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Kasper B, Pink D, Rothermundt C, Richter S, Augustin M, Kollar A, Kunitz A, Eisterer W, Gaidzik V, Brodowicz T, Egerer G, Reichardt P, Hohenberger P, Schuler MK. Geriatric Assessment of Older Patients Receiving Trabectedin in First-Line Treatment for Advanced Soft Tissue Sarcomas: The E-TRAB Study from The German Interdisciplinary Sarcoma Group (GISG-13). Cancers (Basel) 2024; 16:558. [PMID: 38339308 PMCID: PMC10854510 DOI: 10.3390/cancers16030558] [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: 12/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
E-TRAB was a non-interventional, prospective trial investigating the feasibility and predictive value of geriatric assessments (GA) in older STS patients treated with trabectedin as first-line therapy. Primary endpoints were overall survival (OS), quality of life and individual clinical benefit assessed by the patient-reported outcome measures QLQ-C30 and PRO-CTCAE. Further, several GA tools were applied and correlated with clinical outcomes and treatment-related toxicities. The final analyses included 69 patients from 12 German-speaking sites. The median age of patients was 78 years (range: 55 to 88). Baseline data on PROs and GA identified a diverse population of older patients with respect to their global health status, although a large proportion of them suffered from limitations, required geriatric help and had a high risk of morbidity. The Cancer and Age Research Group (CARG) score classified 38%, 29% and 23% of the patients with low, intermediate and high risks for therapy-related side effects, respectively. Median OS was 11.2 months [95%CI: 5.6; 19.4]. The study confirmed that trabectedin as first-line treatment in older patients with STS has an acceptable and manageable safety profile. Potential prognostic factors for clinical outcome and therapy-related toxicity were identified among the GA tools. Long Timed Up and Go (TUG) showed a significant correlation to OS and early death, whereas a high CARG score (>9) was associated with an increase in unplanned hospitalizations and the incidence of toxicities grade ≥ 3.
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Affiliation(s)
- Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Daniel Pink
- Department of Oncology and Palliative Care, HELIOS Klinikum Bad Saarow, 15526 Bad Saarow, Germany;
- Department of Internal Medicine C, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Stephan Richter
- Medical Department I, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
| | - Marinela Augustin
- Department of Hematology and Oncology, Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Attila Kollar
- Department of Medical Oncology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Annegret Kunitz
- Department of Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Spandau, 13585 Berlin, Germany;
| | - Wolfgang Eisterer
- Clinical Division of Oncology, Department of Internal Medicine, Medical University Graz, 8036 Graz, Austria;
| | - Verena Gaidzik
- Clinic for Internal Medicine III, University Hospital Ulm, 89081 Ulm, Germany;
| | - Thomas Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, 1090 Vienna, Austria;
| | - Gerlinde Egerer
- Department of Internal Medicine V, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Peter Reichardt
- Department of Oncology, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, Mannheim Medical Faculty, University of Heidelberg, 68167 Mannheim, Germany
| | - Markus K. Schuler
- Medical Department I, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
- Onkologischer Schwerpunkt am Oskar-Helene Heim, 14195 Berlin, Germany
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Singer S, Semrau S, Golcher H, Fechner K, Kallies A, Zapata Bonilla S, Grützmann R, Fietkau R, Kluba T, Jentsch C, Andreou D, Bornhäuser M, Schmitt J, Schuler MK, Eichler M. The health-related quality of life of sarcoma patients treated with neoadjuvant versus adjuvant radiotherapy - Results of a multi-center observational study. Radiother Oncol 2023; 189:109913. [PMID: 37739319 DOI: 10.1016/j.radonc.2023.109913] [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: 06/08/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
AIM The sequence of radiotherapy and resection in patients with soft tissue sarcomas is usually discussed on an individual basis. Better understanding of potential differences of health-related quality of life (QoL) between patients undergoing adjuvant (ART) versus neoadjuvant radiotherapy (NART) is therefore helpful for clinical decision making. METHODS Adult sarcoma patients from 39 hospitals completed the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Differences in global QoL, physical functioning, role functioning, fatigue, pain, and insomnia between ART versus NART were investigated with multivariate regression, adjusting for age, gender, chemotherapy, grading, stage, tumor location, recurrence/distant metastasis, sarcoma type, time since last treatment, and treatment status using validated thresholds. RESULTS A total of 1110 patients participated. Of them, 340 had received radiotherapy (NART: n = 95, 28%; ART: n = 245, 72%). Global QoL was 59.3 on average after NART and 60.5 after ART (Badj = 1.0, p = 0.74). Physical functioning was 65.9 compared to 70.5 (Badj = 4.2; p = 0.16), role function 48.8 vs. 56.7 (Badj = 7.0, p = 0.08), fatigue 47.5 vs. 45.4 (Badj = -1.2; p = 0.71), pain 40.2 vs. 34.1 (Badj = -6.8; p = 0.08), and insomnia 33.7 vs. 41.6 (Badj = 5.5, p = 0.16). Among patients with NART, clinically relevant QoL impairments were less frequent 2 years after treatment compared to < 2 years thereafter (n = 6 vs. n = 4 on average). CONCLUSION There is little evidence for QoL differences in most domains and overall QoL between the two irradiation groups. However, patients after NART might experience worse role functioning and pain but fewer problems with insomnia compared to patients after ART.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany; University Cancer Centre, Mainz, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Sabine Semrau
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | | | - Katja Fechner
- Department of Surgery, University Hospital, Erlangen, Germany
| | - Annett Kallies
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | - Sergio Zapata Bonilla
- University Cancer Centre, Mainz, Germany; Clinic and Polyclinic for Internal Medicine III, Haematology and Medical Oncology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | | | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | | | - Christina Jentsch
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, Germany; Department of Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
| | - Martin Bornhäuser
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Martin Eichler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
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Salm H, Hentschel L, Eichler M, Pink D, Fuhrmann S, Kramer M, Reichardt P, Schuler MK. Evaluation of electronic patient-reported outcome assessment in inpatient cancer care: a feasibility study. Support Care Cancer 2023; 31:575. [PMID: 37707633 PMCID: PMC10501936 DOI: 10.1007/s00520-023-08014-9] [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] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Patient-reported outcome (PRO) measures are increasingly important in evaluating medical care. The increased integration of technology within the healthcare systems allows for collection of PROs electronically. The objectives of this study were to Ashley et al. J Med Internet Res (2013) implement an electronic assessment of PROs in inpatient cancer care and test its feasibility for patients and Dawson et al. BMJ (2010) determine the equivalence of the paper and electronic assessment. METHODS We analyzed two arms from a study that was originally designed to be an interventional, three-arm, and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, 1 week after, and at discharge. For this analysis - focusing on feasibility of the electronic assessment - the following groups will be considered: Group A (intervention arm) received a tablet version, while group B (control arm) completed the questionnaire on paper. A feasibility questionnaire, that was adapted from Ashley et al. J Med Internet Res (2013), was administered to group A. RESULTS We analyzed 103 patients that were recruited in oncology wards. ePRO was feasible to most patients, with 84% preferring the electronic over paper-based assessment. The feasibility questionnaire contained questions that were answered on a scale ranging from "1" (illustrating non achievement) to "5" (illustrating achieving goal). The majority (mean 4.24, SD .99) reported no difficulties handling the electronic tool and found it relatively easy finding time for filling out the questionnaire (mean 4.15, SD 1.05). There were no significant differences between the paper and the electronic assessment regarding the PROs. CONCLUSION Results indicate that electronic PRO assessment in inpatient cancer care is feasible.
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Affiliation(s)
- Hanna Salm
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany.
