Comparison of pre- and postoperative quality of life in elderly cancer patients

Einleitung: Die Messung der gesundheitsbezogenen Lebensqualität und der Überle-bensrate sind ein Hauptanliegen in der onkologischen Forschung [1]. Für ältere Patienten ist die Verbesserung oder der Erhalt der Lebensqualität meist entscheidender als die Verlängerung des Gesamtüberlebens [2]. Methodik: In der vorliegenden Arbeit wurde die präoperative Lebensqualität mit der postoperativen Lebensqualität bei älteren Patienten ein Jahr nach elektiver Tumorchi-rurgie verglichen. In der Zeit von Juni 2008 bis Oktober 2011 wurden Patienten über 65 Jahre in die Pilotstudie eingeschlossen, die sich aufgrund einer gastrointestinalen, pulmonalen oder urogenitalen Krebserkrankung einer Operation in der Charité Universitätsmedizin Berlin, Campus Mitte, Campus Virchow Klinikum unterzogen. Die gesundheitsbezogene Lebensqualität wurde anhand des Core 30 Fragebogen der European Organisation for Research and Treatment of Cancer (EORTC) erhoben [3]. Ergebnisse: Ein Vergleich der prä- und postoperativen Lebensqualität konnte bei 76 Patienten (45% männlich und 55% weiblich) mit einem Durchschnittsalter von 72 Jah-ren vorgenommen werden. Hinsichtlich der Tumorentitäten und Tumorstadien handelte es sich um ein heterogenes Kollektiv. Bei der globalen Lebensqualität ließ sich kein signifikanter Unterschied (p = 0,771) errechnen. Die Studienteilnehmer gaben jedoch signifikant (p < 0,001) schlechtere Werte für die physische, die kognitive, die soziale und die Rollenfunktion nach einem Jahr an. Bei den Symptomskalen zeigten sich zwölf Monate postoperativ signifikant größere Belastungen bei den Symptomen Müdigkeit (p < 0,001), Schmerz (p = 0,015), Dyspnoe (p < 0,001), Diarrhoe (p < 0,001) und finanzielle Schwierigkeiten (p = 0,001). Schlussfolgerung: Die vorliegende Arbeit macht deutlich, dass eine zufriedenstellende globale Lebensqualität nach Tumoroperation für ältere Patienten möglich ist. Aber die Patienten sind in einigen Subdomänen stärker belastet. Sinnvoll ist auch hier ein adä-quates Assessment. Besonderes Augenmerk sollte hierbei auf postoperative kognitive Störungen, Depressionen und Schmerzen gelegt werden. Zudem ist eine entsprechende (leitliniengerechte) supportive Therapie an dieser Stelle notwendig, damit die Tumortherapie nicht nur tumorspezifisch, sondern auch für jeden Patienten individuell zu einem positiven Behandlungsergebnis führt.Introduction: The measurement of health-related quality of life (HRQoL) as well as the survival rate is a major concern in oncology research [1]. Especially for older patients improving or at least maintaining the quality of life is more important than a mere pro-longation of life [2]. Methodology: In the present study, preoperative and postoperative HRQoL after one year was compared in elderly patients one year after elective cancer surgery. In the period from June 2008 to October 2011 patients over 65 years undergoing sur- gery due to gastrointestinal, pulmonary or genitourinary cancer surgery at the Charité University Medicine Berlin, Campus Mitte, Campus Virchow Klinikum were included in the study. HRQoL was assessed using the Core30 questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) [3]. Results: In 76 patients with a mean age of 72 years pre- and postoperative HRQoL could be compared (55% female and 45% male). With regard to the tumor entities and tumor stages it was a heterogeneous collective. The global quality of life score showed no significant difference (p = 0.771). However, the study participants reported significantly worse scores for physical, cognitive, social and role function after one year (p < 0.001). For the symptom scales significantly great-er loads after twelve months could be calculated in the symptoms fatigue (p < 0.001), pain (p = 0.015), dyspnea (p < 0.001), diarrhea (p < 0.001) and financial difficulties (p = 0.001). Conclusion: The present work shows that a satisfactory global quality of life after cancer surgery in elderly patients is possible. But patients are loaded heavily in some subdomains. It makes sense to use an appropriate assessment here. Particular attention should be put on postoperative cognitive disorders, depression and pain. Moreover, a (according to current guidelines) supportive therapy at this point is necessary so that the tumor therapy for each patient individually, not only tumor-specific, leads to a positive outcome

Recommendations on complementary and alternative medicine within S3 guidelines in oncology: systematic quality assessment of underlying methodology

Purpose!#!Complementary and alternative medicine (CAM) is used by about half of all patients with cancer. Guidelines are an important tool to introduce evidence-based medicine into routine cancer care. The aim of our study was to assess methodology of the statements and recommendations concerning CAM.!##!Methods!#!A systematic assessment of all S3 guidelines published until November 2018 was done. Methodology of all statements and recommendations concerning CAM which were declared as evidence-based was evaluated with respect to international standards. According to the AMSTAR-2 instrument search strategy including filters, searched databases, restrictions to the research question and description of the included studies were examined. In case of adaptations from other guidelines, all underlying guidelines were examined as well.!##!Results!#!After examining 212 guidelines, 82 evidence-based statements and recommendations regarding CAM could be identified. Four were derived by adaptation, 78 by a de-novo search. Only 11 of 78 (14%) fulfilled all assessment criteria. In 18 (19%) cases no information on search strategy was attainable in any document affiliated to the guideline, in 35 (45%) cases information on search strategy was superficial and in 54 (78%) cases the referred evidence was not presented in adequate detail.!##!Conclusions!#!Concerning CAM statements and recommendations within S3 guidelines quality of evidence processing has several shortcomings. Guideline adaptions often lack transparency and traceability

Cancer patients’ perspective on shared decision-making and decision aids in oncology

Purpose!#!Shared Decision-Making (SDM) enhances patients' satisfaction with a decision, which in turn increases compliance with and adherence to cancer treatment. SDM requires a good patient-clinician relationship and communication, patients need information matching their individual needs, and clinicians need support on how to best involve the individual patient in the decision-making process. This survey assessed oncological patients' information needs and satisfaction, their preferred information in patient decision aids (PDAs), and their preferred way of making decisions regarding their treatment.!##!Methods!#!Questionnaires were distributed among attendees of a lecture program on complementary and alternative medicine in oncology of which 220 oncological patients participated.!##!Results!#!Participants reported a generally high need for information-correlating with level of education-but also felt overwhelmed by the amount. The latter proved particularly important during consultation. Use of PDAs increased satisfaction with given information but occurred in less than a third of the cases. Most requested contents for PDAs were pros and cons of treatment options and lists of questions to ask. The vast majority of patients preferred SDM to deciding alone. None wanted their physician to decide for them.!##!Conclusions!#!There is a high demand for SDM but a lack of conclusive evidence on the specific information needs of different types of patients. Conversation between patients and clinicians needs encouragement and support. PDAs are designed for this purpose and have the potential to increase patient satisfaction. Their scarce use in consultations calls for easier access to and better information on PDAs for clinicians

The quality of German - language patient decision aids for oncological patients on the internet

Abstract Background Previous studies have already shown that decision aids are a suitable tool for patient decision-making. The aim of this work is to conduct an online search for freely available, German-language patient decision aids (PDAs) for cancer patients, followed by an assessment of their quality. For this purpose, a rating tool that is as manageable as possible was developed on the basis of already existing quality criteria. Methods A simulated patient online search was conducted via the four most frequently used search engines in Germany. A quality assessment tool was created utilizing international and national guidelines, with a focus on practicality and manageability. Subsequently, the identified PDAs were rated by 4 raters based on the rating tool. Results The number of German-language oncology PDAs is low (n = 22 of 200 URLs) with limited variability regarding rare cancers. Most originate from non-profit organizations. The overall quality is low, as indicated by an average of 57.52% of the maximum evaluation points of the developed quality assessment tool. Reference values used to assess quality were related to e.g. support/effectiveness, adaptation, layout, etc. No qualitative differences were found regarding different publishers. Quality differed between PDAs of different length, with longer PDAs achieving better results. Conclusion Overall, the supply and quality of German-language PDAs is not satisfactory. The assessment tool created in this study provides a solid, but more manageable basis, for developing and identifying high-quality PDAs. Practice implications PDAs should be increasingly used by physicians in practice. For this, a quick qualitative assessment of PDAs in everyday life must be possible. Future research has to investigate especially the aspect of the length of a PDA in more detail

Internet Information on Oral Cancer Drugs: a Critical Comparison between Website Providers

Cancer patients need access to high-quality information, when making decisions about oral cancer drugs. The internet is often used as a source of information published by highly heterogeneous providers. The objective was to evaluate the quality of website providers supplying online information about oral cancer drugs. One hundred websites were analyzed using content-related and formal criteria, selected from three existing evaluation methods used for cancer websites, for medical information (defined by the German Agency for Quality in Medicine), and for the 'fact box' tool. A web search by a patient was simulated to identify websites to evaluate. ANOVA was used to assess information provided by non-profit organizations (governmental and non-governmental), online newspapers, for-profit organizations, and private/unknown providers. Content-related quality differences were found between online newspapers and all other categories, with online newspapers ranking significantly lower than for-profit and non-profit websites. As for formal criteria, for-profit providers scored significantly lower than non-profit providers and online newspapers for the aspect of transparency. Internet information on oral cancer drugs published by non-profit organizations constitutes the best available web-based source of information for cancer patients. Health literacy and e-health literacy should be promoted in the public domain to allow patients to reliably apply web-based information. Certification should be required by law to ensure fulfillment of requirements for data reliability and transparency (authorship and funding) before health professionals recommend websites to cancer patients

Salvation Expectations of Patients of Medicine, Complementary and Alternative Medicine and Religion

Health and holistic quality of life, physical and emotional needs, somatic and spiritual aspects contain a comprehensive promise of healing. The aim of the current study is to measure the expectations of patients of medicine, alternative medicine and religion related to health and illness. The survey was carried out among 103 patients of a rural general practitioner from May to June 2013 and among 103 patients of the outpatient department for endocrinology and metabolic disease of the Jena University Hospital in 2013. All patients were asked by one interviewer (HM) on fears in relation to health/illness and expectations of help for its own life, medicine, alternative medicine and religion. The biggest fear of patients is 'being in need of help of others.' There is no significant difference between religious and non-religious patients. Overall, the expectations of medicine were significantly higher in all sectors than in alternative medicine or religion. Comparing alternative medicine and religion, the expectations of alternative medicine were significantly higher excluding consolation and inner peace. The expectations for medicine in general and for the physician are very high and comprehensive and go beyond diagnosis and realization of therapies. Patients expect hope, guidance, support, comfort, inner peace and advice most from medicine. This results in considerable challenges for the physician, especially in a healthcare system with limited resources and without suitable offers. There is an urgent need to integrate these requirements into daily routine