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Müller S, Fink M, Hense J, Comino MRS, Schuler M, Teufel M, Tewes M. Palliative care outpatients in a German comprehensive cancer center-identifying indicators for early and late referral. BMC Palliat Care 2022; 21:221. [PMID: 36503625 PMCID: PMC9743520 DOI: 10.1186/s12904-022-01114-z] [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: 05/27/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center. METHODS Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3-12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal-Wallis test was used to determine symptom severity and laboratory parameter in each referral category. RESULTS LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER. CONCLUSION A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.
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Affiliation(s)
- S. Müller
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Fink
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - J. Hense
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. R. Salvador Comino
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Schuler
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany ,grid.410718.b0000 0001 0262 7331German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - M. Teufel
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - M. Tewes
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
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Biersching T, Schweda A, Oechsle K, Nauck F, Rosenbruch J, Schuler U, Hense J, Neukirchen M, Weber M, Junghanss C, Kramer T, Ostgathe C, Thuss-Patience P, Van Oorschot B, Teufel M, Schuler M, Bausewein C, Tewes M. The OUTREACH study: oncologists of German university hospitals in rotation on a palliative care unit-evaluation of attitude and competence in palliative care and hospice. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04131-w. [PMID: 35831764 DOI: 10.1007/s00432-022-04131-w] [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: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. METHODS This national prospective multicenter pre-post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire. RESULTS From March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0-19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequently represented were medical oncology (n = 15), and anesthesiology (n = 11). After the rotation, median palliative care knowledge increased from 81.1% to 86.5% (p < .001), and median palliative care self-efficacy expectations scores increased from 38 to 50 points (p < .001). The effect of the 12-month rotation was not significantly greater than that of the 6-month rotation. CONCLUSION An educational rotation presented in a specialized palliative care unit for at least six months significantly improves palliative care knowledge and palliative care self-efficacy expectations of physicians from various medical backgrounds.
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Affiliation(s)
- T Biersching
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - A Schweda
- West German Cancer Centre, Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital Essen, 45147, Essen, Germany
| | - K Oechsle
- Palliative Care Unit, Department for Oncology, Haematology and Bone Marrow Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Nauck
- Department of Palliative Medicine, University Medical Centre Göttingen, Göttingen, Germany
| | - J Rosenbruch
- Department of Palliative Medicine, LMU Munich Hospital, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - U Schuler
- University Palliative Care Centre, Carl Gustav Carus University Hospital, Dresden, Germany
| | - J Hense
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Neukirchen
- Interdisciplinary Centre for Palliative Medicine, University Tumor Centre Düsseldorf - Comprehensive Cancer Centre, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.,Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - M Weber
- Interdisciplinary Department for Palliative Medicine, University Medicine Mainz, Johannes-Gutenberg-University, Mainz, Germany
| | - C Junghanss
- Division of Medicine, Dept. of Haematology, Oncology and Palliative Medicine, University Medical Centre, Rostock, Germany
| | - T Kramer
- Palliative Medicine at the University Centre for Tumor Diseases (UCT), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Ostgathe
- Palliative Medicine Department, Comprehensive Cancer Centre CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - P Thuss-Patience
- University Tumor Centre, Charité University Medicine Berlin, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - B Van Oorschot
- Interdisciplinary Centre for Palliative Medicine, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - M Teufel
- West German Cancer Centre, Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner Location Essen University Hospital, Essen, Germany
| | - C Bausewein
- Department of Palliative Medicine, LMU Munich Hospital, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - M Tewes
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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Frikkel J, Beckmann M, De Lazzari N, Götte M, Kasper S, Hense J, Schuler M, Teufel M, Tewes M. Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months-a comparative study. Support Care Cancer 2021; 29:5127-5137. [PMID: 33608761 PMCID: PMC8295138 DOI: 10.1007/s00520-021-06020-3] [Citation(s) in RCA: 3] [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: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 01/28/2023]
Abstract
Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017
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Affiliation(s)
- J Frikkel
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - N De Lazzari
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Götte
- Department of Pediatric Hematology/Oncology, Center for Child and Adolescent Medicine, University Hospital Essen, Essen, Germany
| | - S Kasper
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - J Hense
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147, Essen, Germany
| | - M Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - M Tewes
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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Berendt J, Ostgathe C, Simon ST, Tewes M, Schlieper D, Schallenburger M, Meier S, Gahr S, Schwartz J, Neukirchen M. [Cooperation between intensive care and palliative care : The status quo in German Comprehensive Cancer Centers]. Med Klin Intensivmed Notfmed 2020; 116:586-594. [PMID: 32767071 PMCID: PMC8494681 DOI: 10.1007/s00063-020-00712-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 07/04/2020] [Indexed: 12/04/2022]
Abstract
Hintergrund Die interdisziplinäre Zusammenarbeit zwischen Intensivmedizin und Palliativmedizin kann die Versorgungsqualität verbessern. Das Ausmaß dieser Zusammenarbeit ist aber bisher kaum untersucht. Ziel der Arbeit Es sollten die angebotenen und in Anspruch genommenen palliativmedizinischen Unterstützungsangebote auf den Intensivstationen deutscher onkologischer Spitzenzentren erfasst werden. Material und Methoden Durchgeführt wurde eine quantitativ-qualitative, deskriptive Umfrage an den 16 von der Stiftung Deutsche Krebshilfe geförderten Zentren. Die im quantitativen Teil erfragten Häufigkeiten werden als Mittelwert und Median mit den jeweiligen Streumaßen dargestellt, während die im qualitativen Teil erhobenen Triggerfaktoren mit einer Inhaltsanalyse nach Mayring ausgewertet wurden. Ergebnisse Von Juli bis August 2017 konnten Angaben aus 15 von 16 onkologischen Spitzenzentren (94 %) erfasst werden. Im Jahr 2016 wurden im Median 33 Intensivpatienten (Min. 0, Max. 100) palliativmedizinisch vorgestellt und 9 Patienten (Min. 1, Max. 30) auf eine Palliativstation verlegt. Regelmäßige intensivmedizinisch-palliativmedizinische Visiten sowie ein Screening-Tool zur Einbindung der spezialisierten Palliativmedizin sind an zwei onkologischen Spitzenzentren implementiert. Anhand von 23 genannten Triggern, die auf der Intensivstation eine palliativmedizinische Mitbehandlung ausgelöst haben, lassen sich nach qualitativer Analyse die drei Kategorien „Entscheidung und Einstellung des Teams“, „Zustand des Patienten“ und „Wunsch von Patienten und Angehörigen“ ableiten. Diskussion Trotz eines verfügbaren Angebots werden palliativmedizinische Ressourcen in den intensivmedizinischen Abteilungen der onkologischen Spitzenzentren immer noch selten genutzt. In die tägliche Routine integrierte Angebote wie Screening-Tools oder gemeinsame Visiten könnten die Ausnutzung der angebotenen palliativmedizinischen Ressourcen erhöhen und die Versorgungsqualität verbessern.
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Affiliation(s)
- J Berendt
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - C Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - S T Simon
- Zentrum für Palliativmedizin, Centrum für Integrierte Onkologie Aachen, Bonn, Köln, Düsseldorf, Uniklinik Köln, Köln, Deutschland
| | - M Tewes
- Westdeutsches Tumorzentrum, Innere Klinik (Tumorforschung), Universitätsklinikum Essen, Essen, Deutschland
| | - D Schlieper
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - M Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - S Meier
- Klinik für Anästhesiologie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - S Gahr
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - J Schwartz
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.,Klinik für Anästhesiologie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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5
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Frikkel J, Götte M, Beckmann M, Kasper S, Hense J, Teufel M, Schuler M, Tewes M. Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients. BMC Palliat Care 2020; 19:43. [PMID: 32234027 PMCID: PMC7110817 DOI: 10.1186/s12904-020-00542-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 10/10/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. Methods Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. Results 141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported “I feel weakened due to my tumor therapy” (n = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n = 107; 75.9%]) and fatigue (n = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p < 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (β = 1.044; p = 0.005). Motivated attitude towards PA was predicted by fatigue (β = − 2.301; p = 0.008), clinically relevant depression (β = − 1.390, p = 0.039), knowledge about PA and quality of life (QoL) (β = 0.929; p = 0.002), PA before diagnosis (β = 0.688; p = 0.005 and Interest in exercise program (β = 0.635; p = 0.008). Conclusion “I feel weakened due to my tumor therapy” is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue. Trial registration German Register of Clinical Trials DRKS00012514, registration date: 30.5.2017.
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Affiliation(s)
- J Frikkel
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Götte
- Department of Pediatric Hematology/Oncology, Center for Child and Adolescent Medicine, University Hospital Essen, Essen, Germany
| | - M Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - S Kasper
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - J Hense
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147, Essen, Germany
| | - M Tewes
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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Kasimir-Bauer S, Bittner AK, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, Keup C. Abstract P4-01-10: The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The detection and characterization of circulating tumor cells (CTCs) as one of the analytes in liquid biopsy has been considered as surrogate marker to improve treatment decisions in metastatic breast cancer (MBC). In addition, cell-free tumor DNA (ctDNA) released by tumor cells and harboring tumor-associated variants is further discussed to give additional information for therapeutic options. Thus, CTC and ctDNA analysis from the same blood tube is desired. To test usability of plasma, generated after CTC isolation from whole blood for ctDNA analysis, we analyzed ctDNA from 42 hormone receptor-positive/HER2-negative MBC patients (pts) for the detection of tumor-associated variants (plasma isolated straight from whole blood) and compared the results for similarities and differences of the detected variants in a subgroup of these pts to those, obtained from plasma generated after CTC selection (taken from a separate tube).
Methods: 4 ml plasma of all MBC pts and 4 ml plasma obtained after immunomagnetic isolation of CTCs from 2x5ml blood [AdnaTest EMT-2/Stem Cell Select (n=17pts) followed by multimarker qPCR] were used for the analysis of cell-free DNA (cfDNA) applying the QIAamp MinElute ccfDNA Kit. A total of 30ng - 60ng cfDNA was applied for library construction using the QIAseq Targeted DNA Panel for Illumina with integrated unique molecular identifiers. Sequencing was executed on the NextSeq® 500 platform (Illumina, US). Data were analyzed using the QIAseq Targeted Sequencing Data Analysis Portal, the Biomedical Genomics Workbench and the Ingenuity Variant Analysis. All materials used were manufactured by QIAGEN, Germany.
Results: In the total cohort of 42 pts, most variants of all analyzed genes were detected in the MUC16 gene (31.2%). ERBB2, EGFR and AR (androgen receptor) also showed high numbers of variants (11.6%, 11.0% and 8.9%, respectively) with a majority detected pathogenic variants (47.7%) in AR. 92% of all detected variants showed an allele frequency of <5% and some of the detected MUC16, ERBB2 and AR mutations significantly correlated with overall survival. Comparing the plasma results from a separate blood draw with the results from plasma samples after CTC selection in a subgroup of 17/42 pts, no significant difference was found for cfDNA concentration but variability within the cohort. Whereas the variant comparison of ctDNA isolated from both plasma sources showed great concordance, additional variants (around 15%) were exclusively found in one of the two matched samples. Interestingly, in the variant population exclusively found in ctDNA isolated after CTC isolation, the relative amount of pathogenic variants was increased compared to the variant fraction only found in ctDNA from plasma of a separate blood tube. Results obtained for frequently overexpressed CTC transcripts in this subgroup included genes involved in the PI3K signaling pathway as well as ERBB2 and ERBB3 in about 30% of the pts.
Conclusion: We here present a feasible workflow for CTC and ctDNA evaluation for expression and mutation analysis from the same blood sample. These data emphasize that the use of different liquid biopsy analytes can empower treatment decisions of MBC pts in the future.
Citation Format: Kasimir-Bauer S, Bittner A-K, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, and Keup C. The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-10.
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Affiliation(s)
- S Kasimir-Bauer
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - A-K Bittner
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - O Hoffmann
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - S Hauch
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Sprenger-Haussels
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Storbeck
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - K Benyaa
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Hahn
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Mach
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Tewes
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - R Kimmig
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - C Keup
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
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7
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Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration. Eur J Cancer Care (Engl) 2015; 25:1076-1090. [PMID: 26361265 DOI: 10.1111/ecc.12383] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 01/23/2023]
Abstract
Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity.
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Affiliation(s)
- M Missel
- Department of Thoracic Surgery, The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen.
| | - J H Pedersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen
| | - C Hendriksen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - M Tewes
- Heart Center, University Hospital of Copenhagen, Copenhagen
| | - L Adamsen
- The Faculty of Health and Medical Sciences and University Centre for Nursing and Care Research (UCSF), Centre for Integrated Rehabilitation of Cancer Patients (CIRE), Copenhagen, Denmark
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MacLeod CL, Morgan CW, Mosquera A, Kochanek CS, Tewes M, Courbin F, Meylan G, Chen B, Dai X, Chartas G. A CONSISTENT PICTURE EMERGES: A COMPACT X-RAY CONTINUUM EMISSION REGION IN THE GRAVITATIONALLY LENSED QUASAR SDSS J0924+0219. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/2/258] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Aktas B, Kasimir-Bauer S, Kasper S, Derks C, Kimmig R, Schuler M, Tewes M. P4-07-05: Comparison of PIK3CA Hot Spot Mutations in the Primary Tumor or Metastases with PIK3CA Mutations or PIK3CA Over-Expression in Circulating Tumor Cells of Metastatic Breast Cancer Patients under Sequential Palliative Therapy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-07-05] [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: 11/16/2022]
Abstract
Abstract
Background: Stem cell like tumor cells have been implied as the active source of metastatic spread in primary tumors. To disseminate and metastasize, these cells may undergo phenotypic changes, known as epithelial-mesenchymal transition (EMT). The PI3K/AKT signaling pathway has been identified as one of the most important and most frequently mutated pathways involved in these processes. Assuming that metastasis requires a dissemination of tumor stem cells or tumor cells showing EMT, we studied 174 blood samples of 43 metastatic breast cancer patients under follow-up of palliative chemo-, antibody - or antihormonal therapy for the presence of sternness like circulating tumor cells (slCTCs). Further, we correlated these data with the occurrence of PIK3CA mutations in slCTCs and with the detection of hot spot mutations as well as PTEN loss in primary tumors or metastases.
Materials and Methods: All blood samples underwent immunomagnetic enrichment using the ***AdnaTest ***BreastCancerSelect (AdnaGen AG, Germany). RNA was recovered and reverse transcribed for analysis using the AdnaTest EMT (multiplex RT-PCR for TWIST, AKT2, PI3K), and separately for the stem cell marker ALDH1 applying the AdnaTest TumorStemCell. The identification of EMT markers was considered positive if at least one of the three markers was detected in the sample. The expression of CD34 was analyzed in a subset of samples to exclude potential interference of normal hematopoietic stem cells. The analysis of PCR products was performed by capillary electrophoresis on the Agilent Bioanalyzer 2100. The PIK3CA 3140 G/A mutation in slCTC-derived cDNA was identified by direct sequencing. PIK3CA hot spot mutations in primary tumors or metastases were identified by direct sequencing from microdissected FFPE tumor tissue. PTEN loss (as defined as <10% of cells exhibiting positive staining) was detected by immunohistochemistry.
Results: During follow up, slCTCs were detected in 23/43 (53%) of the patients at least at one time point. ALDH1 was present in 18/43 (42%) patients, and at least one of the EMT markers was detected in 22/43 (51%) of the patients with the over-expression of PI3K (87%), AKT (96%) and TWIST (22%), respectively. Positivity for both, ALDH1 and EMT markers, was found in 15/23 (65%) of the patients. So far, analyzing one sample of each slCTC-positive patient during follow-up of the disease, there seems to be an occurrence of PIK3CA 3140 G/A mutation in slCTCs in about 25% of the patients. Examining the tissue samples, PTEN loss was found in 3/43 (7%) patients, in two of which slCTCs were present. DNA has been extracted from the dissected tumor tissues of all patients and is currently analyzed for PIK3CA mutations. The results will be available for presentation during the SABCS.
Conclusion: This study provides evidence for the presence of therapy-resistant breast cancer stemness like cells in the blood, possibly derived from the tumor or the metastases. Specific PI3K pathway inhibitors, alone or in combination therapy, may provide a therapeutic strategy for eliminating these cells to improve the prognosis of these patients.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-05.
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Affiliation(s)
- B Aktas
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - S Kasimir-Bauer
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - S Kasper
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - C Derks
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - R Kimmig
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M Schuler
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M Tewes
- 1West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Aktas B, Müller V, Tewes M, Zeitz J, Kasimir-Bauer S, Rack B, Janni W, Solomayer E, Fehm T. Vergleich der Östrogen- und Progesteronrezeptorexpression auf zirkulierenden Tumorzellen und dem Primärtumor bei Patientinnen mit metastasiertem Mammakarzinom. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286504] [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: 10/17/2022] Open
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Stoyanov I, Tewes M, Glass S, Koch M, Löhndorf M. Low-cost and Chemical Resistant Microfluidic Devices Based on Thermoplastic Elastomers for a Novel Biosensor System. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-872-j11.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractLow-cost and chemical resistant microfluidic devices based on thermoplastic elastomers have been fabricated by hot embossing technology. Commercial available thermoplastic elastomer foils based on polyurethane (PU) in a thickness range of 100-600 μm have been used. Prior to the fabrication of the microfluidic devices the chemical resistance of the material against a wide range of standard biological buffer solutions and solvents had been analysed. We created systems of channels, reservoirs and holes for the connections to external capillaries by double-sided hot embossing with an alignment accuracy of +/- 3 micrometer. Closed channel structures were produced by an additional chemical bonding process of the embossed devices with another thermoplastic elastomer foil. The total volume of the fluidic cell was 2 μl/sensor for the use with SAW (surface-acoustic wave) sensor chip and about 0.2 μ/sensor for the impedance sensors. A novel multi-chamber fluidic device was successfully tested for in-situ immobilization of thrombin antibodies and Bovin Serum Albumin (BSA) on different sensor elements of the same sensor chip.
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Aktas B, Tewes M, Kimmig R, Kasimir-Bauer S. Abstract PD02-04: Molecular Profiling of Circulating Tumor Cells in Blood of Metastatic Breast Cancer Patients Indicates Therapy Response and Provides Information on Epithelial Mesenchymal Transition and Tumor Stem Cell Metabolism. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd02-04] [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: 11/16/2022]
Abstract
Abstract
Background: Stem cell like tumor cells may undergo phenotypic changes, known as epithelial-mesenchymal transition (EMT), for metastasis formation using different signal transduction pathways. Assuming that metastasis requires a dissemination of tumor stem cells or tumor cells showing EMT, it was the purpose of this study to evaluate the expression of the stem cell marker ALDH1 and markers involved in two different pathways for EMT in 137 blood samples of 34 metastatic breast cancer patients during a follow-up of palliative chemo-, antibody — or hormonal therapy. Results were correlated with the presence of circulating tumor cells (CTCs) and response to therapy.