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.
| | | | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Daniel Pink
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stephan Fuhrmann
- Clinic for Hematology and Oncology, Helios Hospital Emil von Behring Berlin, Berlin, Germany
| | | | - Peter Reichardt
- Clinic for Oncology and Palliative Medicine, Helios Hospital Berlin Buch, Berlin, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, Berlin, Germany
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Eichler M, Hentschel L, Singer S, Hornemann B, Richter S, Hofbauer C, Hohenberger P, Kasper B, Andreou D, Pink D, Jakob J, Grützmann R, Fung S, Wardelmann E, Arndt K, Hermes-Moll K, Schoffer O, Fried M, Jambor HK, Weitz J, Schaser KD, Bornhäuser M, Schmitt J, Schuler MK. Health related Quality of Life over time in German sarcoma patients. An analysis of associated factors - results of the PROSa study. Front Endocrinol (Lausanne) 2023; 14:1166838. [PMID: 37711899 PMCID: PMC10497872 DOI: 10.3389/fendo.2023.1166838] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Sarcomas are rare cancers and very heterogeneous in their location, histological subtype, and treatment. Health-Related Quality of Life (HRQoL) of sarcoma patients has rarely been investigated in longitudinal studies. Methods Here, we assessed adult sarcoma patients and survivors between September 2017 and February 2020, and followed-up for one year in 39 study centers in Germany. Follow-up time points were 6 (t1) and 12 months (t2) after inclusion. We used a standardized, validated questionnaire (the European Organisation for Research and Treatment of Cancer Quality of Life Core Instrument (EORTC QLQ-C30) and explored predictors of HRQoL in two populations (all patients (Analysis 1), patients in ongoing complete remission (Analysis 2)) using generalized linear mixed models. Results In total we included up to 1111 patients at baseline (915 at t1, and 847 at t2), thereof 387 participants were in complete remission at baseline (334 at t1, and 200 at t2). When analyzing all patients, HRQoL differed with regard to tumor locations: patients with sarcoma in lower extremities reported lower HRQoL values than patients with sarcomas in the upper extremities. Treatment which included radiotherapy and/or systemic therapy was associated with lower HRQoL. For patients in complete remission, smoking was associated with worse HRQoL-outcomes. In both analyses, bone sarcomas were associated with the worst HRQoL values. Being female, in the age group 55-<65 years, having lower socioeconomic status, and comorbidities were all associated with a lower HRQoL, in both analyses. Discussion HRQoL increased partially over time since treatment and with sporting activities. HRQoL improved with time since treatment, although not in all domains, and was associated with lifestyle and socioeconomic factors. Bone sarcomas were the most affected subgroup. Methods to preserve and improve HRQoL should be developed for sarcoma patients.
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Affiliation(s)
- Martin Eichler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Leopold Hentschel
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Beate Hornemann
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christine Hofbauer
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
- University Center for Orthopedics and Trauma Surgery, Technical University Dresden, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Jens Jakob
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany
| | - Robert Grützmann
- Clinic for Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Stephen Fung
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Dusseldorf, Dusseldorfn, Germany
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Karin Arndt
- German Sarcoma Foundation, Woelfersheim, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-based Hematologists and Oncologists, Cologne, Germany
| | - Olaf Schoffer
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Marius Fried
- Clinic and Polyclinic for Internal Medicine III/University Cancer Center Mainz, University Hospital Mainz, Mainz, Germany
| | - Helena K. Jambor
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jürgen Weitz
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Dieter Schaser
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
- University Center for Orthopedics and Trauma Surgery, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jochen Schmitt
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Markus K. Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Hamacher R, Liu X, Schuler MK, Hentschel L, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner L, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Kunitz A, Grünwald V. A post hoc analysis of the EPAZ trial: The role of geriatric variables in elderly soft tissue sarcoma patients on toxicity and outcome. Eur J Cancer 2023; 181:145-154. [PMID: 36657323 DOI: 10.1016/j.ejca.2022.12.012] [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: 09/19/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The EPAZ study (NCT01861951) showed recently that pazopanib was non-inferior to doxorubicin in patients ≥60 years treated in first line for advanced soft tissue sarcoma . The current post-hoc analysis aimed to assess the prognostic impact of frailty. METHODS Geriatric assessments were evaluated at baseline. Age >75 years, liposarcoma, ECOG = 2, G8 ≤14, instrumental activities of daily living (IADL) ≥1 and Charlson Comorbidity Index ≥2 were tested for their impact on progression-free survival (PFS), overall survival (OS), CTCAE grade 3/4 adverse events (AEs) or serious AEs (SAEs), using univariate and multivariate analysis models. RESULTS univariate analysis showed an increased risk of grade 3/4 AEs and SAEs for ECOG = 2, G8 score ≤14 or IADL ≥1, independent of treatment. The multivariate analysis exhibited for pazopanib a significantly reduced risk for grade 3/4 AEs (HR 0.53; p = 0.033), and in patients with G8 ≤14 an increased risk for SAEs (HR 2.67; p = 0.011). In the multivariate analysis, G8 ≤14 was a negative prognostic factor for PFS (HR 1.82; p = 0.009) and IADL ≥1 for OS (HR 2.02; p = 0.007). ECOG = 2 was the strongest negative predictor for PFS (HR 4.39; p = 0.001) and OS (HR 3.74; p = 0.004). Neither age nor Charlson Comorbidity Index showed any impact on PFS, OS, incidence of grade 3/4 AEs or SAEs. CONCLUSIONS This post hoc analysis demonstrated that age is not a denominator for outcome or toxicity in elderly patients with soft tissue sarcoma . Instead, geriatric and functional assessments should be used to counsel patients and tailor therapy to individual needs. Moreover, pazopanib has a reduced risk for grade 3/4 AEs compared to doxorubicin.
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Affiliation(s)
- Rainer Hamacher
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Xiaofei Liu
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leopold Hentschel
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Markus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany; Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany; Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
| | - Viktor Grünwald
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany.
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6
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Hofer S, Hentschel L, Richter S, Blum V, Kramer M, Kasper B, Riese C, Schuler MK. Electronic Patient Reported Outcome (ePRO) Measures in Patients with Soft Tissue Sarcoma (STS) Receiving Palliative Treatment. Cancers (Basel) 2023; 15:cancers15041233. [PMID: 36831574 PMCID: PMC9954494 DOI: 10.3390/cancers15041233] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The PazoQoL prospective, randomized, controlled, multicenter study was designed to continuously assess global health related quality of life (HRQoL) during treatment with pazopanib or physician-preferred chemotherapy over a 9-week period. The questionnaires were completed by the patients at home with great reliability during this time period. Continuous electronic patient reported outcome (ePRO) enabled early detection of the onset of deterioration and timely initiation of countermeasures. The Cancer Therapy Satisfaction Questionnaire (CTSQ) showed high interindividual variability and decline over a 9-week period, whereas the Time Trade-off (TTO) proved to be an efficient method for assessing individual benefit from cancer therapy. In our cohort, the TTO clearly demonstrated that the prolongation of life and the side effect profile of continued therapy were not as satisfactory as expected by patients when starting a new therapy. Although the study had to be stopped early due to the pandemic, our findings could translate into clinical practice without much effort and outside of a trial.
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Affiliation(s)
- Silvia Hofer
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-43-2531569
| | - Leopold Hentschel
- Division of Psycho-Oncology, NCT/UCC, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, Sarcoma Center, NCT/UCC, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Veronika Blum
- Department of Internal Medicine, Cantonal Hospital Lucerne, 6002 Lucerne, Switzerland
| | | | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Christoph Riese
- DTB Gesellschaft für digitale Therapiebegleitung mbH, 07745 Jena, Germany
| | - Markus K. Schuler
- Clinic and Polyclinic for Internal Medicine I, Sarcoma Center, NCT/UCC, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
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Zapata Bonilla SA, Fried M, Singer S, Hentschel L, Richter S, Hohenberger P, Kasper B, Andreou D, Pink D, Arndt K, Bornhäuser M, Schmitt J, Schuler MK, Eichler M. Working situation and burden of work limitations in sarcoma patients: results from the multi-center prospective PROSa study. J Cancer Res Clin Oncol 2023:10.1007/s00432-022-04556-3. [PMID: 36624191 PMCID: PMC10356622 DOI: 10.1007/s00432-022-04556-3] [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: 10/13/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated predictors of limitations in work performance, odds of drop out of work, and odds of receiving disability pension in sarcoma patients. METHODS We measured clinical and sociodemographic data in adult sarcoma patients and recorded if the patients received a (1) disability pension at baseline or (2) had dropped out of work 1 year after initial assessment. (3) Work limitations were assessed using the Work-limitations questionnaire (WLQ©). We analyzed exploratively. RESULTS (1) Amongst 364 analyzed patients, odds to receive a disability pension were higher in patients with abdominal tumors, older patients, high grade patients and with increasing time since diagnosis. (2) Of 356 patients employed at baseline, 21% (n = 76) had dropped out of work after 1 year. The odds of dropping out of work were higher in bone sarcoma patients and in patients who received additive radiotherapy ± systemic therapy compared with patients who received surgery alone. Odds of dropping out of work were less amongst self-employed patients and dropped with increasing time since diagnosis. (3) Work limitations were higher in woman and increased with age. Patients with bone and fibrous sarcomas were more affected than liposarcoma patients. Patients with abdominal tumors reported highest restrictions. Sarcoma treatment in the last 6 months increased work limitations. CONCLUSION Work limitations, drop out of work and dependence on a disability pension occurs frequently in patients with sarcoma adding to the burden of this condition. We were able to identify vulnerable groups in both the socioeconomic and disease categories.
