Rehabilitación de los deterioros inducidos por la terapia en pacientes con cáncer de mama

Among various side effects of adjuvant chemotherapy neuropsychological deficits have been described within the last two decades. A literature review shows that especially breast cancer women after adjuvant chemotherapy are suffering from these deficits. Against this background the need for special rehabilitation programms has been discussed to help the patients to cope with this sequelae, but there are only few attempts for special neuropsychological training programms for cancer patient. In the study presented we compared two types of neuropsychological interventions in a rehab setting against a control group with no specific training in a total of 96 female in-patients undergoing inpatient oncological rehabilitation. Most results of a comprehensive neuropsychological test battery improved significantly during the patients’ oncological rehabilitation in all three groups, whereas we could not identify a specific intervention effect neither between the two intervention groups nor between the treatment and control groups. In terms of the follow-up examination we found that clinically relevant neuropsychological deficits were still evident 6 months later in a small subgroup of patientsdéficits neuropsicológicos se han descrito en las últimas dos décadas entre varios de los efectos secundarios de la quimioterapia adyuvante. Una revisión de la literatura muestra especialmente que las mujeres con cáncer de mama después de la quimioterapia adyuvante sufren de este déficit. En este contexto se ha discutido la necesidad de programas de rehabilitación especiales para ayudar a las pacientes a hacer frente a estas secuelas, pero hay sólo unos pocos intentos de programas de entrenamiento neuropsicológico para pacientes con cáncer. En el presente estudio se compararon dos tipos de intervenciones neuropsicológicas en un centro de rehabilitación con un grupo control sin entrenamiento específico, con un total de 96 mujeres hospitalizadas realizando rehabilitación oncológica. La mayoría de los resultados de una batería neuropsicológica compresiva mejoraban significativamente durante la rehabilitación oncológica de las pacientes en los tres grupos, mientras que no se pudo identificar un efecto de la intervención específica ni entre los dos grupos de intervención, ni entre los grupos tratamiento y control. En cuanto a los exámenes de seguimiento se encontró que los déficits neuropsicológicos clínicamente relevantes seguían siendo evidentes seis meses más tarde en un pequeño subgrupo de pacientes

Chemotherapy-induced peripheral neuropathy in cancer patients : a four-arm randomized trial on the effectiveness of electroacupuncture

Purpose. Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dose-limiting side effect of cytostatic drugs. Since there are no proven therapeutic procedures against CIPN, we were interested to define the role of electroacupuncture (EA) from which preliminary data showed promising results. Methods. In a randomized trial with a group sequential adaptive design in patients with CIPN, we compared EA (LV3, SP9, GB41, GB34, LI4, LI11, SI3, and HT3; n=14) with hydroelectric baths (HB, n=14), vitamin B1/B6 capsules (300/300 mg daily; VitB, n=15), and placebo capsules (n=17). The statistical power in this trial was primarily calculated for proving EA only, so results of HB and VitB are pilot data. Results. CIPN complaints improved by 0.8 +- 1.2 (EA), 1.7 +- 1.7 (HB), 1.6 +- 2.0 (VitB), and 1.3 +- 1.3 points (placebo) on a 10-point numeric rating scale without significant difference between treatment groups or placebo. In addition no significant differences in sensory nerve conduction studies or quality of life (EORTC QLQ-C30) were found. Conclusions. The used EA concept, HB, and VitB were not superior to placebo. Since, contrary to our results, studies with different acupuncture concepts showed a positive effect on CIPN, the effect of acupuncture on CIPN remains unclear. Further randomized, placebo controlled studies seem necessary. This trial is registered with DRKS00004448

Rehabilitation of therapy-related cognitive deficits in patients with breast cancer

Among various side effects of adjuvant chemotherapy neuropsychological deficits have been described within the last two decades. A literature review shows that especially breast cancer women after adjuvant chemotherapy are suffering from these deficits. Against this background the need for special rehabilitation programms has been discussed to help the patients to cope with this sequelae, but there are only few attempts for special neuropsychological training programms for cancer patient. In the study presented we compared two types of neuropsychological interventions in a rehab setting against a control group with no specific training in a total of 96 female in-patients undergoing inpatient oncological rehabilitation. Most results of a comprehensive neuropsychological test battery improved significantly during the patients’ oncological rehabilitation in all three groups, whereas we could not identify a specific intervention effect neither between the two intervention groups nor between the treatment and control groups. In terms of the follow-up examination we found that clinically relevant neuropsychological deficits were still evident 6 months later in a small subgroup of patient