Materials and Methods: 2 x 5 ml blood were analyzed for CTCs with the AdnaTest BreastCancer (AdnaGen AG). The recovered c-DNA was additionally multiplex tested for the EMT markers [Twist, Akt2, PI3K (EMT1)], [Jagged, Slug, Snail (EMT2)] and separately for the stem cell marker ALDH1. The analytical sensitivity was determined by the detection of 5 target (IGROV) cells spiked into 5 ml blood of healthy donors using the AdnaTest BreastCancer procedure. The identification of EMT markers was considered positive if at least one marker was detected in the sample. Healthy donor samples without spiked tumor cells were used to determine the specificity of the test. The expression of CD34 was analyzed in a subset of samples to exclude potential interference of normal hematopoietic stem cells.
Results: 97% of 30 healthy donor samples investigated were negative for EMT1, 90% for EMT2 and 95% for ALDH1 transcripts, respectively. The spiking experiments revealed 80% recovery of the IGROV cells. In total, CTCs were detected in 35/137 (26%) blood samples. In 13/14 (93%) patients responding to a given therapy, no CTCs were detected or dissapeared in the course of the therapy. In contrast, 10/20 patients (50%) not responding to therapy were detected positive for CTCs. All samples were further examined for EMT1, EMT2 and ALDH1, respectively. A subset of samples was tested for CD34 expression with none of the samples found positive. Interestingly, EMT2 markers were only detected in 2/34 (5%) patients. Thus, the following calculations refer to EMT1. In the CTC (+) group, 59% (20/34) of the samples were positive for at least one of the EMT markers or ALDH1 but also in the CTC (-) group, EMT1 or ALDH1 were found in 34% (31/90) of the samples investigated, respectively. In patients diagnosed as non-responders and found positive for EMT markers and ALDH1 during therapy, persistence or reappearance of CTCs was found in 8/9 cases (88%) whereas in the responder group negative for EMT1 and ALDH1, CTCs persisted in only 10% (1/10) of the cases. Conclusion: In metastatic breast cancer (1) a major proportion of CTCs shows EMT and tumor stem cell characteristics (2) the PI3K/AKT pathway and TWIST as a transcription factor seem to be dominant (3) EMT markers or ALDH1 were also detectable in a group of patients negative for CTCs assuming that such markers could indicate a tumor cell phenotype that is not anymore detectable by epithelial markers and thus, could add additional sensitivity for CTC detection.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD02-04.
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Affiliation(s)
- B Aktas
- University Hospital of Essen, Germany
| | - M Tewes
- University Hospital of Essen, Germany
| | - R Kimmig
- University Hospital of Essen, Germany
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Tewes M, Peuker U. Herstellung von Partikeln durch Sprühtrocknen höherviskoser Polymerlösungen. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050466] [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: 11/10/2022]
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Aktas B, Mueller V, Schumacher K, Tewes M, Zeitz J, Kasimir-Bauer S, Rack B, Janni W, Solomayer E, Fehm T. ER and PR Expression Profile of Circulating Tumor Cells in Metastatic Breast Cancer Patients in Comparison to the Primary Tumor. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3009] [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: 11/16/2022]
Abstract
Abstract
Background: Introduktion: Several studies have indicated that the expression of predictive markers including ER and PR can change during course of disease. Therefoore, reassesment of of the prediktive markers at the time of disease progression might help to optimize treatment decisions. Metastatic tissue may be difficult to obtain for repeated analysis. In this context, characterization of circulating tumor cells (CTCs) could be of relevance. Therefore, the purpose of the present study was: (1) to reevaluate the ER/PR expression by circulating tumor cells and (2) to compare the hormone receptor status expression profile of CTC with the primary tumor. Materials and Methods: We ecaluated, 166 blood samples from metastatic breast cancer patients at the time of first diagnosis of first metastatic disease or disease progression. All samples underwent immunomagnetic enrichment using the AdnaTest BreastCancerSelect (AdnaGen AG, Germany) within 4 hours after blood withdrawal followed by RNA isolation and subsequent gene expression analysis by reverse transcription and Multiplex-PCR in separated tumor cells using the AdnaTest BreastCancerDetect. CTC were analyzed for the three breast cancer associated markers: GA733-2, Muc-1, Her-2 and β-actin as an internal PCR control. Expression of the estrogen (ER) and progesterone (PR) receptor was assessed in an additional RT-PCR. The analysis of PCR products was performed by capillary electrophoresis on the Agilent Bioanalyzer 2100. Results: The overall detection rate for CTC was 38% (63/166 patients) with the expression rates of 79% for EpCAM (50/63 patients), 77% for MUC1 (49/63 patients), 49% for HER2 (31/63 patients), 23% for ER (15/65 patients) and 11% for PR (7/65 patients), respectively. Comparisons with the primary tumor were only performed in CTC+ patients (n=65). In 41 of 65 (63%) patients with ER+ tumors, CTC were ER- and 38/65 (58%) patients with PR+ tumors did not express PR on CTC. Primary tumors and CTC displayed a concordant ER and PR status in only 34% and 61% of cases, respectively. Conclusion: Most of the CTC were ER/PR-negative despite the presence of an ER/PR-positive primary tumor. The predictive value of hormone receptor status expression profile of CTC for palliative endocrine therapy has to be prospectively evaluated.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3009.