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Affiliation(s)
- Sergio Armando Zapata Bonilla
- Clinic and Polyclinic for Internal Medicine III, Haematology and Medical Oncology/University Centre for Tumor Diseases (UCT), University Hospital Johannes Gutenberg, University Hospital Mainz, Mainz, Germany.
| | - Marius Fried
- Clinic and Polyclinic for Internal Medicine III, Haematology and Medical Oncology/University Centre for Tumor Diseases (UCT), University Hospital Johannes Gutenberg, University Hospital Mainz, Mainz, Germany
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Hospital Mainz, Mainz, Germany
| | - Leopold Hentschel
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Heidelberg, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Munster, Munster, Germany.,Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Brandenburg, Germany.,Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Karin Arndt
- German Sarcoma Foundation, Woelfersheim, Germany
| | - Martin Bornhäuser
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jochen Schmitt
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU, Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
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Thomas B, Bigdeli AK, Nolte S, Gazyakan E, Harhaus L, Bischel O, Lehner B, Egerer G, Mechtersheimer G, Hohenberger P, Horch RE, Andreou D, Schmitt J, Schuler MK, Eichler M, Kneser U. The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany-Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa). Cancers (Basel) 2022; 14:cancers14174312. [PMID: 36077847 PMCID: PMC9454490 DOI: 10.3390/cancers14174312] [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: 08/08/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The mainstay of soft-tissue-sarcoma treatment remains ablative surgery with complete tumor resection. In this context, reconstructive plastic surgery has become an important aspect of multidisciplinary sarcoma therapy aiming at limb preservation as an alternative to amputations. In this present study, cross-sectional data collected prospectively at 39 study centers across Germany were analyzed, focusing on both the inhouse availability of plastic surgery and external accessibility to plastic surgery in 621 cases. In summary, unplanned and incomplete primary tumor resections carried out at centers with lower degrees of specialization were associated with a significantly increased need for subsequent flap-based defect coverage. In line with this, a readily available team of plastic surgeons was independently associated with successful defect reconstruction, which in turn was associated with significantly higher chances of limb preservation. We conclude that easily accessible plastic surgery and a high degree of expertise in the field of sarcoma treatment are indispensable for limb preservation following sarcoma resection. Plastic and reconstructive surgery therefore plays a vital role in achieving the best possible outcomes in the interdisciplinary treatment of soft-tissue sarcomas. Abstract Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (n = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort.
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Affiliation(s)
- Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Correspondence: (B.T.); (U.K.); Tel.: +49-(621)-6810-2944 (B.T.); +49-(621)-6810-2328 (U.K.)
| | - Amir K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Steffen Nolte
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Oliver Bischel
- Department of Trauma and Orthopedics, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Peter Hohenberger
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, 48149 Münster, Germany
- Department of Orthopedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Jochen Schmitt
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, 01307 Dresden, Germany
| | - Markus K. Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Correspondence: (B.T.); (U.K.); Tel.: +49-(621)-6810-2944 (B.T.); +49-(621)-6810-2328 (U.K.)
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Eichler M, Hentschel L, Singer S, Hornemann B, Hohenberger P, Kasper B, Andreou D, Pink D, Jakob J, Arndt K, Kirchberg J, Richter S, Bornhäuser M, Schmitt J, Schuler MK. Distress in soft-tissue sarcoma and GIST patients -Results of a German multicentre observational study (PROSa). Psychooncology 2022; 31:1700-1710. [PMID: 35949152 DOI: 10.1002/pon.6009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Soft tissue sarcomas (STS) and gastrointestinal stromal tumours (GIST) are a group of rare malignant tumours with a high and heterogenous disease burden. As evidence is lacking, we aimed to determine the prevalence of increased emotional distress and to identify associated factors in these patients. METHODS The PROSa-study (Burden and medical care of sarcoma) was conducted between 2017 and 2020 in 39 study centres. Cross-sectional data from adult STS and GIST patients were analysed. Distress was measured with the Patient Health Questionnaire (PHQ-4). The relation of socioeconomic and clinical factors with distress was explored in adjusted logistic regression models. RESULTS Among 897 patients, prevalence of elevated anxiety and depression was 17% resp. 19%. Unemployed patients (odds ratio (OR) 6.6 (95% confidence interval (CI) 2.9-15.0)) and those with a disability pension (OR 3.1 (95% CI 1.9-5.0)) were more likely to experience distress (vs. employed patients). Patients with a disability pass (vs. none) had higher odds of increased distress (OR 1.8 (95% CI 1.2-2.7)). Lowest distress was observed in patients 2-<5 years and ≥5 years after diagnosis (comparison: <6 months) (OR 0.4 (95% CI 0.2-0.6) and 0.3 (95% CI 0.2-0.6)). Patients with thoracic STS (vs. lower limbs) had twice the odds to experience distress (OR 2.0 (95% CI 1.1-3.6)). Distress was seen almost twice as often in patients with progressive disease (vs. complete remission) (OR 1.7 (95% CI 1.1-2.8)). CONCLUSION Prevalence of elevated distress in STS and GIST patients is high. Unemployed patients, those with a disability pension and newly diagnosed patients are more often distressed than other patients. Clinicians and psycho-oncologists should be aware of these factors and consider the social aspects of the disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Martin Eichler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Leopold Hentschel
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Beate Hornemann
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Heidelberg, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, Münster, Germany
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Jens Jakob
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany
| | - Karin Arndt
- German Sarcoma Foundation, Woelfersheim, Germany
| | - Johanna Kirchberg
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jochen Schmitt
- Sarcoma Center, National Center for Tumor Diseases (NCT/UCC), University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Jakob J, Hentschel L, Richter S, Kreisel I, Hohenberger P, Kasper B, Andreou D, Pink D, Schmitt J, Schuler MK, Eichler M. Transferability of health-related quality of life data of large observational studies to clinical practice - comparing retroperitoneal sarcoma patients from the PROSa study to a TARPS-WG cohort. Oncol Res Treat 2022; 45:660-669. [PMID: 35700716 DOI: 10.1159/000525288] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Health-Related Quality of Life (HRQoL) is crucial for shared decision-making. The "Patient-Reported Outcome measures in Sarcoma" (PROSa) study evaluated HRQoL in general. We evaluated the transferability of PROSa data to clinical practice for the subgroup of retroperitoneal sarcoma (RPS). METHODS To obtain a PROSa-RPS cohort we excluded patients with bone sarcomas and gastrointestinal stromal tumors from the complete PROSa-cohort (n=1113), limited tumor localization to trunk and retroperitoneum and excluded patients with metastases. We evaluated the HRQoL data of the resulting 76 patients and compared their clinical data to those of the Transatlantic Autralasian Retroperitoneal Sarcoma Working Group (TARPS-WG, n=1007). RESULTS Confidence intervals for patient sex, histological subtype (LPS vs. non-LPS), grading (G1 vs. G2/3), surgical margins (R2 vs. no R2) and perioperative chemo- and radiotherapy (yes vs. no) were overlapping in both cohorts. EORTC QLQ-C30 from RPS-PROSa patients demonstrated that two thirds had clinically relevant restrictions in physical functioning. Two thirds reported dyspnoea, followed by fatigue and pain. CONCLUSION Clinical data from RPS-PROSa patients are comparable to those of a RPS reference cohort from expert centers. We believe that HRQoL-data of RPS patients extracted from PROSa are transferable to clinical practice.
