Methoden zum Vergleich von Pflegebedürftigkeit : eine Gegenüberstellung von Bundesländern unter der Verwendung von Raumkategorien

Im Rahmen der Sozialen Pflegeversicherung werden routinemäßig Leistungsdaten (beantragte Leistungen, begutachtete Pflegestufe) erhoben, mit denen sich die räumliche Verteilung von Pflegebedürftigkeit beschreiben läßt. Mittels verschiedener Raumkategorien (ländliche, urbane,suburbane Räume), die der offiziellen Raumplanung entliehen sind, werden Methoden entwickelt, die einen Vergleich der Pflegesituationen zwischen den Bundesländern verbessern sollen. Hypothese: Die Pflegebedürftigkeit variiert in Antragstellung und Pflegestufenverteilung innerhalb einer Raumkategorie über die Bundesländer weniger stark als innerhalb eines Landes über die Raumkategorien. Diese Hypothese wird auf zwei Arten überprüft. Zum einen wird nach Unterschieden zwischen den Ländern jeweils innerhalb einer Raumkategorie und zum zweiten nach räumlichen Mustern jeweils innerhalb eines Landes gesucht. Ergebnisse: Der Einfluß des Bundeslandes auf die Ergebnisse ist stärker als vermutet. Nach der Eliminierung des Landeseffektes zeigen sich in allen untersuchten Bundesländern gleiche räumliche Muster

Different Aspects of Self-Reported Quality of Life in 450 German Melanoma Survivors

Abstract: The present study was aimed at assessing quality of life (QoL) in a total of 450 melanoma patients who filled out the EORTC QLQ-C30 (Q1; 15 months post diagnosis) as part of the OVIS Study. Follow-up questionnaires (Q2) were administered two years after Q1. The analyses presented herein were based on the following assumptions: QoL of melanoma patients is worse than that of a German reference population. Further, both tumor location and tumor stage have an influence on self-reported QoL, with patients with tumors located on face, head, neck, and advanced tumor stage (T3/T4) reporting the worst QoL levels. Finally, patients' QoL improves over time based on the theory of disease adaptation. In contrast to the above assumptions, with the exception of global health/QoL scores, differences between OVIS and the reference population were below the minimal clinical important difference of ten points. Furthermore, no clinically meaningful differences were found between patients after stratifying our data by tumor location and tumor stage. Finally, no clinically relevant changes were seen between Q1 and Q2 across all scales of the EORTC QLQ-C30. However, when data were stratified by patients with stable disease versus those with OPEN ACCESS Cancers 2011, 3 2317 progression, clinically relevant differences were found between Q1 and Q2 predominantly in women in the latter group regarding emotional function, insomnia, dyspnoea, and fatigue. The lack of clinically meaningful differences across strata (tumor location; tumor stage), time, and patients compared to a reference population is surprising. However, it is possible that the instrument used, a generic QoL instrument, is generally not sensitive enough to detect differences in melanoma patients. Our findings may further be explained by the fact that all patients included in our sample had been diagnosed well before Q1, i.e., main illness adaptation processes may have occurred before study entry

Different aspects of self-reported quality of life in 450 German melanoma survivors

The present study was aimed at assessing quality of life (QoL) in a total of 450 melanoma patients who filled out the EORTC QLQ-C30 (Q1; 15 months post diagnosis) as part of the OVIS Study. Follow-up questionnaires (Q2) were administered two years after Q1. The analyses presented herein were based on the following assumptions: QoL of melanoma patients is worse than that of a German reference population. Further, both tumor location and tumor stage have an influence on self-reported QoL, with patients with tumors located on face, head, neck, and advanced tumor stage (T3/T4) reporting the worst QoL levels. Finally, patients\u27 QoL improves over time based on the theory of disease adaptation. In contrast to the above assumptions, with the exception of global health/QoL scores, differences between OVIS and the reference population were below the minimal clinical important difference of ten points. Furthermore, no clinically meaningful differences were found between patients after stratifying our data by tumor location and tumor stage. Finally, no clinically relevant changes were seen between Q1 and Q2 across all scales of the EORTC QLQ-C30. However, when data were stratified by patients with stable disease versus those with progression, clinically relevant differences were found between Q1 and Q2 predominantly in women in the latter group regarding emotional function, insomnia, dyspnoea, and fatigue. The lack of clinically meaningful differences across strata (tumor location; tumor stage), time, and patients compared to a reference population is surprising. However, it is possible that the instrument used, a generic QoL instrument, is generally not sensitive enough to detect differences in melanoma patients. Our findings may further be explained by the fact that all patients included in our sample had been diagnosed well before Q1, i.e., main illness adaptation processes may have occurred before study entry

The population-based oncological health care study OVIS – recruitment of the patients and analysis of the non-participants

<p>Abstract</p> <p>Background</p> <p>The ageing of the population is expected to bring an enormous growth in demand for oncological health care. In order to anticipate and respond to future trends, cancer care needs to be critically evaluated. The present study explores the possibility of conducting representative and population-based research on cancer care on the basis of data drawn from the Cancer Registry.</p> <p>Methods</p> <p>A population-based state-wide cohort study (OVIS) has been carried out in Schleswig-Holstein, Germany. All patients with malignant melanoma, breast, or prostate cancer were identified in the Cancer Registry. Epidemiological data were obtained for all the patients and screened for study eligibility. A postal questionnaire requesting information on diagnosis, therapy, QoL and aftercare was sent to eligible patients.</p> <p>Results</p> <p>A total of 11,489 persons diagnosed with the cancer types of interest in the period from January 2002 to July 2004 were registered in the Cancer Registry. Of the 5,354 (47%) patients who gave consent for research, 4,285 (80% of consenters) completed the questionnaire. In terms of relevant epidemiological variables, participants with melanoma were not found to be different from non-participants with the same diagnosis. However, participants with breast or prostate cancer were slightly younger and had smaller tumours than patients who did not participate in our study.</p> <p>Conclusion</p> <p>Population-based cancer registry data proved to be an invaluable resource for both patient recruitment and non-participant analysis. It can help improve our understanding of the strength and nature of differences between participants and non-respondents. Despite minor differences observed in breast and prostate cancer, the OVIS-sample seems to represent the source population adequately.</p

Research with cancer registries—what is and is not (yet) possible?

Hintergrund Eine der Aufgaben der Landeskrebsregister ist die Bereitstellung von Daten für Forschung oder eigene Forschung. Daten werden im Krebsregister nicht primär für Forschung, sondern mit Meldepflicht und ohne Einwilligung der Betroffenen für die Erfüllung gesetzlicher Aufgaben erhoben. Sind Daten der Krebsregister für Forschung sinnvoll nutzbar, werden sie genutzt und welche Rahmenbedingungen zur Datennutzung sollten nachgebessert werden? Methoden Mittels PubMed®-Recherche wurde die Nutzung von Krebsregisterdaten in wissenschaftlichen Publikationen für Deutschland und für das US-SEER-Programm (Surveillance, Epidemiology, and End Results Program) ermittelt. Aus Landes- und Bundesgesetzen wurden Möglichkeiten zur Datennutzung ermittelt. Ergebnisse Für Deutschland wurden 2268 Artikel mit Krebsregisterdaten identifiziert, für 2022 etwa 250 Publikationen. Aus dem US-SEER-Programm gehen derzeit über 1500 Publikationen pro Jahr hervor. Aus den Krebsregistergesetzen wurden folgende wesentliche Nutzungsarten identifiziert: Bereitstellung und Nutzung von aggregierten und Einzelfalldaten, Kontaktierung von Krebserkrankten aus dem Registerbestand und Abgleich bestehender Kohorten mit dem Krebsregister. Während sich aggregierte und Einzelfalldaten i. d. R. mittels standardisierten Formulars beantragen lassen, erfordern die andern Nutzungsarten übliche wissenschaftliche Anträge mit Ethikvotum und ggf. weiteren Genehmigungen. Ausgewählte Praxisbeispiele zeigen die verschiedenen Nutzungsarten. Schlussfolgerung Die steigende Zahl an Publikationen belegt eine rege Forschungsnutzung. Dennoch ist in Deutschland das Potenzial nicht ausgereizt. Bundesländerübergreifende Projekte mit Verlinkung zu anderen Daten sind sehr aufwendig oder wegen bürokratischer Hürden oft nicht realistisch durchführbar. Mit Projekten und Gesetzesinitiativen wird derzeit versucht, solche Datennutzungen zu vereinfachen.Background One of the tasks of state cancer registries is to provide data for research or one’s own research. Data is not collected in the cancer registry primarily for research, but with mandatory reporting and without the consent of the persons concerned for the fulfilment of legal tasks. Can data from cancer registries be meaningfully used for research, are they used and which framework conditions for data use should be improved? Methods Using PubMed®, the use of cancer registry data in scientific publications was determined for Germany and for the US Surveillance, Epidemiology, and End Results (SEER) program. Possibilities for data use were identified from state and federal laws. Results For Germany, 2268 articles with cancer registry data were identified with about 250 publications in 2022. The US SEER program currently produces over 1500 publications per year. The following main types of use were identified from the cancer registry laws: provision and use of aggregated and individual case data, contacting cancer patients from the registry population, and matching existing cohorts to the cancer registry. While aggregated and individual case data can usually be applied for using standardized forms, other types of use require standard scientific applications with an ethics vote and, if necessary, further approval. Selected practical examples show the different types of use. Conclusion The increasing number of publications is evidence of lively research use. Nevertheless, the potential in Germany has not been exhausted. Projects across federal states with links to other data are very time-consuming or often not realistically feasible due to bureaucratic hurdles. Attempts are currently being made with projects and legislative initiatives to simplify use of such data.Peer Reviewe