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Affiliation(s)
- B. Aktas
- 1University Hospital Essen, University of Duisburg-Essen, Germany
| | | | | | - M. Tewes
- 4University Hospital Essen, University of Duisburg-Essen, Germany
| | - J. Zeitz
- 2University Hospital Hamburg, Germany
| | - S. Kasimir-Bauer
- 1University Hospital Essen, University of Duisburg-Essen, Germany
| | - B. Rack
- 6University Hospital Munich, Germany
| | - W. Janni
- 5University Hospital Duesseldorf, Germany
| | | | - T. Fehm
- 3University Hospital Tuebingen, Germany
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Aktas B, Tewes M, Hauch S, Fehm T, Kimmig R, Kasimir-Bauer S. Stammzellmarker und Marker einer epithelialen-mesenchymalen Transition werden häufig in Patientinnen mit metastasiertem Mammakarzinom exprimiert, die zirkulierende Tumorzellen aufweisen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238921] [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: 10/20/2022] Open
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Schmitz H, Tewes M, Schmitz A. A biomimetic IR sensor based on a mechanosensor. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.259] [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: 11/25/2022]
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17
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Schlecht U, Malavé A, Gronewold TMA, Tewes M, Löhndorf M. Detection of Rev peptides with impedance-sensors — Comparison of device-geometries. Biosens Bioelectron 2007; 22:2337-40. [PMID: 16901685 DOI: 10.1016/j.bios.2006.06.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 04/20/2006] [Revised: 06/22/2006] [Accepted: 06/30/2006] [Indexed: 11/28/2022]
Abstract
Two different impedance-sensor geometries have been compared for the detection of Rev peptides with a molecular weight of 2.4 kDa. Planar, two-dimensional interdigitated capacitor (IDC) sensors with electrode separations of 1.1 microm as well as three-dimensional nanogap-sensors with an electrode separation of 75 nm have been used. Both sensors have been operated at a fixed frequency of 980 MHz. We discuss the specific interaction of the Rev peptide to an immobilized RNA anti-Rev aptamer (9.2 kDa) for peptide concentrations in the range of 100 nM-2 microM. For the IDC sensor, only peptide concentrations above 500 nM gave detectable signals. For the nanogap sensor, the binding process was clearly visible for all concentrations applied. The higher sensitivity of the nanogap compared to the IDC is ascribed to the improved surface-to-volume ratio.
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Affiliation(s)
- U Schlecht
- Center of Advanced European Studies and Research (caesar), Ludwig-Erhard-Allee 2, 53173 Bonn, Germany.
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Perpeet M, Glass S, Gronewold T, Kiwitz A, Malavé A, Stoyanov I, Tewes M, Quandt E. SAW Sensor System for Marker‐Free Molecular Interaction Analysis. ANAL LETT 2006. [DOI: 10.1080/000327106006714063] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schlecht U, Malavé A, Gronewold T, Tewes M, Löhndorf M. Comparison of antibody and aptamer receptors for the specific detection of thrombin with a nanometer gap-sized impedance biosensor. Anal Chim Acta 2006; 573-574:65-8. [PMID: 17723506 DOI: 10.1016/j.aca.2006.01.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 12/07/2005] [Accepted: 01/09/2006] [Indexed: 10/25/2022]
Abstract
Nanogap-impedance biosensors with electrode separations of 75 nm have been fabricated by means of standard optical lithography and a sacrificial layer technique. Due to a large surface-to-volume ratio and high sensitivity, these sensors are superior compared to open interdigitated electrode structures. As a model, the blood coagulation factor thrombin was detected. As specific receptors, either an antibody or a RNA-aptamer have been used. The microwave frequency impedance measurements showed that both ligands were equally suitable for the specific detection of thrombin.
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Affiliation(s)
- U Schlecht
- Center of Advanced European Studies and Research (caesar), Ludwig-Erhard-Allee 2, 53175 Bonn, Germany.
