Strengthening health data on a rare and heterogeneous disease: sarcoma incidence and histological subtypes in Germany

Background: The population-based incidence of sarcoma and its histological subtypes in Germany is unknown. Up-to-date information on a disease with an incidence comparable to other cancer entities is of high public health relevance. The aim of this study was to determine this incidence and to detect significant changes in incidence trends using data from German epidemiological cancer registries. Methods: Pooled data from the German Centre for Cancer Registry Data with a primary diagnosis occurring in 2013 were used. To date, this is the latest data on cancer incidence available for Germany. All German cancer registries with sufficient completeness were included (10 out of 11), covering a population of 70.0 million people, representing 87% of the German population. All malignant sarcomas according to the RARECARE Project and the WHO classification 2002 were considered for analysis and, above all, gastrointestinal stromal tumours (GIST) of uncertain behaviour. Sensitivity analysis was performed excluding certain histologies. Results: The analysis included 3404 cases in men and 3442 cases in women diagnosed in 2013. The age adjusted sarcoma incidence (European standard) was 7.4 (men) and 6.6 (women) per 100,000 inhabitants. About 70% of sarcomas were soft tissue sarcomas, about 22% GIST, and about 9% bone sarcomas. The most common histological subtypes besides GIST were fibrosarcomas (14%) and liposarcomas (12%) in men and complex mixed and stromal neoplasms (22%), non-uterine leiomysarcomas (10%) and fibrosarcomas (9%) in women. Considering the trend for the years of diagnosis 2004 to 2013, there was a significant increase in incidence for GIST while the incidence of soft tissue sarcomas (only men) as well as of bone sarcoma stayed constant over time. As to soft tissue sarcoma in women, the incidence stayed constant up to the year 2009 and significantly decreased afterwards. Conclusion: This study is the first detailed analysis of a German-wide population-based sarcoma incidence showing results comparable to the incidence detected in the RARECARE Project

Current Practice of Heart Donor Evaluation in Germany: Multivariable Risk Factor Analysis Confirms Practicability of Guidelines

Background. Organ shortage has liberalised the acceptance criteria of grafts for heart transplantation, but which donor characteristics ultimately influence the decision to perform transplantation? For the first time this was evaluated using real-time donor data from the German organ procurement organization (DSO). Observed associations are discussed with regard to international recommendations and guidelines. Methods. 5291 German donors (2006–2010) were formally eligible for heart donation. In logistic regression models 160 donor parameters were evaluated to assess their influence on using grafts for transplantation (random split of cases: 2/3 study sample, 1/3 validation sample). Results. Successful procurement was determined by low donor age (OR 0.87 per year; 95% CI [0.85–0.89], P<0.0001), large donor height (OR 1.04 per cm; 95% CI [1.02–1.06], P<0.0001), exclusion of impaired left ventricular function or wall motion (OR 0.01; 95% CI [0.002–0.036], P<0.0001), arrhythmia (OR 0.05; 95% CI [0.009–0.260], P=0.0004), and of severe coronary artery disease (OR 0.003; 95% CI [<0.001–0.01], P<0.0001). Donor characteristics differed between cases where the procedure was aborted without and with allocation initiated via Eurotransplant

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life

Predictors of the need for psychosocial care: Multivariable logistic regression based on multiple imputation (10 imputation data sets, Nagelkerkes R² .41-.44).

<p>* Multiple Imputation for a set of covariates selected by forward and backward selection (level of selection 5%) in single imputation data</p><p>Predictors of the need for psychosocial care: Multivariable logistic regression based on multiple imputation (10 imputation data sets, Nagelkerkes R² .41-.44).</p

Demographic and medical characteristics of the sample (n = 689).

<p>¹UICC-stage: till 2003 (year of diagnosis) according to TNM 5. ed., Springer publisher 1997, from 2004 (year of diagnosis) TNM 6. ed., Springer publisher 2002; classification according to TNM 6 in A and B were subsumed to the particular stage; missing data: marital status (1), partnership (23), educational level (1), melanoma surgery (9)</p><p>Demographic and medical characteristics of the sample (n = 689).</p

Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies

Background: Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods: The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged >= 30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. Results: In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%-95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00-1.21; PCR: 1.07, 95% CI, 1.00-1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99-1.00). NNC was highest for Pap cotesting. Conclusions: Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals. Impact: HPV stand-alone screening offers a better balance of benefits and harms than cotesting

Item and scale analysis of the Hornheide Questionnaire short form (HQ-S).

<p>¹6-point Likert Scale from 0 = “does not apply" to 5 = “applies and troubles me extremely”, Cronbach´s α = .87”;r_it = discrimination power; item cut-off scores (care need prevalent) underlined</p><p>²a care need prevalent, if the sum of the anxiety measuring items (3, 6) is <u>7</u>, <u>8</u>, <u>9</u> or <u>10</u></p><p>³Care need index: sum score ≥ 16: 14% of the sample, M = 6.78, SD = 7.85; need for psychosocial intervention (HQ-S ≥ 16 or underlined item cut-off scores), prevalent 36% (n = 239), not prevalent 64% (n = 433)</p><p>Item and scale analysis of the Hornheide Questionnaire short form (HQ-S).</p

Quality of life (EORTC QLQ30) in male and female survivors of malignant melanoma across the age range.

<p>¹⁾Survivors below 30 years excluded due to small sample sizes (male: N = 2, female: N = 4);</p><p>²⁾ Means/SD are presented</p><p>Quality of life (EORTC QLQ30) in male and female survivors of malignant melanoma across the age range.</p

Depression (PHQ-9) and anxiety (GAD-7) in male and female malignant melanoma survivors and in the general population.

<p>¹⁾Multiple regression, separately for men and women with group (melanoma vs. general population) as predictor: men: beta = 1.05 (95% CI: .59 to 1.51); p<.0001; women: beta = 1.87 (95% CI: 1.42 to 2.32); p<.0001</p><p>²⁾Multiple regression, separately for men and women with group (melanoma vs. general population) as predictor: men: beta = .13 (95% CI-.28 to .54); n.s.; women: beta = .59 (95% CI .17 1.02); p = .006</p><p>Depression (PHQ-9) and anxiety (GAD-7) in male and female malignant melanoma survivors and in the general population.</p

Concepts and Outcomes of Perioperative Therapy in Stage IA-III Pancreatic Cancer&mdash;A Cross-Validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT)

(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers&mdash;Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p &lt; 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone