell R, Berk H, Bitter M, Bretz N, Budny R, Bush C, Cauffman S, Chang CS, Chang Z, Cheng C, Darrow D, Dendy R, Dorland W, Dudek L, Duong H, Durst R, Efthimion P, Evenson H, Fisch N, Fisher R, Fonck R, Forrest C, Fredrickson E, Fu G, Furth H, Gorelenkov N, Grek B, Grisham L, Hammett G, Heidbrink W, Herrmann H, Herrmann M, Hill K, Hooper B, Hosea J, Houlberg W, Hughes M, Jassby D, Jobes F, Johnson D, Kaita R, Kamperschroer J, Kesner J, Krazilniknov A, Kugel H, Kumar A, LaMarche P, LeBlanc B, Levine J, Levinton F, Lin Z, Machuzak J, Majeski R, Mansfield D, Mazzucato E, Mauel M, McChesney J, McGuire K, McKee G, Meade D, Medley S, Mikkelsen D, Mimov S, Mueller D, Navratil G, Nazikian R, Nevins B, Okabayashi M, Osakabe M, Owens D, Park H, Park W, Paul S, Petrov M, Phillips C, Phillips M, Phillips P, Ramsey A, Redi M, Rewoldt G, Rice B, Rogers J, Roquemore A, Ruskov E, Sabbagh S, Sasao M, Schilling G, Schmidt G, Scott S, Semenov I, Skinner C, Spong D, Strachan J, Strait E, Stratton B, Synakowski E, Takahashi H, Tang W, Taylor G, Goeler SV, Halle AV, White R, Williams M, Wilson J, Wong K, Wurden G, Young K, Zarnstorff M, Zweben S. Review of D-T Results from TFTR. ACTA ACUST UNITED AC 2018. [DOI: 10.13182/fst96-a11963011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Personalized medicine is a keyword in modern oncology summarizing biomarker-driven targeted therapies. Those novel agents enhance our therapeutic portfolio and offer new options for our patients. But the term is often misleading and implicates a tailored therapy to the individual person, but it rather means a treatment stratified on genetic characteristics of the tumor. Molecular therapies raise expectations of curability or long-term treatments making former life-threatening diseases to more chronic ones but this is true only for some patients. So we have to carefully communicate with our patients about the options and limitations of those modern therapies not to trigger disappointments.
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Affiliation(s)
- Georgia Schilling
- Department of Oncology with Section Hematology, Asklepios Klinik Altona, Asklepios Cancer Center Hamburg , Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany.
| | - Frank Schulz-Kindermann
- Institute of Medical Psychology, University Hospital Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
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16
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Hawryluk RJ, Mueller D, Hosea J, Barnes CW, Beer M, Bell MG, Bell R, Biglari H, Bitter M, Boivin R, Bretz NL, Budny R, Bush CE, Chen L, Cheng CZ, Cowley S, Dairow DS, Efthimion PC, Fonck RJ, Fredrickson E, Furth HP, Greene G, Grek B, Grisham LR, Hammett G, Heidbrink W, Hill KW, Hoffman D, Hulse RA, Hsuan H, Janos A, Jassby DL, Jobes FC, Johnson DW, Johnson LC, Kamperschroer J, Kesner J, Phillips CK, Kilpatrick SJ, Kugel H, LaMarche PH, LeBlanc B, Manos DM, Mansfield DK, Marmar ES, Mazzucato E, McCarthy MP, Machuzak J, Mauel M, McCune D, McGuire KM, Medley SS, Monticello DR, Mikkelsen D, Nagayama Y, Navratil GA, Nazikian R, Owens DK, Park H, Park W, Paul S, Perkins F, Pitcher S, Rasmussen D, Redi MH, Rewoldt G, Roberts D, Roquemore AL, Sabbagh S, Schilling G, Schivell J, Schmidt GL, Scott SD, Snipes J, Stevens J, Stratton BC, Strachan JD, Stodiek W, Synakowski E, Tang W, Taylor G, Terry J, Timberlake JR, Ulrickson HH, Towner M, von Goeler S, Wieland R, Wilson JR, Wong KL, Woskov P, Yamada M, Young KM, Zamstorff MC, Zweben SJ. Status and Plans for TFTR. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst92-a29907] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R. J. Hawryluk
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. Mueller
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Hosea
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | - M. Beer
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - M. G. Bell
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - R. Bell
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. Biglari
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - M. Bitter
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - R. Boivin
- Massachusetts Institute of Technology, Cambridge, MA
| | - N. L. Bretz
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - R. Budny
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - C. E. Bush
- Oak Ridge National Laboratory, Oak Ridge, TN
| | - L. Chen
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - C. Z. Cheng
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. Cowley
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. S. Dairow
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - P. C. Efthimion
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | - E. Fredrickson
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. P. Furth
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - G. Greene
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - B. Grek
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - L. R. Grisham
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - G. Hammett
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | - K. W. Hill
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. Hoffman
- Oak Ridge National Laboratory, Oak Ridge, TN
| | - R. A. Hulse
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. Hsuan
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - A. Janos
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. L. Jassby
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - F. C. Jobes
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. W. Johnson
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - L. C. Johnson
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Kamperschroer
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Kesner
- Massachusetts Institute of Technology, Cambridge, MA
| | - C. K. Phillips
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. J. Kilpatrick
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. Kugel
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - P. H. LaMarche
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - B. LeBlanc
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. M. Manos
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. K. Mansfield
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - E. S. Marmar
- Massachusetts Institute of Technology, Cambridge, MA
| | - E. Mazzucato
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - M. P. McCarthy
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Machuzak
- Massachusetts Institute of Technology, Cambridge, MA
| | - M. Mauel
- Columbia University, New York, NY
| | - D.C. McCune
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - K. M. McGuire
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. S. Medley
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. R. Monticello
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. Mikkelsen
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | | | - R. Nazikian
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - D. K. Owens
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. Park
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - W. Park
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. Paul
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - F. Perkins
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. Pitcher
- Canadian Fusion Fuels Technology Project, Toronto, Canada
| | | | - M. H. Redi
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - G. Rewoldt
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | - A. L. Roquemore
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | | | - G. Schilling
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Schivell
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - G. L. Schmidt
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. D. Scott
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Snipes
- Massachusetts Institute of Technology, Cambridge, MA
| | - J. Stevens
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - B. C. Stratton
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. D. Strachan
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - W. Stodiek
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - E. Synakowski
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - W. Tang
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - G. Taylor
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. Terry
- Massachusetts Institute of Technology, Cambridge, MA
| | - J. R. Timberlake
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - H. H. Ulrickson
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - M. Towner
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. von Goeler
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - R. Wieland
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - J. R. Wilson
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - K. L. Wong
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - P. Woskov
- Massachusetts Institute of Technology, Cambridge, MA
| | - M. Yamada
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - K. M. Young
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - M. C. Zamstorff
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
| | - S. J. Zweben
- Plasma Physics Laboratory, Princeton University P.O. Box 451 Princeton, N.J. 08543 USA (609) 243-3306
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Basse NP, Dominguez A, Edlund EM, Fiore CL, Granetz RS, Hubbard AE, Hughes JW, Hutchinson IH, Irby JH, LaBombard B, Lin L, Lin Y, Lipschultz B, Liptac JE, Marmar ES, Mossessian DA, Parker RR, Porkolab M, Rice JE, Snipes JA, Tang V, Terry JL, Wolfe SM, Wukitch SJ, Zhurovich K, Bravenec RV, Phillips PE, Rowan WL, Kramer GJ, Schilling G, Scott SD, Zweben SJ. Diagnostic Systems on Alcator C-Mod. Fusion Science and Technology 2017. [DOI: 10.13182/fst07-a1434] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- N. P. Basse
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. Dominguez
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - E. M. Edlund
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - C. L. Fiore
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. S. Granetz
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. E. Hubbard
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. W. Hughes
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - I. H. Hutchinson
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. H. Irby
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - B. LaBombard
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - L. Lin
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - Y. Lin
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - B. Lipschultz
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. E. Liptac
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - E. S. Marmar
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - D. A. Mossessian
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. R. Parker
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - M. Porkolab
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. E. Rice
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. A. Snipes
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - V. Tang
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. L. Terry
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. M. Wolfe
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. J. Wukitch
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - K. Zhurovich
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. V. Bravenec
- Fusion Research Center, University of Texas, Austin, Texas 78712
| | - P. E. Phillips
- Fusion Research Center, University of Texas, Austin, Texas 78712
| | - W. L. Rowan
- Fusion Research Center, University of Texas, Austin, Texas 78712
| | - G. J. Kramer
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - G. Schilling
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - S. D. Scott
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - S. J. Zweben
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
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Bonoli PT, Parker R, Wukitch SJ, Lin Y, Porkolab M, Wright JC, Edlund E, Graves T, Lin L, Liptac J, Parisot A, Schmidt AE, Tang V, Beck W, Childs R, Grimes M, Gwinn D, Johnson D, Irby J, Kanojia A, Koert P, Marazita S, Marmar E, Terry D, Vieira R, Wallace G, Zaks J, Bernabei S, Brunkhorse C, Ellis R, Fredd E, Greenough N, Hosea J, Kung CC, Loesser GD, Rushinski J, Schilling G, Phillips CK, Wilson JR, Harvey RW, Fiore CL, Granetz R, Greenwald M, Hubbard AE, Hutchinson IH, Labombard B, Lipschultz B, Rice J, Snipes JA, Terry J, Wolfe SM. Wave-Particle Studies in the Ion Cyclotron and Lower Hybrid Ranges of Frequencies in Alcator C-Mod. Fusion Science and Technology 2017. [DOI: 10.13182/fst07-a1430] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- P. T. Bonoli
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. Parker
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. J. Wukitch
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - Y. Lin
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - M. Porkolab
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. C. Wright
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - E. Edlund
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - T. Graves
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - L. Lin
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. Liptac
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. Parisot
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. E. Schmidt
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - V. Tang
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - W. Beck
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. Childs
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - M. Grimes
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - D. Gwinn
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - D. Johnson
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. Irby
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. Kanojia
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - P. Koert
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. Marazita
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - E. Marmar
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - D. Terry
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. Vieira
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - G. Wallace
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. Zaks
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. Bernabei
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - C. Brunkhorse
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - R. Ellis
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - E. Fredd
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - N. Greenough
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - J. Hosea
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - C. C. Kung
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - G. D. Loesser
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - J. Rushinski
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - G. Schilling
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - C. K. Phillips
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - J. R. Wilson
- Princeton University, Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | | | - C. L. Fiore
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - R. Granetz
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - M. Greenwald
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - A. E. Hubbard
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - I. H. Hutchinson
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - B. Labombard
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - B. Lipschultz
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. Rice
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. A. Snipes
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - J. Terry
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
| | - S. M. Wolfe
- Massachusetts Institute of Technology, Plasma Science and Fusion Center, Cambridge, Massachusetts 02139
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Esser P, Kuba K, Mehnert A, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Schilling G, Götze H, Scherwath A. Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT. Bone Marrow Transplant 2017; 52:753-758. [DOI: 10.1038/bmt.2016.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/28/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023]
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Quidde J, von Grundherr J, Koch B, Bokemeyer C, Escherich G, Valentini L, Buchholz D, Schilling G, Stein A. Improved nutrition in adolescents and young adults after childhood cancer - INAYA study. BMC Cancer 2016; 16:872. [PMID: 27825320 PMCID: PMC5101649 DOI: 10.1186/s12885-016-2896-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/26/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multimodality treatment improves the chance of survival but increases the risk for long-term side effects in young cancer survivors, so-called" Adolescents and Young Adults"(AYAs). Compared to the general population AYAs have a 5 to 15-fold increased risk of cardiovascular morbidity. Thus, improving modifiable lifestyle risk factors is of particular importance. METHODS The INAYA trial included AYAs between 18 and 39 years receiving an intensified individual nutrition counseling at four time points in a 3-month period based on a 3-day dietary record. At week 0 and 12 AYAs got a face-to-face counseling, at week 2 and 6 by telephone. Primary endpoint was change in nutritional behavior measured by Healthy Eating Index - European Prospective Investigation into Cancer and Nutrition (HEI-EPIC). RESULTS Twenty-three AYAs (11 female, 12 male, median age 20 years (range 19-23 years), median BMI: 21.4 kg/m2 (range: 19.7-23.9 kg/m2) after completion of cancer treatment for sarcoma (n = 2), carcinoma (n = 2), blastoma (n = 1), hodgkin lymphoma (n = 12), or leukemia (n = 6) were included (median time between diagnosis and study inclusion was 44 month). The primary endpoint was met, with an improvement of 20 points in HEI-EPIC score in 52.2 % (n = 12) of AYAs. At baseline, median HEI-EPIC score was 47.0 points (range from 40.0 to 55.0 points) and a good, moderate and bad nutritional intake was seen in 4.3, 73.9 and 21.7 % of AYAs. At week 12, median HEI-EPIC improved significantly to 65.0 points (range from 55.0 to 76.0 points) (p ≤ 0.001) and a good, moderate and bad nutritional intake was seen in 47.8, 52.2 and 0 % of AYAs. No change was seen in quality of life, waist-hip ratio and blood pressure. CONCLUSION Intensified nutrition counseling is feasible and seem to improve nutritional behavior of AYAs. Further studies will be required to demonstrate long-term sustainability and confirm the results in a randomized design in larger cohorts. TRIAL REGISTRATION Clinical trial identifier DRKS00009883 on DRKS.