Cancer Rehabilitation Indicators for Europe

Little is known of cancer rehabilitation needs in Europe. EUROCHIP-3 organised a group of experts to propose a list of population-based indicators used for describing cancer rehabilitation across Europe. The aim of this study is to present and discuss these indicators. A EUROCHIP-3 expert panel reached agreement on two types of indicators. (a) Cancer prevalence indicators. These were proposed as a means of characterising the burden of cancer rehabilitation needs by time from diagnosis and patient health status. These indicators can be estimated from cancer registry data or by collecting data on follow-up and treatments for samples of cases archived in cancer registries. (b) Indicators of rehabilitation success. These include: return to work, quality of life, and satisfaction of specific rehabilitation needs. Studies can be performed to estimate these indicators in individual countries, but to obtain comparable data across European countries it will be necessary to administer a questionnaire to randomly selected samples of patients from population-based cancer registry databases. However, three factors complicate questionnaire studies: patients may not be aware that they have cancer; incomplete participation in surveys could lead to bias; and national confidentiality laws in some cases prohibit cancer registries from approaching patients. Although these studies are expensive and difficult to perform, but as the number of cancer survivors increases, it is important to document their needs in order to provide information on cancer control

KOKON: A Germany-Wide Collaborative Research Project to Identify Needs, Provide Information, Foster Communication and Support Decision-Making about Complementary and Alternative Medicine in Oncology

Background: The German Cancer Aid set up a priority research programme with the intention to generate high-quality information based on evidence and to make this information easily accessible for health-care professionals and advisors, researchers, patients, and the general public. Summary: The Kompetenznetz Komplementärmedizin in der Onkologie (KOKON) received 2 funding periods within this programme. During the first funding period, KOKON assessed patients’ and health-care professionals’ informational needs, developed a consulting manual for physicians, developed an education programme for self-help groups, set up a knowledge database, and developed a pilot information website for patients. Funding period 2 continues with work that allows cancer patients and health-care professionals to make informed decisions about complementary and alternative medicine (CAM). For this aim, KOKON evaluates training programmes for physicians (oncology physicians, paediatric oncologists, and general practitioners) and for self-help groups. All training programmes integrate results from an analysis of the ethical, psychological, and medical challenges of CAM in the medical encounter, and the knowledge database is being extended with issues related to CAM for supportive and palliative care. Key Message: A Germany-wide collaborative research project to identify needs, provide information, foster communication, and support decision-making about CAM in oncology is being set up

Kompetenznetz Komplementärmedizin in der Onkologie (KOKON)

Für viele Krebspatienten und ihr soziales Umfeld spielt der Umgang mit dem Thema Komplementärmedizin eine wichtige Rolle. Das Kompetenznetz Komplementärmedizin in der Onkologie (KOKON) ist ein von der Deutschen Krebshilfe geförderter deutschlandweiter interdisziplinärer Forschungsverbund von Experten aus akademischen Einrichtungen. Es möchte zur Professionalisierung von Informationen zur Komplementärmedizin in der Onkologie und von Trainings zur Weitergabe dieser Informationen beitragen. Damit soll die Entwicklung hin zu einer sinnvollen und praktisch umsetzbaren integrativen Onkologie unterstützt werden. In der ersten Förderphase von KOKON (2012–2015) haben 15 Institutionen in 7 Projekten den Bedarf und die nutzerspezifischen Bedürfnissen evaluiert, Informationsstandards, Kommunikations- und Beratungskonzepte, Fachinformationen und Trainingsangebote entwickelt sowie eine Informationsplattform für Patienten pilotiert. Aus den Ergebnissen der ersten Förderphase wurden Fragestellungen für die zweite Förderphase (2016–2019) entwickelt, die von 20 Institutionen in 7 Projekten bearbeitet werden. Schwerpunkt sind die Entwicklung, Implementierung und Evaluierung von Trainingsprogrammen für onkologisch tätige Ärzte, Hausärzte und Kinderonkologen. Auch die Wissensbasis wird weiter ausgebaut, ferner werden Aspekte der Kommunikations- und Entscheidungsfindung bearbeitet und erweiterte Projekte mit der Selbsthilfe durchgeführt

Cancer rehabilitation indicators for Europe

Little is known of cancer rehabilitation needs in Europe. EUROCHIP-3 organised a group of experts to propose a list of population-based indicators used for describing cancer rehabilitation across Europe. The aim of this study is to present and discuss these indicators. A EUROCHIP-3 expert panel reached agreement on two types of indicators. (a) Cancer prevalence indicators. These were proposed as a means of characterising the burden of cancer rehabilitation needs by time from diagnosis and patient health status. These indicators can be estimated from cancer registry data or by collecting data on follow-up and treatments for samples of cases archived in cancer registries. (b) Indicators of rehabilitation success. These include: return to work, quality of life, and satisfaction of specific rehabilitation needs. Studies can be performed to estimate these indicators in individual countries, but to obtain comparable data across European countries it will be necessary to administer a questionnaire to randomly selected samples of patients from population-based cancer registry databases. However, three factors complicate questionnaire studies: patients may not be aware that they have cancer; incomplete participation in surveys could lead to bias; and national confidentiality laws in some cases prohibit cancer registries from approaching patients. Although these studies are expensive and difficult to perform, but as the number of cancer survivors increases, it is important to document their needs in order to provide information on cancer control. © 2012 Elsevier Ltd. All rights reserved

Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer