Survivorship - lebenslange Begleitung von Krebspatienten

Survivorship - lebenslange Begleitung von Krebspatiente

The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care

The original publication is available at http://www.samj.org.zaBackground. There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. Objectives. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). Methods. We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of highperformance liquid chromatography. Results. The therapeutic maximum plasma concentration (Cmax) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic Cmax for isoniazid. No patient reached sub-therapeutic Cmax for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic Cmax for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). Conclusions. A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with ‘sub-therapeutic’ rifampicin concentrations.Publishers' Versio

The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care

Background. There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. Objectives. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). Methods. We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of high-performance liquid chromatography. Results. The therapeutic maximum plasma concentration (Cmax) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic Cmax for isoniazid. No patient reached sub-therapeutic Cmax for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic Cmax for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). Conclusions. A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with ‘sub-therapeutic’ rifampicin concentrations

Surfactant protein B gene variations enhance susceptibility to squamous cell carcinoma of the lung in German patients

Genetic factors are thought to influence the risk for lung cancer. Since pulmonary surfactant mediates the response to inhaled carcinogenic substances, candidate genes may be among those coding for pulmonary surfactant proteins. In the present matched case–control study a polymorphism within intron 4 of the gene coding for surfactant specific protein B was analysed in 357 individuals. They were divided into 117 patients with lung cancer (40 patients with small cell lung cancer, 77 patients with non small cell lung cancer), matched controls and 123 healthy individuals. Surfactant protein B gene variants were analysed using specific PCR and cloned surfactant protein B sequences as controls. The frequency of the intron 4 variation was similar in both control groups (13.0% and 9.4%), whereas it was increased in the small cell lung cancer group (17.5%) and the non small cell lung cancer group (16.9%). The gene variation was found significantly more frequently in patients with squamous cell carcinoma (25.0%, P=0.016, odds ratio=3.2, 95%CI=1.24–8.28) than in the controls. These results indicate an association of the surfactant protein B intron 4 variants and/or its flanking loci with mechanisms that may enhance lung cancer susceptibility, especially to squamous cell carcinoma of the lung

Improving the quality of life and recurrence-free survival in cancer patients. How does sport work? Hypothesis development

Actually we have to consider, that activity or sport of tumor patients will have a positive effect on the prognosis of their illness, while the mechanism of action is poorly understood. In the literature few explanations are discussed in the moment. One of them is the role of insulin growth factor (IGF-1), the activation of brain derived neurotropic brain factor (BDNF) or weight reduction. Another explanation may be the better social reintegration of tumor patients due to their sport activity. All this factors are discussed in the article, while none of them is able to explain the effect of sport on the tumor prognosis at least.Insgesamt ist festzustellen, dass die Ursache des positiven Effektes von Sport auf eine Tumorerkrankung derzeit nicht erklärbar ist. Möglicherweise ist die Ursache in molekularbiologischen Veränderungen (Reduktion von IGF-1), Aktivierung von BDNF oder durch eine kontinuierliche Gewichtsreduktion bzw. durch eine Wandel im Lebensstil (s. Ernährung) oder aber durch die verbesserte soziale Integration von Tumorpatienten zu erklären. Studien, die diese Hypothesen überprüfen, sind dringend zu fordern

Socio-medical assessment of colorectal cancer - a recommendation out of clinical practice

Colorectal cancer (CRC) is the second most frequent cancer in women and men in Germany. CRC is a rare diagnosis before the age of 40. Age-specific incidence rates increase significantly from 50 years on and in each following decade thereafter. Consequently, a relevant number of patients suffer from CRC during their work lifetime.Colorectal Cancer itself and also its treatment are associated with physical and psychosocial impairments. Recent advances in CRC therapy have resulted in increased survival times, especially in younger patients. Therefore, rehabilitation and integration into work life is of major concern for CRC patients. This publication deals with the assessment of secondary disorders and restrictions with regard to the patient's further professional activity (socio-medical assessment)Das kolorektale Karzinom (KRK) ist der zweithäufigste Tumor bei Frauen und Männern in Deutschland. Vor dem 40. Lebensjahr wird es selten beobachtet. Die altersspezifischen Inzidenzraten steigen ab dem 50. Lebensjahr in jeder folgenden Dekade immer deutlicher an. Daher erkrankt eine nicht unerhebliche Anzahl der Patienten während ihrer aktiven Berufstätigkeit. Das kolorektale Karzinom selbst und auch seine Therapie sind häufig mit körperlichen und psychosozialen Beeinträchtigungen verbunden. Behandlungsfortschritte in der jüngeren Vergangenheit führten zu verbesserten Überlebenszeiten, insbesondere bei jüngeren Patienten. Wiederherstellung der Gesundheit und Wiedereingliederung in den Arbeitsprozess sind daher für Patienten nach Behandlung eines KRK von hoher Bedeutung.Die vorliegende Publikation beschäftigt sich mit der Bewertung und Beurteilung von Folgestörungen und Beeinträchtigungen nach Behandlung eines KRK und die hiermit verbundenen Auswirkungen auf die berufliche Reintegration (sozialmedizinische Beurteilung)