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Affiliation(s)
- J Quidde
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - J von Grundherr
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - B Koch
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - C Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - G Escherich
- Department of Paediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - L Valentini
- Hochschule Neubrandenburg - University of Applied Sciences, Fachbereich Agrarwirtschaft und Lebensmittelwissenschaften, Brodaer Straße 2, 17033, Neubrandenburg, Germany
| | - D Buchholz
- Hochschule Neubrandenburg - University of Applied Sciences, Fachbereich Agrarwirtschaft und Lebensmittelwissenschaften, Brodaer Straße 2, 17033, Neubrandenburg, Germany
| | - G Schilling
- Hamburger Krebsgesellschaft e.V., Butenfeld 18, 22529, Hamburg, Germany
| | - A Stein
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Engelmann D, Scheffold K, Friedrich M, Hartung TJ, Schulz-Kindermann F, Lordick F, Schilling G, Lo C, Rodin G, Mehnert A. Death-Related Anxiety in Patients With Advanced Cancer: Validation of the German Version of the Death and Dying Distress Scale. J Pain Symptom Manage 2016; 52:582-587. [PMID: 27521283 DOI: 10.1016/j.jpainsymman.2016.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/18/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Distress and anxiety about issues related to death and dying is commonly experienced in patients with advanced disease and a limited life expectancy. OBJECTIVES To evaluate the psychometric properties of the German version of the Death and Dying Distress Scale (DADDS-G) in advanced cancer patients. METHODS We recruited advanced patients with mixed tumor entities (Union for International Cancer Control [UICC] Stage III/IV) treated in two German University Medical Centers during their outpatient treatment. After testing a preliminary version of the state-of-the-art translated original Death and Dying Distress Scale, we analyzed the psychometric properties of the shortened nine-item adapted DADDS-G using validated instruments measuring distress, anxiety, depression, fear of progression, and quality of life. RESULTS We obtained complete questionnaires from 77 of 93 patients with advanced cancer (response rate: 83%). Participants were mostly married or cohabiting (75%), well-educated, and both sexes were almost equally represented (52% men; mean age 58 years, SD = 12). The total mean DADDS-G score was 13.3 (SD = 8.5). Patients reported to be most distressed by the feeling of being a burden to others. The exploratory factor analysis led to one factor that accounted for more than 59% of the variance. The DADDS-G's internal consistency was excellent with Cronbach alpha = 0.91. The confirmatory factor analysis demonstrated a very good model fit. Death-related anxiety was significantly associated with distress, depression, anxiety, fear of progression, and lower quality of life (P < 0.001). CONCLUSION Results provide further evidence that the DADDS-G is a valid and reliable instrument of high clinical relevance for use in patients with advanced cancer.
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Affiliation(s)
- Dorit Engelmann
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Katharina Scheffold
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Tim J Hartung
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Frank Schulz-Kindermann
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | | | - Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
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Abstract
97 Background: General Practitioners (GP) play a pivotal role in caring for patients with malignant diseases in screening and detection, additional supporting care whilst treatment, and (long-term) follow-up. They often do not feel to be qualified enough for this task, and as well claim to lack support by specialists. This is a well-known problem, already addressed by the Institute of Medicine a few years ago. As an increasing number of patients will be diagnosed with cancer – and will survive for many years, following curatively intended treatment or with a chronic cancer disease, Cancer Survivorship was identified as the area of utmost importance. The relevance of this field was underlined by the disappointing results of the simple question we asked GPs: “When and how often should the tumor markers CEA, CA 15.3, and PSA be assessed during standardized follow-up of patients with early breast cancer, colorectal cancer or prostate cancer?”. Only one out of 30 answered it correctly. Together with the State Chamber of Medicine of Südbaden, we started an education program for GPs to improve this critical interface. Methods: During a full day training, we provided an educational program covering the most relevant topics in Cancer Survivorship: physical long-term sequelae and late complications after multimodal therapy strategies, their prevention and treatment; fatigue and self management, reasonable complementary and alternative medicine; management of chronic pain syndromes, recommendations for tertiary prevention, physical activities, nutrition and a guideline conform follow-up. Training was completed by a knowledge test and an overall evaluation. Results: All participants welcomed this newly implemented training program and considered it as very useful for their daily practice. Further support was urgently requested by the GPs, preferably in the format of (defined) Survivorship Care plans and follow-up schedules. Conclusions: GPs need more support and information in Cancer Survivorship. Widespread trainings programs should be developed and offered, in close collaboration with the respective State Chambers of Medicine and cancer specialists, and GPs, and further improve the outpatient care of cancer survivors.
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Affiliation(s)
- Georgia Schilling
- Klinik für Internistische Onkologie, Klinik für Tumorbiologie, Freiburg, Germany
| | - Wilhelm Niebling
- Department of General Practice, Albert Ludwigs University, Freiburg, Germany
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Sarkar S, Sautier L, Schilling G, Bokemeyer C, Koch U, Mehnert A. Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients. J Cancer Surviv 2015; 9:567-75. [DOI: 10.1007/s11764-015-0434-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023]
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Luetkens T, Kobold S, Cao Y, Ristic M, Schilling G, Tams S, Bartels BM, Templin J, Bartels K, Hildebrandt Y, Yousef S, Marx A, Haag F, Bokemeyer C, Kröger N, Atanackovic D. Functional autoantibodies against SSX-2 and NY-ESO-1 in multiple myeloma patients after allogeneic stem cell transplantation. Cancer Immunol Immunother 2014; 63:1151-62. [PMID: 25078248 PMCID: PMC11029676 DOI: 10.1007/s00262-014-1588-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple myeloma (MM) is the malignancy with the most frequent expression of the highly immunogenic cancer-testis antigens (CTA), and we have performed the first analysis of longitudinal expression, immunological properties, and fine specificity of CTA-specific antibody responses in MM. METHODS Frequency and characteristics of antibody responses against cancer-testis antigens MAGE-A3, NY-ESO-1, PRAME, and SSX-2 were analyzed using peripheral blood (N = 1094) and bone marrow (N = 200) plasma samples from 194 MM patients. RESULTS We found that antibody responses against CTA were surprisingly rare, only 2.6 and 3.1 % of patients evidenced NY-ESO-1- and SSX-2-specific antibodies, respectively. NY-ESO-1-specific responses were observed during disease progression, while anti-SSX-2 antibodies appeared after allogeneic stem cell transplantation and persisted during clinical remission. We found that NY-ESO-1- and SSX-2-specific antibodies were both capable of activating complement and increasing CTA uptake by antigen-presenting cells. SSX-2-specific antibodies were restricted to IgG3, NY-ESO-1 responses to IgG1 and IgG3. Remarkably, NY-ESO-1-positive sera recognized various non-contiguous regions, while SSX-2-specific responses were directed against a single 6mer epitope, SSX-2(85-90). CONCLUSIONS We conclude that primary autoantibodies against intracellular MM-specific tumor antigens SSX-2 and NY-ESO-1 are rare but functional. While their contribution to disease control still remains unclear, our data demonstrate their theoretic ability to affect cellular anti-tumor immunity by formation and uptake of mono- and polyvalent immune complexes.
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Affiliation(s)
- Tim Luetkens
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Sebastian Kobold
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Division of Clinical Pharmacology, Department of Internal Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Yanran Cao
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marina Ristic
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Georgia Schilling
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Sinje Tams
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Britta Marlen Bartels
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Julia Templin
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Katrin Bartels
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - York Hildebrandt
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Yousef
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Andreas Marx
- Institute for Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Haag
- Institute for Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Djordje Atanackovic
- Department of Internal Medicine II, Oncology/Hematology/Bone Marrow Transplantation with the Section Pneumology, University Cancer Center Hamburg (Hubertus Wald Tumorzentrum), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
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Schilling G. Leben mit Metastasen – Erfahrungen, Erwartungen und Wünsche der Patienten. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maria Murga Penas E, Schilling G, Behrmann P, Klokow M, Vettorazzi E, Bokemeyer C, Dierlamm J. Comprehensive cytogenetic and molecular cytogenetic analysis of 44 Burkitt lymphoma cell lines: Secondary chromosomal changes characterization, karyotypic evolution, and comparison with primary samples. Genes Chromosomes Cancer 2014; 53:497-515. [DOI: 10.1002/gcc.22161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 02/12/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eva Maria Murga Penas
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Institute of Human Genetics, Christian-Albrechts-University of Kiel & University Hospital Schleswig-Holstein; Campus Kiel Germany
| | - Georgia Schilling
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Petra Behrmann
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Marianne Klokow
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Carsten Bokemeyer
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Judith Dierlamm
- Department of Oncology and Hematology; BMT with Section Pneumology, Hubertus Wald Cancer Center, University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Abstract
High-dose chemotherapy followed by autologous haematopoetic stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Unfortunately, there are no randomized clinical studies examining the role of a second ASCT in patients who relapse after the initial autotransplant. Analysing all available retrospective studies, it seems that salvage ASCT can safely be performed in most patients with an overall treatment-related mortality rate <5%. Approximately 65% of patients will achieve an objective response and progression-free and overall survival will be around 12 months and 32 months, respectively. Retrospective data suggest that patients with a progression-free survival of ≥18 months after initial ASCT are most likely to benefit from a salvage autotransplant. However, patients with a <12-month duration of response after initial ASCT should not be considered for a second autograft in the relapsed setting because this group will probably only experience ASCT-related toxicity without any clinical benefit. Quality of response after initial ASCT and number of therapies preceding salvage ASCT may also have a predictive value. Importantly, these findings need to be verified by randomized clinical trials in order to firmly integrate salvage ASCT into a global therapeutic concept for myeloma patients including optimized induction, consolidation, and maintenance approaches.
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Affiliation(s)
- Djordje Atanackovic
- Department of Oncology/Haematology/Bone Marrow Transplantation, Pneumology Section, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Sautier L, Mehnert A, Höcker A, Schilling G. Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact? Eur J Cancer Care (Engl) 2013; 23:140-8. [DOI: 10.1111/ecc.12122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- L. Sautier
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Division of Psychosocial Oncology; Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - A. Höcker
- Center for Interdisciplinary Addiction Research; University of Hamburg; Hamburg Germany
- c/o Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - G. Schilling
- Department of Hematology and Oncology, University Cancer Center Hamburg; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Billecke L, Murga Penas EM, May AM, Engelhardt M, Nagler A, Leiba M, Schiby G, Kröger N, Zustin J, Marx A, Matschke J, Tiemann M, Goekkurt E, Heidtmann HH, Vettorazzi E, Dierlamm J, Bokemeyer C, Schilling G. Cytogenetics of extramedullary manifestations in multiple myeloma. Br J Haematol 2013; 161:87-94. [PMID: 23368088 DOI: 10.1111/bjh.12223] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 12/17/2012] [Indexed: 11/27/2022]
Abstract
Extramedullary disease in patients with multiple myeloma is a rare event, occurring mostly in advanced disease or relapse. Outcome is poor and prognostic factors predicting the development of extramedullary disease have not been defined. We investigated cytogenetic alterations of myeloma cells in different extramedullary manifestations by adapting the fluorescence in situ hybridization (FISH) technique in combination with cytoplasmic immunoglobulin staining to study the cytogenetics of plasma cell tumours on paraffin embedded material. Thirty six patients were investigated: 19 with extramedullary disease, 11 with skeletal extramedullary disease and six with solitary extramedullary plasmacytoma. The first two groups showed the following results: del(17p13) 32% vs. 27%, del(13q14) 35% vs. 27%, MYC-overrepresentation 28% vs. 18% and t(4;14) 37% vs. 18%. We detected an overall higher incidence of del(17p13) in both groups compared to data from bone marrow samples of multiple myeloma reported to date (range 7-16%). The solitary extramedullary plasmacytomas presented overall less cytogenetic aberrations than the other groups. Most important, three patients with extramedullary disease and one with skeletal extramedullary disease presented different FISH findings in the extramedullary tumour compared to their bone marrow plasma cells. del(17p13), occurring additional in three of four cases, seems a strong marker for extramedullary progression of myeloma.