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Affiliation(s)
- Jens Jakob
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | | | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Inga Kreisel
- Department of Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Dimosthenis Andreou
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, TU Dresden, Dresden, Germany
| | | | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
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Eichler M, Singer S, Hentschel L, Richter S, Hohenberger P, Kasper B, Andreou D, Pink D, Jakob J, Grützmann R, Fung S, Wardelmann E, Arndt K, Heidt V, Bonilla SAZ, Gaidzik VI, Jambor HK, Weitz J, Schaser KD, Bornhäuser M, Schmitt J, Schuler MK. The association of Health-Related Quality of Life and 1-year-survival in sarcoma patients—results of a Nationwide Observational Study (PROSa). Br J Cancer 2022; 126:1346-1354. [PMID: 35058591 PMCID: PMC9042816 DOI: 10.1038/s41416-022-01702-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Sarcomas are rare cancers of high heterogeneity. Health-Related Quality of Life (HRQoL) has been shown to be a prognostic factor for survival in other cancer entities but it is unclear whether this applies to sarcoma patients. Patients and methods HRQoL was prospectively assessed in adult sarcoma patients from 2017 to 2020 in 39 German recruiting sites using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Vital status was ascertained over the course of 1 year. HRQoL domains were analysed by multivariable cox-regressions including clinical and socio-economic risk factors. Results Of 1102 patients, 126 (11.4%) died during follow-up. The hazard ratio (HR) for global health was 0.73 per 10-point increase (95% confidence interval (CI) 0.64–0.85). HR for the HRQoL-summary score was 0.74 (CI 0.64–0.85) and for physical functioning 0.82 (CI 0.74–0.89). There was also evidence that fatigue (HR 1.17, CI 1.10–1.25), appetite loss (HR 1.15, CI 1.09–1.21) and pain (HR 1.14, CI 1.08–1.20) are prognostic factors for survival. Conclusion Our study adds sarcoma-specific evidence to the existing data about cancer survival in general. Clinicians and care-givers should be aware of the relations between HRQoL and survival probability and include HRQoL in routine assessment.
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12
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Eichler M, Pink D, Menge F, Jakob J, Hentschel L, Richter S, Hohenberger P, Kasper B, Andreou D, Singer S, Grützmann R, Dmytrow DI, Arndt K, Tuchscherer A, Reichardt P, Ahrens M, Kunitz A, Mohm J, Bornhäuser M, Schmitt J, Schuler MK. Quality of life of GIST patients with and without current tyrosine kinase inhibitor treatment: Cross-sectional results of a German multicentre observational study (PROSa). Eur J Cancer Care (Engl) 2021; 30:e13484. [PMID: 34342924 DOI: 10.1111/ecc.13484] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/12/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We investigated the health-related quality of life (HRQoL) of patients with gastrointestinal stromal tumours (GIST). METHODS In the multicentre PROSa study, the HRQoL of adult GIST patients was assessed between 2017 and 2019 using the European Organisation for Research and Treatment of Cancer HRQoL questionnaire (EORTC QLQ-C30). We performed group comparisons and multivariate linear regressions. RESULTS Among 130 patients from 13 centres, the mean global HRQoL was 63.3 out of 100 points. Higher sores indicate better HRQoL. The highest restrictions were in emotional, social, role functioning, insomnia, fatigue, and pain. In multivariate linear regression, we found no significant differences between patients receiving tyrosine kinase inhibitor (TKI) treatment and those without TKI treatment as well as between patients treated with curative or with palliative intent. Patients who received multiple lines of TKI treatment had the most restrictions, notably in physical (unstandardized regression coefficient [B] = -15.7), role (B = -25.7), social (B = -18.4), and cognitive functioning (B = -19.7); fatigue (B = 15.93); general health (B = -14.23); and EORTC-sum score (B = -13.82) compared to all other patients. CONCLUSION The highest HRQoL restrictions were in GIST patients receiving multiple lines of TKI therapy. Underlying causes need further investigation.
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Affiliation(s)
- Martin Eichler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Daniel Pink
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany.,Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Franka Menge
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Jens Jakob
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany
| | | | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Interdisciplinary Tumour Centre, Sarcoma Unit, University Medical Center Mannheim, Mannheim, Germany
| | - Dimosthenis Andreou
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.,Department of General Orthopedics and Tumor Orthopedics, University Hospital Munster, Muenster, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Hospital Mainz, Mainz, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Karin Arndt
- German Sarcoma Foundation, Woelfersheim, Germany
| | - Armin Tuchscherer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Peter Reichardt
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Berlin Buch, Berlin, Germany
| | - Marit Ahrens
- Medical Clinic II, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Johannes Mohm
- Onkopraxis, Joint Practice for Hematology and Oncology, Dresden, Germany
| | - Martin Bornhäuser
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Jochen Schmitt
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Büttner M, Singer S, Hentschel L, Richter S, Hohenberger P, Kasper B, Andreou D, Pink D, Taylor K, Arndt K, Bornhäuser M, Schmitt J, Schuler MK, Eichler M. Financial toxicity in sarcoma patients and survivors in Germany: results from the multicenter PROSa study. Support Care Cancer 2021; 30:187-196. [PMID: 34247310 PMCID: PMC8636412 DOI: 10.1007/s00520-021-06406-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/09/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Cancer patients have been shown to frequently suffer from financial burden before, during, and after treatment. However, the financial toxicity of patients with sarcoma has seldom been assessed. Therefore, the aim of this study was to evaluate whether financial toxicity is a problem for sarcoma patients in Germany and identify associated risk factors. Methods Patients for this analysis were obtained from a multicenter prospective cohort study conducted in Germany. Using the financial difficulties scale of the EORTC QLQ-C30, financial toxicity was considered to be present if the score exceeded a pre-defined threshold for clinical importance. Comparisons to an age- and sex-matched norm population were performed. A multivariate logistic regression using stepwise backward selection was used to identify factors associated with financial toxicity. Results We included 1103 sarcoma patients treated in 39 centers and clinics; 498 (44.7%) patients reported financial toxicity. Sarcoma patients had 2.5 times the odds of reporting financial difficulties compared to an age- and sex-matched norm population. Patient age < 40 and > 52.5 years, higher education status, higher income, and disease progression (compared to patients with complete remission) were associated with lower odds of reporting financial toxicity. Receiving a disability pension, being currently on sick leave, and having a disability pass were statistically significantly associated with higher odds of reporting financial toxicity. Conclusion Financial toxicity is present in about half of German sarcoma patients, making it a relevant quality of life topic for patients and decision-makers.
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Affiliation(s)
- Matthias Büttner
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany. .,University Cancer Centre, Mainz, Germany.