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Trarbach T, Schleucher N, Tewes M, Seeber S, Junker U, Laurent D, Vanhoefer U, Masson E, Lebwohl D. Phase I/II study of PTK787/ZK 222584 (PTK/ZK), a novel, oral angiogenesis inhibitor in combination with FOLFIRI as first-line treatment for patients with metastatic colorectal cancer (CRC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. Trarbach
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - N. Schleucher
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - M. Tewes
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - S. Seeber
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - U. Junker
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - D. Laurent
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - U. Vanhoefer
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - E. Masson
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - D. Lebwohl
- Univ of Essen Medcl Sch, Essen, Germany; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
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Mross K, Richly H, Schleucher N, Korfee S, Tewes M, Scheulen ME, Seeber S, Beinert T, Schweigert M, Sauer U, Unger C, Behringer D, Brendel E, Haase CG, Voliotis D, Strumberg D. A phase I clinical and pharmacokinetic study of the camptothecin glycoconjugate, BAY 38-3441, as a daily infusion in patients with advanced solid tumors. Ann Oncol 2004; 15:1284-94. [PMID: 15277271 DOI: 10.1093/annonc/mdh313] [Citation(s) in RCA: 17] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to define the maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and pharmacokinetics of the camptothecin glycoconjugate BAY 38-3441, administered as an infusion for 30 min on two separate schedules every 3 weeks. PATIENTS AND METHODS A total of 81 patients with advanced solid tumors were treated with BAY 38-3441 either at doses of 20, 40, 67, 100, 140, 210, 315, 470 and 600 mg/m2/day for 1 day every 3 weeks (single-dose schedule), or at doses of 126, 189, 246, 320 and 416 mg/m2/day once daily for three consecutive days every 3 weeks (3-day schedule). Plasma sampling was performed to characterize the pharmacokinetics of BAY 38-3441 and camptothecin with these schedules. RESULTS DLTs included renal toxicity, granulocytopenia and thrombocytopenia on the single-day schedule at doses > or = 470 mg/m2/day, and diarrhea and thrombocytopenia on the 3-day schedule at doses > or = 320 mg/m2/day. Other non-DLTs were gastrointestinal, dermatological and hematological. Pharmacokinetics of BAY 38-3441 and camptothecin appear to be dose-dependent, but not linear. CONCLUSIONS Renal toxicity was dose-limiting for BAY 38-3441 using 30-min infusions on the single-dose schedule. Dose escalation to 470 mg/m2/day is feasible using a 2-h infusion. However, because of the superior safety profile, we recommend the 3-day schedule for BAY 38-3441 at a dose of 320 mg/m2/day as 30-min infusions for further phase II studies.
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Affiliation(s)
- K Mross
- Department of Medical Oncology, Tumor Biology Center at the University of Freiburg, Berlin, Germany
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Schleucher N, Trarbach T, Junker U, Tewes M, Masson E, Lebwohl D, Seeber S, Laurent D, Vanhoefer U. Phase I/II study of PTK787/ZK 222584 (PTK/ZK), a novel, oral angiogenesis inhibitor in combination with FOLFIRI as first-line treatment for patients with metastatic colorectal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. Schleucher
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - T. Trarbach
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - U. Junker
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - M. Tewes
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - E. Masson
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - D. Lebwohl
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - S. Seeber
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - D. Laurent
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - U. Vanhoefer
- University of Essen Medical Center, Essen, Germany; Schering AG, Berlin, Germany; Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Tewes M, Schleucher N, Achterrath W, Wilke HJ, Frings S, Seeber S, Harstrick A, Rustum YM, Vanhoefer U. Capecitabine and irinotecan as first-line chemotherapy in patients with metastatic colorectal cancer: results of an extended phase I study. Ann Oncol 2003; 14:1442-8. [PMID: 12954586 DOI: 10.1093/annonc/mdg376] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To define the maximum-tolerated dose (MTD) and to evaluate the dose-limiting toxicities (DLTs) of the combination of capecitabine and irinotecan in patients with metastatic colorectal cancer. PATIENTS AND METHODS Thirty-seven patients with measurable metastatic colorectal cancer with no prior chemotherapy for metastatic disease were treated at three dose levels (DLs). For the first two dose levels, irinotecan (70 mg/m(2)) was administered once a week for 6 weeks in combination with 2 weeks of capecitabine at 1000 mg/m(2) (DL1) or 1250 mg/m(2) (DL2) twice daily, starting on days 1 and 22. In the last dose escalation step, the dose of irinotecan was increased to 80 mg/m(2) (DL3). One cycle lasted 7 weeks. RESULTS In the subsequent phase I trial, 96 cycles of capecitabine and irinotecan were administered. At DL3, three out of six patients experienced DLTs (diarrhea, neutropenia, asthenia). In order to confirm the safety of the recommended dose, DL2 was extended to 15 patients. Five patients (33%) showed DLTs at this dose level, which was considered too high to embark on further clinical studies. Subsequently, the starting dose (DL1) was extended to a total of 16 patients, with diarrhea being the main toxicity. The overall response rate was 38% [95% confidence interval (CI) 21% to 58%], with a median response duration of 8.7 months (95% CI 6.4-11.5 months). CONCLUSIONS The recommended doses for further studies are irinotecan 70 mg/m(2) and capecitabine 1000 mg/m(2). The combination of capecitabine and irinotecan appears to have significant therapeutic efficacy with manageable toxicity.
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Affiliation(s)
- M Tewes
- Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Essen Medical School, Essen, Germany
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Adamsen L, Tewes M. Discrepancy between patients' perspectives, staff's documentation and reflections on basic nursing care. Scand J Caring Sci 2002; 14:120-9. [PMID: 12035275] [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: 02/25/2023]
Abstract
In recent years, Denmark has witnessed an increasing written and oral debate concerning the quality of basic nursing care. The present study is an attempt to characterize basic nursing care in a Danish hospital by collecting data on patient perceptions of their main somatic problems in seven pre-set categories. These data include documentation of patient problems in corresponding problem categories, and the staff's additional knowledge about patient problems. Triangulation of methods was used. Data were collected on 120 patients and from 22 nurses. The patients had 2.3 problems on average: pain (58%) and sleep (43%) were the problems cited most frequently. Only 31% of patients' experienced problems were documented in the nursing records. The nursing staff had more knowledge than was registered in the nursing records. However, one-third of the patients' problems was totally unknown to the nursing staff. From the patients' point of view, essential aspects of basic nursing care are overlooked in daily clinical practice. The findings show that the method employed is suitable for integration of the patients' perspective.
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Affiliation(s)
- L Adamsen
- University Hospitals Centre for Nursing and Care Research, Rigshospitalet, Blegdamsvej 9, afsn. 7331, DK-2100 Copenhagen, Denmark.
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Thoms M, Brems K, Tewes M, De Lichtenberg AM. [Nursing records improving]. Sygeplejersken 1998; 98:20-5. [PMID: 9496145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M Thoms
- Klinisk oversygeplejerske, Frederiksberg Hospital
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Tewes M. [Prevention and treatment of pressure sores--a neglected research subject? An overview of clinically controlled studies in the period 1987-91]. Vard Nord Utveckl Forsk 1993; 13:4-7. [PMID: 8337782 DOI: 10.1177/010740839301300204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Pressure sores are frequently seen in elderly hospitalized patients and leads to prolonged hospitalization and increased morbidity and mortality. The object of this paper was to retrieve the last five years literature regarding prevention and treatment of pressure sores. During the period 1987-1991, 751 papers on this topic were published and indexed in Medline. Only 9 of these papers represented controlled clinical trials. Three of them dealt with prevention, and the remaining 6 with treatment. Although 4 of 9 studies showed statistically significant differences between the actively treated group and the placebo group, none of the studies showed convincing clinical differences. Serious methodological flaws with respect to design, blinding, randomisation, sample size and statistical analysis were found in 8 of 9 studies. None of the clinical controlled studies on prevention of pressure sores showed any statistically significant differences between the control group and treatment with, respectively Prevasore lotion, Foam cushion and Silicore mattress. In the 6 trials on treatment of pressure sores, respectively mucopolysaccharide polysulphate creme, ketanserin creme and air-fluidized beds showed statistically better results than control treatment. We conclude that well-designed controlled clinical trials are needed to establish rational routines for prevention and treatment of pressure sores.
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Meyer G, Tewes M, Wiesner A, Nägerl H. [Factors influencing the corrosion of amalgams]. Dtsch Zahnarztl Z 1989; 44:544-7. [PMID: 2630286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a comparative corrosion test specimen were produced from eleven different amalgams using two different plugging pressures and were exposed to two different corrosive solutions. As was to be expected containing amalgams corroded the most. A more accurate differentiation between the individual non gamma 2 amalgams and the two different plugging pressures was only possible with the stronger corrosive solution. Therefore this solution seemed to be better suited for a standardized corrosion test according to DIN 13904, part 2. The greater plugging pressure inhibits corrosion especially in badly corroding amalgams. This seems to be due to the limited diffusion which is the result of a smaller pore size.
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Tewes M. [Nursing research. We must argue for nursing and use of resources]. Sygeplejersken 1983; 83:4-7. [PMID: 6552098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Tewes M. [Development of health and nursing care in an ambulatory clinic]. Sygeplejersken 1982; 82:4-7. [PMID: 6923614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tewes M, Maegaard E. [Self catheterization - an aid to patients who cannot empty the bladder with normal urination]. Sygeplejersken 1982; 82:6-7. [PMID: 6920928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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