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Affiliation(s)
- Lisa Billecke
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Kröger N, Badbaran A, Zabelina T, Ayuk F, Wolschke C, Alchalby H, Klyuchnikov E, Atanackovic D, Schilling G, Hansen T, Schwarz S, Heinzelmann M, Zeschke S, Bacher U, Stübig T, Fehse B, Zander AR. Impact of high-risk cytogenetics and achievement of molecular remission on long-term freedom from disease after autologous-allogeneic tandem transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant 2012; 19:398-404. [PMID: 23078786 DOI: 10.1016/j.bbmt.2012.10.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
Within a prospective protocol, the incidence and impact of achievement of molecular remission (mCR) and high-risk cytogenetics was investigated in 73 patients with multiple myeloma (MM) after autologous (auto)-allogeneic (allo) tandem stem cell transplantation (SCT). After induction chemotherapy, patients received melphalan 200 mg/m(2) before undergoing auto-SCT, followed 3 months later by melphalan 140 mg/m(2) and fludarabine 180 mg/m(2) before allo-SCT. Sixteen patients had high-risk cytogenetic features, defined by positive FISH for del(17p13) and/or t(4;14). Overall, 66% of the patients achieved CR or near-CR, and 41% achieved mCR, which was sustained negative (at least 4 consecutive samples negative) in 15 patients (21%), with no significant difference in incidence between the patients with high-risk cytogenetics and others (P = .70). After a median follow-up of 6 years, overall 5-year progression-free survival was 29%, with no significant difference between del 17p13/t(4;14)-harboring patients and others (24% versus 30%; P = .70). The 5-year progression-free survival differed substantially according to the achieved remission: 17% for partial remission, 41% for CR, 57% for mCR, and 85% for sustained mCR. These results suggest that auto-allo tandem SCT may overcome the negative prognostic effect of del(17p13) and/or t(4;14) and that achievement of molecular remission resulted in long-term freedom from disease.
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Affiliation(s)
- Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Kröger N, Zabelina T, Klyuchnikov E, Kropff M, Pflüger KH, Burchert A, Stübig T, Wolschke C, Ayuk F, Hildebrandt Y, Bacher U, Badbaran A, Schilling G, Hansen T, Atanackovic D, Zander AR. Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients. Bone Marrow Transplant 2012; 48:403-7. [DOI: 10.1038/bmt.2012.142] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Billecke L, Penas EMM, May AM, Engelhardt M, Nagler A, Leiba M, Schiby G, Kröger N, Zustin J, Marx A, Matschke J, Tiemann M, Goekkurt E, Bokemeyer C, Schilling G. Similar incidences of TP53 deletions in extramedullary organ infiltrations, soft tissue and osteolyses of patients with multiple myeloma. Anticancer Res 2012; 32:2031-2034. [PMID: 22593484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Extramedullary (EM) organ impairment in patients with multiple myeloma (MM) is a rare event, occurring mostly during disease relapse after high-dose chemotherapy with autologous or allogeneic stem cell transplantation. This manifestation is commonly associated with an unfavourable outcome. Previous studies suggested a correlation between the clinical course of patients with MM and EM and the cytogenetic findings, e.g. deletion of TP53 on 17p13. MATERIALS AND METHODS We investigated patients with these rare plasma cell organ infiltrations (n=17) as well as bone lesions or soft tissue lesions, known to be a common clinical feature of MM (n=14), using a newly established method of fluorescence in situ hybridization in combination with cytoplasmic immunoglobulin staining (cIg-FISH) on paraffin-embedded sections and a specific probe for TP53 on 17p13. RESULTS AND CONCLUSION The incidence of del(17)(p13) was similar in both groups but overall it was higher when compared to published data obtained from bone marrow samples and material originating from osteolyses. Further investigations on a larger patient cohort are needed in order to confirm these findings.
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Affiliation(s)
- Lisa Billecke
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Germany
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34
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Atanackovic D, Luetkens T, Kloth B, Fuchs G, Cao Y, Hildebrandt Y, Meyer S, Bartels K, Reinhard H, Lajmi N, Hegewisch-Becker S, Schilling G, Platzbecker U, Kobbe G, Schroeder T, Bokemeyer C, Kröger N. Cancer-testis antigen expression and its epigenetic modulation in acute myeloid leukemia. Am J Hematol 2011; 86:918-22. [PMID: 21898529 DOI: 10.1002/ajh.22141] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/09/2011] [Accepted: 07/11/2011] [Indexed: 11/10/2022]
Abstract
Cancer-testis antigens (CTA) represent attractive targets for tumor immunotherapy. However, a broad picture of CTA expression in acute myeloid leukemia (AML) is missing. CTA expression was analyzed in normal bone marrow (BM) as well as in AML cell lines before and after treatment with demethylating agents and/or histone acetylase inhibitors. Presence of selected CTA with a strictly tumor-restricted expression was then determined in samples of patients with AML before and after demethylating therapy. Screening AML cell lines for the expression of 20 CTA, we identified six genes (MAGE-A3, PRAME, ROPN1, SCP-1, SLLP1, and SPO11) with an AML-restricted expression. Analyzing the expression of these CTA in blast-containing samples from AML patients (N = 64), we found all samples to be negative for MAGE-A3 and SPO11 while a minority of patients expressed ROPN1 (1.6%), SCP-1 (3.1%), or SLLP1 (9.4%). The only CTA expressed in substantial proportion of patients (53.1%) was PRAME. Following demethylating treatment with 5'-aza-2'-deoxycytidine, we observed an increased or de novo expression of CTA, in particular of SSX-2, in AML cell lines. In AML patients, we detected increased expression of PRAME and induction of SSX-2 after demethylating therapy with 5-azacytidine. With the exception of PRAME, CTA are mostly absent from AML blasts. However, demethylating treatment induces strong expression of CTA, particularly of SSX-2, in vitro and in vivo. Therefore, we propose that CTA-specific immunotherapy for AML should preferentially target PRAME and/or should be combined with the application of demethylating agents opening the perspective for alternative targets like CTA SSX-2.