Long-term improvement of anxiety and depression in cancer patients by an intensive psycho-oncological care (IPO)

Introduction: Every second tumor patient is suffering from psychological effects of cancer or its treatment. The present study evaluates the effectiveness of intensified psycho-oncological care compared to a standard rehabilitation.Material and methods: Over a period of 6 months 70 patients were interviewed by using questionnaires at the beginning, at the end and 5 weeks after rehabilitation. One group of patients received a standard rehabilitation while the other was treated with intensified psycho-oncological care.Results: All evaluated items improved during rehabilitation. Patients of the intervention group showed lower values for anxiety and depression during the follow-up.Discussion: Patients with psychological comorbidities benefit from an oncological rehabilitation. In particular, patients in the intervention group reported a positive long-term effect in terms of anxiety and depression.Einleitung: Jeder zweite onkologische Patient leidet unter psychischen Folgen der Krebserkrankung oder deren Therapie. Die vorliegende Untersuchung eruiert die Effektivität einer intensivierten psychoonkologischen Betreuung im Vergleich zu einer standardisierten onkologischen Rehabilitation.Material und Methoden: In einem Zeitraum von 6 Monaten wurden 70 Patienten mittels Fragebögen zu Beginn, am Ende und 5 Wochen nach erfolgter Rehabilitation befragt. Eine Gruppe von Patienten erhielt eine intensivierte psychoonkologische Betreuung, während eine zweite Gruppe eine standardisierte onkologische Rehabilitation erhielt.Resultate: Alle erfassten Items besserten sich während der Rehabilitation signifikant. Im Follow-up wiesen Patienten der Interventionsgruppe deutlich geringere Werte für Angst und Depression auf. Diskussion: Patienten mit psychischen Komorbiditäten profitieren von einer onkologischen Rehabilitation. Insbesondere Patienten der Interventionsgruppe wiesen in Hinblick auf Angst und Depression einen Langzeiteffekt auf

Social consequences of a tumor disease - an unexpected problem for relatives

On one hand financial distress is a problem in long-term cancer survivors. On the other hand little is known about theses consequences regarding their family member or relatives. Aim of this study was to look for the incidence of financial distress for family members or relatives due to the cancer diagnosis in the family.27 relatives, who presented themselves in facilities of the "Hessische Krebsgesellschaft", were analyzed by questionnaire consecutively.Regarding our data one third of the relatives who were interviewed reduced their working time and therefore their salary Therefore we think in case of a talk about the financial situation of a cancer patient relatives should be included.Finanzielle und soziale Konsequenzen einer Krebserkrankung bzw. deren Therapie sind ein häufiges und relevantes Problem für Langzeitkrebsüberlebende. Inwieweit eine solche Entwicklung auch Angehörige trifft ist aber vollkommen unklar und bis dato auch nicht untersucht.In der vorliegenden Untersuchung wurden 27 Angehörige, die in einem Zeitraum von 5 Monaten die Beratungsstellen der hessischen Krebsgesellschaften aufsuchten, konsekutiv befragt. Von den Befragten gaben 33% an, dass sie bedingt durch die Tumorerkrankung ihres Angehörigen den zeitlichen Umfang ihrer beruflichen Tätigkeit auf Kosten ihres Einkommens veränderten.Während das Sozialsystem der Bundesrepublik Deutschland erkrankten Patienten in diesen Situationen über das Sozialgesetzbuch IX eine Fülle an Hilfestellungen anbietet, besteht für Angehörige keine Versorgungsstruktur.Aus diesem Grunde sollten unserer Meinung nach bei jeder sozialmedizinischen Beratung von Tumorpatienten, wenn möglich, auch die Angehörigen befragt werden oder, wenn dies nicht möglich ist, deren Situation mit berücksichtigt werden