Evaluating the use of prostate-specific antigen as an instrument for early detection of prostate cancer beyond urologists: Results of a representative cross-sectional questionnaire study of general practitioners and internal specialists

OBJECTIVES The aim of this cross-sectional study was to evaluate the value of prostate-specific antigen (PSA) testing as a tool for early detection of prostate cancer (PCa) applied by general practitioners (GPs) and internal specialists (ISs) as well as to assess criteria leading to the application of PSA-based early PCa detection. METHODS Between May and December 2012, a questionnaire containing 16 items was sent to 600 GPs and ISs in the federal state Brandenburg and in Berlin (Germany). The independent influence of several criteria on the decision of GPs and ISs to apply PSA-based early PCa detection was assessed by multivariate logistic regression analysis (MLRA). RESULTS 392 evaluable questionnaires were collected (return rate 65%). 81% of the physicians declared that they apply PSA testing for early PCa detection; of these, 58 and 15% would screen patients until the age of 80 and 90 years, respectively. In case of a pathological PSA level, 77% would immediately refer the patient to a urologist, while 13% would re-assess elevated PSA levels after 3-12 months. Based on MLRA, the following criteria were independently associated with a positive attitude towards PSA-based early PCa detection: specialisation (application of early detection more frequent for GPs and hospital-based ISs) (OR 3.12; p < 0.001), physicians who use exclusively GP or IS education (OR 3.95; p = 0.002), and physicians who recommend yearly PSA assessment after the age of 50 (OR 6.85; p < 0.001). CONCLUSIONS GPs and ISs frequently apply PSA-based early PCa detection. In doing so, 13% would initiate specific referral to a urologist in case of pathological PSA values too late. Improvement of this situation could possibly result from specific educational activities for non-urological physicians active in fields of urological core capabilities, which should be guided by joint boards of the national associations of urology and general medicine

Patientenwissen nach dem Aufklärungsgespräch zur radioonkologischen Behandlung unter Berücksichtigung der Lebensqualität

Zielsetzung: Das Ziel dieser Studie war es, die Patienteninformiertheit nach dem Aufklärungsgespräch zur radioonkologischen Behandlung unter Einbeziehung von Zufriedenheit, Angst und Depressivität sowie des Gesundheitsverhaltens zu untersuchen. Die Perspektive der Studienärztinnen komplettierte die Analyse. Material/Methoden: Es wurden 60 Patienten unterschiedlicher Tumorentitäten befragt, die zu einer radioonkologischen Therapie aufgeklärt worden waren. Dies erfolgte zu 3 Zeitpunkten (zu Beginn [A], zum Ende [B] des Bestrahlungszeitraums und zur Nachsorge, 6 Wochen nach Ende der Bestrahlung [C]). Die aufklärenden Ärztinnen wurden im Anschluss an das Aufklärungsgespräch bezüglich der Charakterisierung der Gespräche und zu den vermittelten Aufklärungsinhalten befragt. Verwendung fanden selbst konzipierte Fragebögen und der „Hospital anxiety and depression scale“ (HADS - Bogen). Ergebnisse: Das Arztgespräch war die Hauptquelle für Informationen. Es zeigte sich eine sehr gute Gesamtinformiertheit zu allen Zeitpunkten. Das Wissen zu den Nebenwirkungen war nur befriedigend (3 Punkte). Die Palliativpatienten waren zum Therapieziel schlecht informiert (palliativ: 1 Punkt vs. kurativ: 5 Punkte). Ältere Patienten (> 56 Jahre) und Patienten ohne Schulabschluss zeigten eine geringere Informiertheit. Eine höhere Anzahl an Informationsquellen steigerte die Informiertheit. Die Zufriedenheit sank unter Therapie ab. Palliativpatienten zeigten geringeres emotionales und körperliches Wohlbefinden. Jüngere Patienten (< 56 Jahre) machten sich mehr Sorgen über die Zukunft. Diese Sorgen beeinträchtigten auch die Informiertheit. Ausführliche Erklärungen, z.B. zur Prognose und zum Bestrahlungsablauf steigerten die Zufriedenheit und reduzierten Angst und Depressivität. Besonders bei Palliativpatienten und bei älteren Patienten waren vermehrt Hinweise auf Angst und Depressivität zu finden. Im Laufe der Therapie verminderte sich der Anteil von Patienten mit Angst und Depressivität. Das Gesundheitsverhalten war gut. Während Frauen ein gutes Gesundheitsverhalten zeigten, neigten Männer zu vermehrtem Alkohol- und Tabakkonsum. Die Gespräche wurden von den Studienärztinnen positiv bewertet. Ausgeglichene Gesprächsanteile steigerte die Informiertheit der Patienten. Schlussfolgerung: Das Berücksichtigen einer bio-psycho-sozialen Sichtweise im ärztlichen Aufklärungsgespräch bildet die Grundlage für das Funktionieren einer partizipativen Entscheidungsfindung. Das persönliche Arzt-Patienten-Gespräch stellt die beste Möglichkeit dar, Informationen zu vermitteln, Sorgen und Ängste abzubauen und auf bevorstehende Nebenwirkungen vorzubereiten. Vor diesem Hintergrund erscheint eine standardmäßige Erhebung von Angst und Depressivität in Bereichen mit schwierigen und umfassenden Aufklärungsgesprächen als sinnvoll

Influence of Gender and Age on the Willingness to Reduce Nicotine Consumption—Results of a Survey in Urological Cancer Patients (KRAUT Study)

Although it is well-known that smoking can cause lung cancer, the relationship between smoking and urologic cancers seems not as obvious and awareness is not widespread in the general population. For the KRAUT (knowledge of the relation between smoking and urological tumors among patients with a urological tumor disease) study, 258 patients with the diagnosis of urological cancer were interviewed using a questionnaire. Most (72.1%) stated that they never had a conversation regarding this topic with any doctor. Educational work in this field should be intensified to reduce the development and progression of urologic cancer. Purpose: Our objective was to investigate whether patients with urologic tumors were aware of smoking as a risk factor for the development and progression of several urologic cancers and the extent of the medical education they had received. Another aim was to investigate whether gender or age influenced patients' willingness to change their smoking habits. Materials and Methods: Patients with histologically malignant urologic tumors were enrolled in our questionnaire-based study from September 2013 to December 2014 in 2 urology departments. Patients were asked about their smoking habits and their general understanding of the relationship between smoking and the onset of cancer (urologic cancer and lung cancer). Also, the extent of information they had acquired from a physician was assessed. The descriptive and oncologic data of the patients were recorded. Results: Of 258 enrolled patients, 186 (72.1%) had never had an informational discussion with a doctor about smoking and their urologic tumor disease. Of the 160 active and former smokers, only 45 (28.1%) were planning to stop or reduce smoking because of their tumor disease. The willingness to change smoking habits was greater for women, with a statistically significant difference (odds ratio, 5.59; P = .002). Younger patients aged <58 years were also more willing to reduce or stop smoking. Conclusion: In our study, most patients with urologic cancer were unaware of smoking as the most probable cause of tumor development. The patients had not received proper counseling from doctors on smoking and the risk it poses for tumor progression. Efforts to balance compliance among the genders and age groups through risk-adapted counseling should be undertaken. (C) 2018 Elsevier Inc. All rights reserved

What do patients with urothelial cancer know about the association of their tumor disease with smoking habits? Results of a German survey study

Purpose: Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods: Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results: The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions: The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care