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MESH Headings
- Aged
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/metabolism
- Antimetabolites, Antineoplastic/pharmacology
- Azacitidine/analogs & derivatives
- Azacitidine/pharmacology
- Biomarkers/analysis
- Bone Marrow Cells/cytology
- Bone Marrow Cells/immunology
- Bone Marrow Cells/metabolism
- Case-Control Studies
- Cell Line, Tumor
- DNA Methylation
- Decitabine
- Epigenomics
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Histone Deacetylase Inhibitors/adverse effects
- Histone Deacetylase Inhibitors/pharmacology
- Histone Deacetylases/metabolism
- Humans
- Hydroxamic Acids/adverse effects
- Hydroxamic Acids/pharmacology
- Immunotherapy/methods
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Molecular Targeted Therapy
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Up-Regulation
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Affiliation(s)
- Djordje Atanackovic
- Center of Oncology, Department of Internal Medicine II, Oncology/Hematology/Stem Cell Transplantation, University Cancer Center Hamburg, Germany.
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Kasenda B, Rückert A, Farthmann J, Schilling G, Schnerch D, Prömpeler H, Wäsch R, Engelhardt M. Management of Multiple Myeloma in Pregnancy: Strategies for a Rare Challenge. Clinical Lymphoma Myeloma and Leukemia 2011; 11:190-7. [DOI: 10.1016/j.clml.2011.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 09/12/2010] [Accepted: 10/11/2010] [Indexed: 11/15/2022]
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Shimoni A, Hardan I, Ayuk F, Schilling G, Atanackovic D, Zeller W, Yerushalmi R, Zander AR, Kroger N, Nagler A. Allogenic hematopoietic stem-cell transplantation with reduced-intensity conditioning in patients with refractory and recurrent multiple myeloma: long-term follow-up. Cancer 2010; 116:3621-30. [PMID: 20564132 DOI: 10.1002/cncr.25228] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Allogeneic stem cell transplantation (SCT) with myeloablative conditioning is potentially curative therapy for myeloma, but is reportedly associated with a high risk of nonrecurrence mortality (NRM). Reduced-intensity conditioning (RIC) allows for the reduction of NRM, but the recurrence rate is increased. The role and timing of allogeneic SCT in the disease course remains controversial. To the authors' knowledge, there are limited data regarding the long-term outcome of RIC in the recurrent/refractory setting. METHODS A retrospective analysis was conducted of SCT outcomes in 50 patients who received RIC for recurrent/refractory myeloma between the years 2001 and 2004. All patients were given fludarabine-melphalan based conditioning and stem cell grafts from a related (n=27) or unrelated donor (n=23). RESULTS The median age was 53 years. Forty-seven patients failed a prior autologous SCT. Thirty patients were in disease remission at the time of SCT and 20 had stable or progressive disease. With a median follow-up of 6.4 years (range, 5-7.9 years), the overall and progression-free survival (PFS) rates were 34% and 26%, respectively. The NRM rate was 26%. Adverse prognostic factors for survival included SCT not in remission, long duration of disease (>5 years from diagnosis), and transplantation from a female donor to a male recipient. The 7-year PFS in 19 patients with none of these adverse prognostic factors was 47%. Chronic graft versus host disease and the achievement of complete remission after SCT were associated with improved outcome. CONCLUSIONS Allogeneic SCT can result in long-term PFS in a subset of myeloma patients who fail prior therapy and should be considered early after failure and after achieving remission.
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Affiliation(s)
- Avichai Shimoni
- Division of Hematology and Bone Marrow Transplantation, Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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37
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Pabst C, Zustin J, Jacobsen F, Luetkens T, Kröger N, Schilling G, Bokemeyer C, Sauter G, Atanackovic D, Marx A. Expression and prognostic relevance of MAGE-C1/CT7 and MAGE-C2/CT10 in osteolytic lesions of patients with multiple myeloma. Exp Mol Pathol 2010; 89:175-81. [PMID: 20621094 DOI: 10.1016/j.yexmp.2010.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
Cancer-testis (CT) antigens are promising targets for antigen-specific therapy of multiple myeloma (MM). Osteolytic lesions represent the most common clinical manifestation of myeloma and it is possible that osseous myeloma lesions differ from bone-infiltrating tumor cells with regard to the extent of CT antigen expression based on the epigenetic regulation of these genes. We, therefore, performed the first analysis of CT antigen expression in osteolytic lesions of myeloma patients to further define the diagnostic, prognostic, and therapeutic value of these proteins. Lytic bone samples were obtained from MM patients during surgical interventions and a tissue microarray was constructed. 105 bone samples and 24 bone marrow biopsies were stained immunohistochemically with antibodies against CT antigens MAGE-C1/CT7 and MAGE-C2/CT10 and Ki-67. MAGE-C1/CT7 and MAGE-C2/CT10 were frequently expressed in osteolytic lesions (46% and 54%) and bone marrow (75% and 54%). Expression of MAGE-C1/CT7 was significantly more frequent in patients with advanced stage of disease (p=0.023) and with a chromosomal deletion 17p13 (p53) (p=0.047). Samples with more than 75% MAGE-C1/CT7 expressing myeloma cells showed a higher proliferative rate (indicated by the expression of Ki67) than those with less than 25% MAGE-C1/CT7 expressing cells (p=0.011). Moreover, a content of ≥50% MAGE-C1/CT7 expressing myeloma cells in a sample was associated with reduced overall survival (p=0.013). Our results, therefore, suggest that expression of MAGE-C1/CT7 and MAGE-C2/CT10 in osteolytic lesions of myeloma patients can be used for diagnostic, prognostic, as well as immunotherapeutic purposes.
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Affiliation(s)
- Caroline Pabst
- Department of Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schilling G. ASTROPHYSICS: Neutron Stars Imply Relativity's a Drag. Science 2010; 289:1448a. [PMID: 17839511 DOI: 10.1126/science.289.5484.1448a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A new finding, based on x-rays from distant neutron stars, could be the first clear evidence of a weird relativistic effect called frame dragging, in which a heavy chunk of spinning matter wrenches the space-time around it like an eggbeater. Using data from NASA's Rossi X-ray Timing Explorer, three astronomers in Amsterdam found circumstantial evidence for frame dragging in the flickering of three neutron stars in binary systems. They announced their results in the 1 September issue of The Astrophysical Journal.
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Abstract
Most astrophysicists puzzling over what causes gamma ray bursts--short, intense explosions of high-energy photons that occur deep in space--now agree that the answer is a hypernova, the blast of energy released when a supermassive star collapses into a black hole. Two papers in this issue of Science (pp. 953 and 955), reporting on new x-ray observations of two gamma ray bursts, argue that the hypernova model tells only half of the story. On its way to becoming a black hole, the authors propose, the supermassive star actually collapses twice.