Recent Trends in Breast Cancer Incidence and Mortality in Germany

BACKGROUND: Breast cancer is the most common cancer among women in Germany with high public health impact. In the last decade rapid changes in risk factor patterns, early breast cancer detection, and therapy have taken place. Their effects on breast cancer epidemiology in Germany are described. MATERIALS AND METHODS: A register-based survey using recent incidence data from German cancer registries was performed. Mortality data were provided by the Central Federal Statistical Office. We calculated age-standardized rates and 5- and 10-year trends. RESULTS: Breast cancer incidence increased until the year 2002, thereafter a discreet decline occurred until 2005 (−6.8%). In the age group 50–59 years this reduction was most pronounced (−12%). Mortality declined from 1996/7 to 2004/5 by 19%, with the strongest effect in women younger than 55 years (approximately 30%). Regional patterns of breast cancer incidence and mortality revealed differences within Germany of greater than 30%. CONCLUSION: Declining hormone replacement therapy prescription is the most likely factor to explain the drop in breast cancer incidence. The reduction in mortality might be caused by better therapy and enhanced early detection during the last decade. Differences in breast cancer incidence and mortality between Eastern and Western Germany give reason for further research and discussion

Colorectal Cancer Survival in German–Danish Border Regions—A Registry-Based Cohort Study

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German–Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan–Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014–2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts

Oral cancer awareness campaign in Northern Germany: first positive trends in incidence and tumour stages

Purpose!#!Oral cancer is a still underestimated public health problem. In Germany, until 2007, there was no systematic approach available for the purpose of raising the awareness of the public. From 2007 to 2011, a concept was developed for such an approach, and the campaign was launched in Northern Germany in 2012, and concluded in 2014. This report aims at presenting incidence trends of oral cancer, stratified according to sex, age, and tumour stages, before the introduction of this campaign and upon completion thereof.!##!Methods!#!The data kept by the Schleswig-Holstein Cancer Registry on incidence rates (ICD-10, C00-C14) focused on oral cancer (C00-C06) and stratified by sex, age-groups and tumour stages, from 2000 to 2006 and from 2007 to 2014.!##!Results!#!From 2000 to 2014, a total of 6760 cases of oral and pharyngeal cancer (C00-C14) were registered. When data on oral cancer was taken into account, stage I cancers of women in particular, increased over time. Regarding the stages, stage IV was the most frequent and stage I the second most frequent stage for both men and women. Over time, a small shift towards detection of tumours at earlier stages was observed.!##!Conclusion!#!A slight trend towards a temporary increase in incidence rates, especially among women, was observed. From an epidemiological point of view, this might indicate the initial success of this campaign. The slight trend in favour of stage I tumours could be seen as an initial minor success in terms of the early detection of oral cancer