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.,University Cancer Centre, Mainz, Germany
| | | | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, University Medical Center Mannheim, Mannheim, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Munster, Münster, Germany.,Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.,Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Kathy Taylor
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.,University Cancer Centre, Mainz, Germany
| | - Karin Arndt
- German Sarcoma Foundation, Woelfersheim, Germany
| | - Martin Bornhäuser
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.,Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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14
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Salm H, Hentschel L, Kramer M, Pink D, Schuler MK. Mobile and comprehensive assessment of patient-reported outcomes (PRO) in routine inpatient cancer care: A three-arm randomized controlled feasibility study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18664] [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
e18664 Background: Most of the work on PRO has been done in outpatient setting. However, cancer patients might even suffer from more severe problems when admitted to hospital for anticancer therapy. The question whether and how patients’ well-being changes during the course of the hospital stay and if electronically assessed PRO (ePRO) will bring benefit to patients and physicians remains unanswered. Implementing such a tool into routine clinical care can be considered as an additional challenge.The objectives of this study were to implement a multidimensional ePRO system to improve patient-physician interaction in inpatient cancer care and test its feasibility. A comprehensive set of PRO measures that would broadly assess the patient’s situation was developed by a multidisciplinary expert team. Before study initiation, semi-structured interviews with patients were carried out to optimize visualization and user experience. The tool included a rapid response ePRO system with a patient-tailored graphical feedback for physicians. The effect of the mobile tool on quality of life (QoL), symptom burden and patients’ satisfaction with care were explored. Methods: The study is an interventional, three-arm and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, one week after and at discharge. Group A (intervention arm) and B received tablet versions while group C (control) completed the questionnaire on paper. Additional to the mere assessment of electronic patient reported outcome, results from group A were presented graphically to the treating physicians. Standardized instruments included measures of QoL (EORTC QLQ-C30), patients’ satisfaction with care (IN-PATSAT32) and adverse events (PRO-CTCAE). A feasibility questionnaire was administered to arm A and B. Results: N = 185 patients (mean age 63.5, 44.3% female) were recruited in oncology wards. 62% of patients were treated for oncological disease (33% with stage IV disease) and 37% for hematological disease. Feasibility questions revealed that the majority of patients preferred the electronic tool and believed that the tool was of high value for individualized patient care. Among others, symptom burden and global QoL did not significantly change during hospital stay. Satisfaction with care was significantly lower ( p = 0.047) in the intervention group (mean 3.55) versus the control group (mean 3.77) with scores ranging from 0-5. Conclusions: Results indicate that the intervention is feasible. Some of the results are counterintuitive and could possibly be influenced by a lack of physician compliance due to a busy daily routine. Moreover, the optimal interval and composition of questionnaires has yet to be determined in inpatient setting.
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Affiliation(s)
- Hanna Salm
- Helios Klinikum Bad Saarow-Sarcoma Center Berlin-Brandenburg and University Medicine Greifswald, Bad Saarow, Germany
| | - Leopold Hentschel
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Michael Kramer
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Daniel Pink
- Helios Klinikum Bad Saarow-Sarcoma Center Berlin-Brandenburg and University Medicine Greifswald, Bad Saarow, Germany
| | - Markus K Schuler
- University Hospital Carl Gustav Carus, Technical University Dresden and Onkologischer Schwerpunkt am Oskar-Helene-Heim, Dresden, Germany
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15
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Eichler M, Andreou D, Golcher H, Hentschel L, Richter S, Hohenberger P, Kasper B, Pink D, Jakob J, Ashmawy H, Hettmer S, Tuchscherer A, Grube M, Heidt V, Jentsch C, Pablik J, Wardelmann E, Kreitner KF, Kneser U, Tonus C, Wimberger P, Schoffer O, Reichardt P, Wartenberg M, Eberlein-Gonska M, Bornhäuser M, Schmitt J, Schuler MK. Utilization of Interdisciplinary Tumor Boards for Sarcoma Care in Germany: Results from the PROSa Study. Oncol Res Treat 2021; 44:301-312. [PMID: 33887740 DOI: 10.1159/000516262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/10/2021] [Accepted: 03/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data on institutional structures of sarcoma care in Germany are scarce. The utilization of an interdisciplinary tumor board (IDTB) is an essential part of modern cancer care. We investigated to which extent and when IDTB are used in sarcoma care. We hypothesized that IDTB before treatment initiation were used more often at certified cancer centers and at high-volume centers and that IDTB utilization increased over time. METHODS From 2017 to 2020 we conducted a prospective cohort study, undertaking major efforts to include the whole spectrum of sarcoma treatment facilities. To analyze potential predictors of IDTB utilization, we calculated multivariable logistic regressions. RESULTS Patients and survivors (n = 1,309) from 39 study centers (22 tertiary referral hospitals, 9 other hospitals, and 8 office-based practices) participated; 88.3% of the patients were discussed at some stage of their disease in an IDTB (56.1% before treatment, 78% after therapy, and 85.9% in metastatic disease). Hypotheses were confirmed regarding the utilization of IDTB in certified cancer centers (vs. all others: OR = 5.39; 95% CI 3.28-8.85) and the time of diagnosis (2018/2019 vs. until 2013: OR = 4.95; 95% CI 2.67-9.21). CONCLUSION Our study adds to the evidence regarding the institutional structures of sarcoma care in Germany. Utilization of a tumor board before therapy seems to be in an implementation process that is making progress but is far from complete. Certification is a possible tool to accelerate this development.
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Affiliation(s)
- Martin Eichler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, Münster, Germany.,Sarcoma Center Berlin-Brandenburg, Helios Hospital, Bad Saarow, Germany
| | | | | | - Stephan Richter
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Interdisciplinary Tumor Center, Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Hospital, Bad Saarow, Germany.,Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
| | - Jens Jakob
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany
| | - Hany Ashmawy
- Clinic for General, Visceral, and Pediatric Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Simone Hettmer
- Center of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Armin Tuchscherer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Matthias Grube
- Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Vitali Heidt
- The Scientific Institute of Office-Based Hematologists and Oncologists, Cologne, Germany
| | - Christina Jentsch
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jessica Pablik
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Institute for Pathology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Eva Wardelmann
- Gerhard Domagk Institute for Pathology, University Hospital Münster, Münster, Germany
| | - Karl-Friedrich Kreitner
- Clinic and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Mainz, Mainz, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, Reconstructive and Microsurgery, BG Trauma Center Ludwigshafen and Heidelberg University, Ludwigshafen, Germany
| | - Carolin Tonus
- Clinic for General and Visceral Surgery, Asklepios Hospital St. Georg Hamburg, Hamburg, Germany
| | - Pauline Wimberger
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Clinic and Polyclinic for Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Olaf Schoffer
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Peter Reichardt
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Berlin Buch, Berlin, Germany
| | | | - Maria Eberlein-Gonska
- Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Jochen Schmitt
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Markus K Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
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16
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Schoffer O, Roessler M, Datzmann T, Andreou D, Jakob J, Eichler M, Richter S, Schuler MK, Schmitt J. Medical Care and Survival of Soft-Tissue and Bone Sarcoma Patients: Results and Methodological Aspects of a German Subnational Cohort Study Based on Administrative Healthcare Data. Oncol Res Treat 2020; 44:103-110. [PMID: 33378758 DOI: 10.1159/000513178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Medical care of soft-tissue sarcoma (STS) and bone sarcoma (BS) patients in Germany has rarely been investigated. The objectives of this article were (1) to investigate medical care and survival in STS and BS patients, and (2) to examine methodological aspects of corresponding analyses based on administrative healthcare data. METHODS We analyzed data from a statutory health insurance located in Saxony, Germany, covering approximately 2 million individuals. We identified incident STS and BS patients in the period 2012-2016 using 4 different case definitions. We examined treatment rates and visits to medical oncologists and medical practices descriptively, and then compared results between case definitions. We investigated survival prospects using a relative survival analysis and estimated hazard ratios (HRs) for risk factors for mortality using Cox regression. RESULTS Across case definitions, the number of included sarcoma patients (STS: n = 871-1,757; BS: n = 216-689) and applied treatments (STS: 42.2-83.1%; BS: 28.3-77.8%) varied substantially. Irrespective of the case definition, the minority of patients visited medical oncologists (STS: 9.8-10.8% BS: 4.4-7.9%) and "experienced" medical practices (STS: 27.7-38.4%; BS: 18.3-23.6%). Survival prospects were better for patients who visited "experienced" medical practices (STS: HR = 0.55; BS: HR = 0.42). CONCLUSION Treatment rates clearly <100% and evidence from survival analyses indicate the potential for improvements in the care of sarcoma patients in Germany, e.g., by physicians in "experienced" medical practices.