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Shimoni A, Hardan I, Ayuk F, Schilling G, Atanackovic D, Zeller W, Shem-Tov N, Rand A, Yerushalmi R, Zander A, Kröger N, Nagler A. Allogeneic Hematopoietic Stem Cell Transplantation With Reduced-Intensity Conditioning In Patients With Refractory And Relapsing Multiple Myeloma: Long-Term Follow-Up. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Kröger N, Shimoni A, Schilling G, Schwerdtfeger R, Bornhäuser M, Nagler A, Zander AR, Heinzelmann M, Brand R, Gahrton GÃ, Morris C, Niederwieser D, de Witte T. Unrelated stem cell transplantation after reduced intensity conditioning for patients with multiple myeloma relapsing after autologous transplantation. Br J Haematol 2010; 148:323-31. [DOI: 10.1111/j.1365-2141.2009.07984.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Rix A, Schilling G, Röttger D, Wolff A, Tacchini E, Sander S, Mosca G. Kolonnen-Optimierung mit Hochleistungsböden. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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43
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Lioznov M, El-Cheikh J, Hoffmann F, Hildebrandt Y, Ayuk F, Wolschke C, Atanackovic D, Schilling G, Badbaran A, Bacher U, Fehse B, Zander AR, Blaise D, Mohty M, Kröger N. Lenalidomide as salvage therapy after allo-SCT for multiple myeloma is effective and leads to an increase of activated NK (NKp44+) and T (HLA-DR+) cells. Bone Marrow Transplant 2009; 45:349-53. [DOI: 10.1038/bmt.2009.155] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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44
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Kröger N, Badbaran A, Lioznov M, Schwarz S, Zeschke S, Hildebrand Y, Ayuk F, Atanackovic D, Schilling G, Zabelina T, Bacher U, Klyuchnikov E, Shimoni A, Nagler A, Corradini P, Fehse B, Zander A. Post-transplant immunotherapy with donor-lymphocyte infusion and novel agents to upgrade partial into complete and molecular remission in allografted patients with multiple myeloma. Exp Hematol 2009; 37:791-8. [PMID: 19487069 DOI: 10.1016/j.exphem.2009.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate post-transplant immunotherapy with escalating donor-lymphocyte infusions (DLI) and novel agents (thalidomide, bortezomib, and lenalidomide) to target complete remission (CR). MATERIALS AND METHODS Thirty-two patients with multiple myeloma who achieved only partial remission after allogeneic stem cell transplantation were treated with DLI. If no CR was achieved, one of the novel agents was added to target CR. RESULTS CR defined either by European Group for Blood and Marrow Transplantation criteria, flow cytometry, or molecular methods as assessed by patient-specific immunoglobulin H-polymerase chain reaction or plasma cell chimerism polymerase chain reaction was accomplished in 59%, 63%, and 50% of patients, respectively. Achievement of CR resulted in improved 5-year progressive-free and overall survival, according to European Group for Blood and Marrow Transplantation criteria (53% vs 35%; p=0.03 and 90% vs 62%; p=0.06), flow cytometry (74% vs 15%; p=0.001 and 100% vs 52%; p=0.1), or molecular methods (84% vs 38%; p=0.001 and 100% vs 71%; p=0.03). CONCLUSIONS Our finding demonstrates the clinical relevance of posttransplantation therapies to upgrade remission, and of remission's depth for long-term survival in myeloma patients.
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Affiliation(s)
- Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Schilling G, Schuch G, Panse JP, Sterneck M, Bokemeyer C. Activity of lenalidomide in metastatic hepatic epithelioid hemangioendothelioma (HEH): A case report. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e21527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21527 Background: HEH is a rare tumor of the liver with an unpredictable malignant potential. Surgical resection or liver transplantation is recommended in locally advanced disease and has been successfully performed in selected cases with extrahepatic manifestations. Systemic therapy, however, is not standardized. Small cohorts have been treated with interferon, chemotherapy and angiogenesis inhibitors such as thalidomide with various results. Case report: A 33-year old caucasian previously healthy male was admitted to hospital with newly diagnosed suspicious lesions in liver and spleen. Further analyses showed additional pulmonal nodules. Biopsy revealed a tumor with predominant epithelioid cells, positive for CD31 and CD34 and negative for CD117, HHV8, AFP and CEA, classified as a HEH. Disease progressed during first line treatment with adriamycin and ifosfamide (2 cycles given). Based on a case report with encouraging results with thalidomide we treated our patient with lenalidomide, which is known to have less side effects while being more effective in the myeloma setting. After 6 courses of lenalidomide 25mg daily (21/28), regression of the splenic lesions was detected. Retrospective analysis after 9 cycles demonstrated stable disease in comparison to the recent investigation, but an overall progression of 22% according to RECIST criteria in the liver was observed. Due to the excellent tolerance we increased the daily dose to 30 mg (21/28) and 6 months later a slight regression in the lung and overall stable disease in the liver was observed. The splenic lesion disappeared completely. The patient was listed for liver transplantation and after another 4 months on lenalidomide 30 mg, he was successfully transplanted recently. Because of the remaining extrahepatic lesions it is planned to continue lenalidomide therapy in combination with the immunosuppressant rapamycine. Conclusions: We report the first case of successful therapy with lenalidomide in HEH. Higher doses than 25mg seem to be more effective. We grateful thank Celgene for offering us lenalidomide for this off label use. No significant financial relationships to disclose.
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Affiliation(s)
- G. Schilling
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - G. Schuch
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J. P. Panse
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Sterneck
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - C. Bokemeyer
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Schilling G, Hansen T, Shimoni A, Zabelina T, Pérez-Simón JA, Gutierrez NC, Bethge W, Liebisch P, Schwerdtfeger R, Bornhäuser M, Otterstetter S, Penas EMM, Dierlamm J, Ayuk F, Atanackovic D, Bacher U, Bokemeyer C, Zander A, San Miguel J, Nagler A, Kröger N. Erratum: Impact of genetic abnormalities on survival after allogeneic hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2008. [DOI: 10.1038/leu.2008.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schilling G, Bruweleit M, Harbeck N, Thomssen C, Becker K, Hoffmann R, Villena C, Schütte M, Hossfeld DK, Bokemeyer C, de Wit M. Phase II trial of vinorelbine and trastuzumab in patients with HER2-positive metastatic breast cancer. A prospective, open label, non-controlled, multicenter phase II trial (to investigate efficacy and safety of this combination chemotherapy). Invest New Drugs 2008; 27:166-72. [PMID: 18696011 DOI: 10.1007/s10637-008-9166-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 07/21/2008] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to evaluate the efficacy (progression free survival (PFS) and response rate) and safety of vinorelbine and trastuzumab combination chemotherapy in patients with HER2-overexpressing, metastatic breast cancer as a first line chemotherapy regimen. Patients with histologically confirmed, HER2-positive (immunohistochemistry (ICH) 3+, or 2+ and FISH+) metastatic breast cancer who had nor received prior vinorelbine or anti-HER2 therapy in the adjuvant setting, received at least eight weeks of vinorelbine i.v. (25 mg/g weekly) and trastuzumab (4 mg/kg on day 1 followed by 2 mg/kg weekly). Forty-one women from six participating centers were enrolled into the trial. The overall response rate, was 43.9% (18 of 41 patients), (CI 28-60.3%), 30% of patients were progression free after 1 year. Four patients reached complete remission, 14 partial remission and five had stable disease for at least 18 weeks. Six patients developed primary progression. 35 patients (85%) experienced progression after a median time of 235 days. Therapy was in general well-tolerated. There were two CTC grade 4 infusion syndromes and two patients experienced cardiotoxicity at least grade 2. This phase II trial of vinorelbine and trastuzumab demonstrated an effective and well-tolerated regimen with a favourable safety profile.
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Affiliation(s)
- G Schilling
- Onkologisches Zentrum, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Schilling G, Hansen T, Shimoni A, Zabelina T, Pérez-Simón JA, Simon-Perez JA, Gutierrez NC, Bethge W, Liebisch P, Schwerdtfeger R, Bornhäuser M, Otterstetter S, Penas EMM, Dierlamm J, Ayuk F, Atanackovic D, Bacher U, Bokemeyer C, Zander A, San Miguel J, Miguel JS, Nagler A, Kröger N. Impact of genetic abnormalities on survival after allogeneic hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2008; 22:1250-5. [PMID: 18418408 DOI: 10.1038/leu.2008.88] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed the prognostic impact of the most frequent genetic abnormalities detected by fluorescence in situ hybridization in 101 patients with multiple myeloma, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) after melphalan/fludarabine-based reduced conditioning. The incidences of abnormalities in the present analysis were as follows: del(13q14) (61%), t(11;14)(q13;q32) (14%), t(4;14)(p16.3;q32) (19%), MYC-gain gains (8q24) (21%), del(17p13) (16%) and t(14;16)(q32;q23) (5%). None of the patients had t(6;14)(p25;q32). The overall complete remission (CR) rate was 50% with no differences between the genetic abnormalities except for patients with del(17p13) who achieved less CR (7 vs 56%; P=0.001). Univariate analysis revealed a higher relapse rate in patients aged >50 years (P=0.002), patients with del(13q14) (P=0.006) and patients with del(17p13) (P=0.003). In multivariate analyses, only del(13q14) (HR: 2.34, P=0.03) and del(17p13) (HR: 2.24; P=0.04) significantly influenced the incidence of relapse, whereas for event-free survival, only age (HR 2.8; P=0.01) and del(17p13) (HR: 2.05; P=0.03) retained their negative prognostic value. These data show that del(17p13) is a negative prognostic factor for achieving CR as well as for event-free survival after HSCT. Translocation t(4;14) might be overcome by allogeneic HSCT, which will have implication for risk-adapted strategies.
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Affiliation(s)
- G Schilling
- Department of Oncology and Hematology, Medical Clinic II, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Bojanowski S, Fiedler A, Frank A, Stadlbauer E, Schilling G. Catalytic Production of Liquid Fuels from Organic Residues of Rendering Plants. Eng Life Sci 2007. [DOI: 10.1002/elsc.200720220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Andritzky B, Adler S, Burkholder I, Thöm I, Schuch G, Görn M, Schilling G, Edler L, Bokemeyer C, Laack E. Analysis of 94 patients with advanced biliary tract cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15172 Background: Cholangiocarcinoma or gallbladder cancer are often diagnosed at an advanced stage with limited treatment options. Methods: Between 1994 and 2004, 94 patients (pts) (47 male, 47 female) with advanced biliary tract cancer were treated at the Department of Oncology and Hematology, University Hospital Hamburg-Eppendorf. Clinical and histopathological characteristics, response to chemotherapy, and survival were investigated in a retrospective analysis. Median age was 59 years (range 30–80) and median Karnofsky performance status was 90%. Predominant histologic type was adenocarcinoma (94.7%). Primary tumor sites were extrahepatic bile duct (29.9%), gallbladder (28.7%), intrahepatic bile duct (10.6%), ampulla of Vater (2.1%), not specified (28.7%). Predominant localizations of metastases were liver (73 pts (77.7%)), lymph nodes (49 pts (52.1%)) and the peritoneum (14 pts (14.9%)). 33 pts (35.1%) underwent surgery of the primary tumor at time of diagnosis. Results: 72 of 94 pts (76.6%) received a first-line chemotherapy, all together 10 different chemotherapy regimens were used. The median number of cycles was 2.5 (range 1 - 12). A single agent chemotherapy with gemcitabine was the most often adminstered regimen (23 pts (31.9%)), followed by carboplatin and etoposide plus whole body hyperthermia (12 pts (16.7%)) and 5- fluorouracil and folic acid (10 pts (13.9%)). The overall response rate was 8.3% (95% CI 3.1 - 17.3) (34.7% SD, 47.2% PD, 9.7% not evaluable). Second-line chemotherapy was given in 27 patients, which induced no tumor response, but a stable disease rate of 22.2%. Median time to follow- up was 44.8 months. Survival was calculated for all 94 pts since time of diagnosis. Median overall survival was 12.2 months and median progression-free survival 9.2 months. The median overall survival time for the 72 pts who were treated with chemotherapy was 14.0 months, and for the 22 pts who did not receive chemotherapy 10.7 months (p=0.2). Conclusions: Our analysis showed a poor prognosis for patients with advanced biliary tract cancer. Response rate to chemotherapy was low. Therefore, well tolerated cytotoxic agents should be used and new treatment strategies (including molecular targeted therapy) should be further investigated. No significant financial relationships to disclose.
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Affiliation(s)
- B. Andritzky
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - S. Adler
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - I. Burkholder
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - I. Thöm
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Schuch
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - M. Görn
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Schilling
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - L. Edler
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - C. Bokemeyer
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - E. Laack
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
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