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Affiliation(s)
- Olaf Schoffer
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Martin Roessler
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany,
| | - Thomas Datzmann
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Dimosthenis Andreou
- Abteilung für Tumororthopädie und Sarkomchirurgie, Sarkomzentrum Berlin-Brandenburg, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - Jens Jakob
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Georg-August-Universität, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Martin Eichler
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC), Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Stephan Richter
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Markus K Schuler
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany.,Klinik für Onkologie, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Jochen Schmitt
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
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17
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Eichler M, Schmitt J, Schuler MK. Die Dauer von Ethikvoten in Deutschland - am Beispiel einer nicht-interventionellen Beobachtungsstudie mit 44 teilnehmenden Zentren (PROSa). Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2019; 146:15-20. [DOI: 10.1016/j.zefq.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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18
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De Giorgi U, Richard S, Badoglio M, Kanfer E, Bourrhis JH, Nicolas-Virelizier E, Vettenranta K, Lioure B, Martin S, Dreger P, Schuler MK, Thomson K, Scarpi E, Rosti G, Selle F, Mangili G, Lanza F, Bregni M. Salvage high-dose chemotherapy in female patients with relapsed/refractory germ-cell tumors: a retrospective analysis of the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol 2018; 28:1910-1916. [PMID: 28510616 DOI: 10.1093/annonc/mdx259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background High-dose chemotherapy (HDC) with hematopoietic progenitor cell transplantation is a standard option for relapsed/refractory testicular germ-cell tumor (GCT), but only few data have been reported in female patients with GCT. We conducted a retrospective analysis of female patients with GCT treated with HDC and registered with the European Society for Blood and Marrow Transplantation. Patients and methods Between 1985 and 2013, 60 registered female patients with GCT, median age 27 years (range 15-48), were treated with salvage HDC. Forty patients (67%) had primary ovarian GCT, 8 (13%) mediastinal, 7 (12%) retroperitoneal and 5 (8%) other primary sites/unknown. Twenty-two patients (37%) received HDC as second-line therapy, 29 (48%) as third-line, and 9 (15%) as fourth- to sixth-line. Nine of 60 patients (15%) received HDC as late-intensification with no evidence of metastasis before HDC. The conditioning HDC regimens comprised carboplatin in 51 of 60 cases (85%), and consisted of a single HDC cycle in 31 cases (52%), a multi-cycle HDC regimen in 29 (48%). Results Nine cases who underwent late intensification HDC were not evaluable for response. Of the other 51 assessable patients, 17 (33%) achieved a complete response (CR), 8 (16%) a marker-negative partial remission (PRm-), 5 (10%) a marker-positive partial remission, 5 (10%) stable disease, and 13 (25%) progressive disease. There were 3 toxic deaths (6%). With an overall median follow-up of 14 months (range 1-219), 7 of 9 (78%) patients with late intensification and 18 of the 25 patients (72%) achieving a CR/PRm- following HDC were free of relapse/progression. In total, 25 of 60 patients (42%) were progression-free following HDC at a median follow-up of 87 months (range 3-219 months). Conclusions Salvage HDC based on carboplatin represents a therapeutic option for female patients with relapsed/refractory GCT.
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Affiliation(s)
- U De Giorgi
- Department of Medical Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Richard
- Department of Medical Oncology, Hopital Tenon, Paris
| | | | - E Kanfer
- Department of Hematology, Imperial College, Hammersmith Hospital, London, UK
| | - J H Bourrhis
- Hematology-Marrow Transplant Service, Institute Gustave-Roussy, Villejuif
| | | | - K Vettenranta
- Department of Pediatrics, University of Helsinki, Helsinki, Finland
| | - B Lioure
- Department of Hematology/Oncology, Strasbourg University Hospital, Strasbourg, France
| | - S Martin
- Department of Internal Medicine II, Robert-Bosch-Hospital, Stuttgart
| | - P Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg
| | - M K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - K Thomson
- Department of Haematology, University College London Hospital, London, UK
| | - E Scarpi
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - G Rosti
- Department of Oncology, Policlinico San Matteo IRCCS, Pavia
| | - F Selle
- Department of Medical Oncology, Hopital Tenon, Paris
| | - G Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Milan
| | - F Lanza
- Department of Onco-Hematology, Santa Maria delle Croci Hospital, Ravenna
| | - M Bregni
- Department of Medical Oncology, Busto Arsizio Hospital, Busto Arsizio, Italy
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19
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Dittrich A, Schubert B, Kramer M, Lenz F, Kast K, Schuler U, Schuler MK. Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction. Support Care Cancer 2017; 25:2849-2856. [DOI: 10.1007/s00520-017-3700-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/31/2017] [Indexed: 11/24/2022]
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20
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Schuler MK, Hentschel L, Kisel W, Kramer M, Lenz F, Hornemann B, Hoffmann J, Richter S, Ehninger G, Bornhäuser M, Kroschinsky F. Impact of Different Exercise Programs on Severe Fatigue in Patients Undergoing Anticancer Treatment-A Randomized Controlled Trial. J Pain Symptom Manage 2017; 53:57-66. [PMID: 27744016 DOI: 10.1016/j.jpainsymman.2016.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 05/11/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022]
Abstract
CONTEXT Physical exercise can alleviate cancer-related fatigue. Randomized controlled trials in patients with advanced cancer are scarce. OBJECTIVES We test the impact of a structured, individual sports program on fatigue in patients with advanced cancer. METHODS Seventy-seven patients were invited to participate in this randomized controlled trial exploring the effects of physical exercises on fatigue 12 and 24 weeks after baseline. Patients were randomized into three groups. Group A received treatment as usual, Group B was taught a structured, individual sports program, and Group C received additional ambulatory physiotherapeutical supervision. Primary outcome was general fatigue, secondary outcomes included rate of severe general fatigue, further dimensions of the Multidimensional Fatigue Inventory (MFI), as well as walking distance. RESULTS Mean score of general fatigue as well as other MFI subdimensions differed nonsignificantly between all groups at 12 weeks. However, the mental fatigue score demonstrated a statistically significant difference between the three groups. The rate of severe general fatigue was significantly reduced within Intervention Group C. Significant longitudinal change of MFI-dimension mental fatigue was found and reached the threshold for minimal clinically important difference, while all MFI-dimensions increased in Group A. CONCLUSION Our results imply that tumor-patients' severe general fatigue can be reduced when patients conduct appropriate physical exercise. This study amends previous knowledge, as it describes the impact of outpatient physical exercise on fatigue in a heterogeneous patient cohort with various advanced cancer entities. Furthermore, this trial differentiates between patients with only a self-directed exercise program versus those receiving additional partially professional supervision.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Clinic for Internal Medicine II, HELIOS Hospital Emil von Behring, Berlin, Germany
| | - Leopold Hentschel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Wadim Kisel
- Department of Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felicitas Lenz
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Beate Hornemann
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julia Hoffmann
- University Physiotherapy Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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21
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Schuler MK, Gerdes S, West A, Richter S, Busemann C, Hentschel L, Lenz F, Kopp HG, Ehninger G, Reichardt P, Pink D. Efficacy and safety of Dexrazoxane (DRZ) in sarcoma patients receiving high cumulative doses of anthracycline therapy - a retrospective study including 32 patients. BMC Cancer 2016; 16:619. [PMID: 27507014 PMCID: PMC4977890 DOI: 10.1186/s12885-016-2654-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/10/2015] [Accepted: 07/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracyclines, as the most effective therapy, are the cornerstone of advanced stage sarcoma treatment. However, anthracyclines can also contribute to myocardial dysfunction and congestive heart failure, ultimately limiting the therapeutic potential of the drug. Coadministration of Dexrazoxane has been shown to effectively reduce cardiotoxicity, however primarily in patients suffering in diseases other than sarcoma. METHODS The aim of this retrospective analysis was to evaluate safety and efficacy of chemotherapy with high cumulative doses of anthracyclines in combination with Dexrazoxane. The medical charts of 32 patients treated in four institutions were analyzed. Reasons for coadministration were rechallenge, reaching the cumulative anthracycline dose and preexisting heart failure. RESULTS The median age was 54 years [18-68 years]. The median cumulative anthracycline dose before adding DRZ was 450 mg/m(2) and after administration of last anthracycline containing therapy 750 mg/m(2). Either during treatment or follow up, 2/27 patients (7 %) without preexisting major cardiac findings developed anthracycline-induced cardiotoxicity. The median overall survival (OS) from start of the first anthracycline containing chemotherapy was 46 months and 17 months from the initial coadministration of DRZ. At rechallenge, the median progression free survival (PFS) with DRZ was 7 months. In continuous therapy, the median PFS was 13 months from beginning of chemotherapy and 9 months from the addition of DRZ. CONCLUSION Chemotherapy with high cumulative doses of anthracyclines in addition with DRZ demonstrated a remarkable OS in these advanced disease patients. Cardiac side-effects due to high cumulative doses of anthracyclines requiring discontinuation of anthracycline treatment were rare. A PFS of 9 months from the beginning of the coadministration of DRZ indicates that continuing anthracycline therapy beyond established cumulative doses is a promising therapeutic option.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Department of Internal Medicine II, HELIOS Clinic Emil von Behring, Walterhöferstr. 11, 14165, Berlin, Germany.
| | - Sebastian Gerdes
- Institute of Medical Informatics and Biometry, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Antje West
- Department of Hematology and Oncology, HELIOS Clinic Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph Busemann
- Department of Internal Medicine C, University Hospital Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Leopold Hentschel
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Felicitas Lenz
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Hans-Georg Kopp
- Department of Internal Medicine II, University Hospital Tübingen, Eberhard Karls University Tübingen, Geissweg 3, 72076, Tübingen, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Peter Reichardt
- Department of Interdisciplinary Oncology, HELIOS Clinic Berlin-Buch, Berlin, Germany
| | - Daniel Pink
- Department of Hematology and Oncology, HELIOS Clinic Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany.,Department of Internal Medicine C, University Hospital Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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Schuler MK, Hentschel L, Göbel J, Balaian E, Hornemann B, Hoffmann J, Kramer M, Kasten P, Bornhäuser M, Ehninger G, Platzbecker U. Effects of a home-based exercise program on physical capacity and fatigue in patients with low to intermediate risk myelodysplastic syndrome-a pilot study. Leuk Res 2016; 47:128-35. [PMID: 27326698 DOI: 10.1016/j.leukres.2016.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/23/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Fatigue is a frequent and disabling symptom in myelodysplastic syndromes (MDS). There is evidence for the benefit of exercise on fatigue in haematological malignancies, but clinical trials targeting patients with MDS do not exist. METHODS A prospective, non-randomized feasibility trial was conducted to assess the safety and efficacy of a home-based exercise intervention in patients with MDS. Exercise schedule contained endurance or strength training in daily turns over 12 weeks. Outcome measures included 6-min walking distance (6-MWD), an ergometer check, strength measurement of lower limb, abdomen and back, quality of life and fatigue. RESULTS Twenty-one patients (13 male, 8 female) were included. Median age was 66 years (range 29-87). Fifteen patients (71%) continued the program till week 12 (T1), of whom eleven patients met criteria for program completion. There were no adverse events reported due to the intervention. 6-MWD significantly improved from 580m at T0 to 645m at T1 (p<0.05). Fatigue scores did not significantly change over time (MFI: 12.8 vs. 12.3 vs. 11.9; QLQ-C30 fatigue scale: 48.2 vs. 46.7 vs. 47.4). CONCLUSION These data provide evidence that an unsupervised outpatient exercise program is feasible and can improve physical capacity. Randomized, controlled studies implementing these interventions are warranted.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Clinic for Internal Medicine II, HELIOS Hospital Emil von Behring, Walterhöferstraße 11, 14165 Berlin, Germany
| | - Leopold Hentschel
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Julia Göbel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ekaterina Balaian
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Beate Hornemann
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julia Hoffmann
- University Physiotherapy Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philip Kasten
- Department of Sports Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Practice for Orthopedics and Orthopedic Surgery, Tübingen, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Uwe Platzbecker
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Schuler MK, Trautmann F, Radloff M, Schmädig R, Hentschel L, Eberlein-Gonska M, Petzold T, Vetter H, Oberlack S, Ehninger G, Schmitt J. Implementation of a mobile inpatient quality of life (QoL) assessment for oncology nursing. Support Care Cancer 2016; 24:3391-9. [PMID: 26984243 DOI: 10.1007/s00520-016-3163-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE Cancer patients suffer from a variety of symptoms, but little is known about changes during hospitalization and symptom burden at discharge. We implemented an electronic quality of life (QoL) assessment used by the nursing team in routine inpatient care. Feasibility, acceptance, and the course of QoL were investigated. METHODS A self-administered electronic questionnaire based on the EQ-5D and the EORTC QLQ-C30 was applied in clinical routine. Cancer patients were approached by the nursing staff to complete the QoL assessment twice, at admission and at the day of discharge. Both the feedback of the nursing staff as well as characteristics of participants were used to evaluate the electronic assessment. RESULTS Out of 210 patients from an oncologic ward, 85 patients (40 %) were invited to participate, 95 % of whom (n = 81) agreed to participate. Participation rate depended on the day of admission, the presence of the coordinating nurse, the overall morbidity assessed by patient clinical complexity level, and the patient age. Forty-six patients (56 %) asked for assistance in completing the questionnaire. Patients older than 53 years and male patients were more likely to need assistance. Twenty-two percent of the nursing staff (n = 5) use the information assessed for individual patient care. Fifty-two percent (n = 12) rated the additional workload as very little or little and 68 % (n = 15) agreed that handling for the patient was easy. Global QoL improved during the stay. Most severe symptoms at admission included fatigue, pain, appetite loss, and insomnia. CONCLUSIONS The results of this study indicate that it is feasible to implement and use an electronic QoL assessment by the nursing staff in routine inpatient cancer care. Obstacles and worries of staff members have to be considered when further developing this program.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Freya Trautmann
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany
| | - Mirko Radloff
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Roman Schmädig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Leopold Hentschel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Maria Eberlein-Gonska
- Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Thomas Petzold
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Heike Vetter
- Department of Medical Information Technology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sebastian Oberlack
- Department of Medical Information Technology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Andreou D, Werner M, Pink D, Traub F, Schuler MK, Gosheger G, Jobke B, Reichardt P, Tunn PU. Histological response assessment following neoadjuvant isolated limb perfusion in patients with primary, localised, high-grade soft tissue sarcoma. Int J Hyperthermia 2015; 32:159-64. [PMID: 26670477 DOI: 10.3109/02656736.2015.1109146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Histological response assessment following neoadjuvant treatment can help identify patients at a higher risk for systemic disease progression. Our goal was to evaluate whether mitotic count and the amount of viable tumour following neoadjuvant isolated limb perfusion (ILP) for primary, locally advanced, non-metastatic, high-grade extremity soft tissue sarcoma correlate with prognosis. PATIENTS AND METHODS This study is a retrospective analysis of 61 patients who underwent neoadjuvant ILP followed by surgical resection with curative intent between 2001 and 2011. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test. RESULTS The median follow-up was 44 months for all patients and 55 months for survivors. The amount of viable tumour after ILP had no correlation with overall (OS) (P = 0.227) or event-free (EFS) (P = 0.238) survival probability. Patients with a low mitotic count after ILP had a significantly higher OS (P < 0.001), EFS (P = 0.002) and post-relapse survival probability (P = 0.030) compared to patients with an intermediate or high mitotic count. CONCLUSIONS The mitotic count following ILP for primary, high-grade, locally advanced, non-metastatic soft tissue sarcoma appears to significantly correlate with prognosis. If these results are validated in a prospective setting, they could provide a rationale for the design of adjuvant systemic chemotherapy trials with the goal of improving the prognosis of patients with an intermediate or high mitotic count after ILP.
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Affiliation(s)
- Dimosthenis Andreou
- a Department of General Orthopaedics and Tumour Orthopaedics , Münster University Hospital , Münster , Germany .,b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany
| | - Mathias Werner
- c Department of Pathology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Emil von Behring , Berlin , Germany
| | - Daniel Pink
- d Department of Haematology , Oncology and Palliative Care, Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum , Bad Saarow , Germany
| | - Frank Traub
- b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany
| | - Markus K Schuler
- e Department of Internal Medicine II , HELIOS Klinikum Emil von Behring , Berlin , Germany
| | - Georg Gosheger
- a Department of General Orthopaedics and Tumour Orthopaedics , Münster University Hospital , Münster , Germany
| | - Björn Jobke
- f Department of Radiology , HELIOS Klinikum Berlin-Buch , Berlin , Germany , and
| | - Peter Reichardt
- g Department of Interdisciplinary Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany
| | - Per-Ulf Tunn
- b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany
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Pink D, Richter S, Gerdes S, Andreou D, Tunn PU, Busemann C, Ehninger G, Reichardt P, Schuler MK. Gemcitabine and docetaxel for epithelioid sarcoma: results from a retrospective, multi-institutional analysis. Oncology 2014; 87:95-103. [PMID: 25011671 DOI: 10.1159/000362602] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/31/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Epithelioid sarcoma (ES) presents unique clinical features in comparison to other sarcoma subtypes. Data regarding the benefits of chemotherapy are very limited. Combination regimens using gemcitabine and docetaxel (Gem/Doce) have proven to be effective, especially in uterine and nonuterine leiomyosarcoma. Yet, there is no available data on the efficacy of Gem/Doce in ES. METHODS A retrospective analysis of the three participating institutions was performed. Twenty-eight patients with an ES diagnosis presented at one of the participating institutions between 1989 and 2012. Of this group, 17 patients received chemotherapy. RESULTS Patients' median overall survival (OS) after the beginning of palliative chemotherapy was 21 months, and the 1-year OS was 87%. Twelve patients received Gem/Doce with a clinical benefit rate of 83%. The median progression-free survival (PFS) was 8 months for all patients receiving Gem/Doce. The best response was complete remission in 1 patient and partial remission in 6 patients. All 6 patients receiving Gem/Doce as a first-line treatment showed measurable responses with a median PFS of 9 months. CONCLUSIONS In this retrospective study, Gem/Doce was an effective chemotherapeutic regimen for ES. Prospective studies are needed to better assess the effects of this combination drug therapy.
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Affiliation(s)
- Daniel Pink
- Department of Interdisciplinary Oncology, Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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Link CS, Platzbecker U, Kroschinsky F, Pannach S, Thiede C, Platzek I, Ehninger G, Schuler MK. Association of Oesophageal Varices and Splanchnic Vein Thromboses in Patients with JAK2-Positive Myeloproliferative Neoplasms: Presentation of Two Cases and Data from a Retrospective Analysis. Case Rep Oncol 2013; 6:311-5. [PMID: 23898274 PMCID: PMC3725010 DOI: 10.1159/000352088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Oesophageal varices and gastrointestinal bleeding are common complications of liver cirrhosis. More rarely, oesophageal varices occur in patients with non-cirrhotic portal hypertension that results from thromboses of portal or splanchnic veins. CASE REPORT We describe 2 young men who initially presented with varices as a result of portal vein thromboses. In the clinical follow-up, both were tested positive for a JAK2 mutation and consequently diagnosed with myeloproliferative neoplasms (MPNs). In an attempt to characterise the frequency of gastrointestinal complications in patients with JAK2-positive MPNs, we retrospectively analysed all known affected patients from our clinic for the diagnosis of portal vein thromboses and oesophageal varices. Strikingly, 48% of those who had received an oesophagogastroduodenoscopy had detectable oesophageal or gastric varices, and 82% of those suffered from portal or splanchnic vein thromboses. CONCLUSION While the association between JAK2, myeloproliferative disease and thrombotic events is well established, patients with idiopathic oesophageal varices are not regularly tested for JAK2 mutations. However, the occurrence of oesophageal varices may be the first presenting symptom of a MPN with a JAK2 mutation, and affected patients may profit from a close haematological monitoring to assure the early detection of developing MPN.
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Affiliation(s)
- Cornelia S Link
- Departments of Medicine I, Dresden Technical University, Dresden, Germany
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Schuler MK, Kroschinsky F, Schaich M, Kalauch A, Stroszczynski C, Kellermann S, Ehninger G, Benter T. Sézary syndrome: infiltration of the gastric wall--does it matter? Ann Hematol 2012; 91:1507-9. [PMID: 22362119 DOI: 10.1007/s00277-012-1426-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 02/03/2012] [Indexed: 02/07/2023]
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Schuler MK, Sell S, Aicher WK. Protein kinase signals activate interleukin 16 encoding transcripts in rheumatoid arthritis versus osteoarthritis synovial fibroblasts. Ann Rheum Dis 2003; 62:182-3. [PMID: 12525392 PMCID: PMC1754429 DOI: 10.1136/ard.62.2.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
We report on two cases in which the differential diagnosis between an os tibiale externum (os naviculare accessorius) and a post-traumatic pseudarthrosis of the os naviculare was subject to discussion.Both patients had suffered an acute trauma in the region of the middle foot and showed identical clinical symptoms. Conventional X-ray did not allow a definite classification of the diagnosis either.However, this was possible in both cases by virtue of typical signs evidenced by computed tomography and magnetic resonance imaging.
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Parak WJ, Dannöhl S, George M, Schuler MK, Schaumburger J, Gaub HE, Müller O, Aicher WK. Metabolic activation stimulates acid production in synovial fibroblasts. J Rheumatol 2000; 27:2312-22. [PMID: 11036823] [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: 02/18/2023]
Abstract
OBJECTIVE In rheumatoid arthritis (RA), synovial fibroblasts express proteases such as collagenases or cathepsins and inflammatory cytokines at elevated levels and so contribute to the inflammatory degradation process. Extracellular matrix degradation and cathepsin activity is dependent upon the presence of an acidic milieu. We examined whether activated synovial fibroblasts secrete acidic components. METHODS Synovial fibroblasts were isolated and immortalized to study the mechanisms of metabolic activation. Naïve and immortalized fibroblasts were activated with different cytokines. The responses were investigated by immunoblot to detect Egr-1 and by a cytosensor microphysiometer analysis to evaluate acid secretion. Basic gene expression patterns were investigated in naïve and immortalized cells by RT-PCR analysis. RESULTS We found RA synovial fibroblasts respond to different cytokines associated with the pathomechanisms of RA including interleukin 1, basic fibroblast growth factor, platelet derived growth factor, and tumor necrosis factor-alpha, with metabolic activation and enhanced secretion of acidic components. In addition, naive and SV40 TAg immortalized fibroblasts rapidly release acidic components after stimulation with phorbol ester or ionomycin as well. CONCLUSION Activated synovial fibroblasts not only express inflammatory cytokines and matrix degrading proteases that are associated with the pathomechanisms of RA, but upon stimulation may release acidic components that lower pH and consequently enhance cathepsin activity and collagen solubilization.
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Affiliation(s)
- W J Parak
- Institute of Applied Physics, University of Munich, Germany
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May TB, Guikema JA, Henry RL, Schuler MK, Wong PP. Gabaculine Inhibition of Chlorophyll Biosynthesis and Nodulation in Phaseolus lunatus L. Plant Physiol 1987; 84:1309-13. [PMID: 16665603 PMCID: PMC1056770 DOI: 10.1104/pp.84.4.1309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Gabaculine (3-amino-2,3-dihydrobenzoic acid) was an inhibitor of in vivo chlorophyll biosynthesis in lima bean (Phaseolus lunatus L. cv Henderson). When applied to roots of 9-day-old plants, 10 micromolar gabaculine was sufficient to terminate biosynthesis of new chlorophyll. The trifoliolate leaves which emerged after gabaculine treatment were yellow. Gabaculine-treated plants had slightly lower dry weights; yet, overall plant size showed very little change. Chlorophyll fluorescence induction kinetics and CO(2) exchange measurements were used to monitor both immediate and long-term effects of gabaculine on photosynthesis. A lowered rate of the decline from the maximum level of fluorescence was observed after 10 hours for nitrate-supplemented plants, and all treated plants showed a slightly increased level of original fluorescence after 6 days. No change was observed in the rate of photosynthesis by unifoliolate leaves. The trifoliolate leaves, though not able to photosynthesize, were able to continue respiration. This suggested that heme biosynthesis for mitochondrial cytochromes was not abolished. In untreated lima bean, root nodules were induced by Rhizobium sp. 127E15. Following gabaculine treatment, root nodules formed, but were largely ineffective in nitrogen fixation. Nodule dry weight, nitrogen fixation activity, and leghemoglobin content were decreased by gabaculine.
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Affiliation(s)
- T B May
- Division of Biology, Kansas State University, Manhattan, Kansas 66506
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