Epidemiologie des CUP-Syndroms in Deutschland

Der Artikel gibt einen Überblick über Inzidenz‑, Mortalitäts- und Überlebensraten des „cancer of unknown primary“ (CUP) in Deutschland, beruhend auf den Daten der epidemiologischen Krebsregister in Deutschland sowie der amtlichen Todesursachsenstatistik. Danach erkrankten in Deutschland zuletzt jährlich rund 11.000 Personen an einem CUP, was einem Anteil von 2,3 % an allen Malignomen entspricht. Bei knapp 10.000 Menschen wird ein unbekannter oder nicht näher bezeichneter Primärtumor (ICD-10: C80) als Todesursache angegeben. Aktuelle internationale Vergleichsdaten deuten allerdings darauf hin, dass die Inzidenz für das echte CUP-Syndrom eher niedriger liegen dürfte, wahrscheinlich weil die Unterscheidung zwischen einem tatsächlich unbekannten und einem lediglich nicht näher bezeichneten Primärtumor v. a. bei den nur über Todesbescheinigungen identifizierten Fällen schwierig ist. Morphologisch überwiegt das Adenokarzinom; in etwa 30 % der Fälle sind nur unspezifische Histologien angegeben. Die Prognose des CUP entspricht mit relativen Fünfjahresüberlebensraten um 18 % etwa der des Lungenkarzinoms, wobei Patienten in jüngerem Alter und solche mit Plattenepithelkarzinomen deutlich höhere Überlebenschancen aufweisen

Data from Population-based Cancer Registration for Secondary Data Analysis: Methodological Challenges and Perspectives

Population-based cancer registries have a long-standing role in cancer monitoring. Scientific use of cancer registry data is one important purpose of cancer registration, but use of cancer registry data is not restricted to cancer registries. Cancer registration in Germany is currently heading towards population-based collection of detailed clinical data. This development together with additional options for record linkage and long-term follow-up will offer new opportunities for health services and outcome research. Both regional population-based registries and the German Centre for Cancer Registry Data (ZfKD) at the Robert Koch-Institute as well as international cancer registries and consortia or organizations may provide external researchers access to individual or aggregate level data for secondary data analysis. In this review, we elaborate on the access to cancer registry data for research purposes, availability of specific data items, and options for data linkage with external data sources. We also discuss as well as on limitations in data availability and quality, and describe typical biases in design and analysis.Peer Reviewe

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

Epidemiology of CUP syndrome in Germany

Der Artikel gibt einen Überblick über Inzidenz‑, Mortalitäts- und Überlebensraten des „cancer of unknown primary“ (CUP) in Deutschland, beruhend auf den Daten der epidemiologischen Krebsregister in Deutschland sowie der amtlichen Todesursachsenstatistik. Danach erkrankten in Deutschland zuletzt jährlich rund 11.000 Personen an einem CUP, was einem Anteil von 2,3 % an allen Malignomen entspricht. Bei knapp 10.000 Menschen wird ein unbekannter oder nicht näher bezeichneter Primärtumor (ICD-10: C80) als Todesursache angegeben. Aktuelle internationale Vergleichsdaten deuten allerdings darauf hin, dass die Inzidenz für das echte CUP-Syndrom eher niedriger liegen dürfte, wahrscheinlich weil die Unterscheidung zwischen einem tatsächlich unbekannten und einem lediglich nicht näher bezeichneten Primärtumor v. a. bei den nur über Todesbescheinigungen identifizierten Fällen schwierig ist. Morphologisch überwiegt das Adenokarzinom; in etwa 30 % der Fälle sind nur unspezifische Histologien angegeben. Die Prognose des CUP entspricht mit relativen Fünfjahresüberlebensraten um 18 % etwa der des Lungenkarzinoms, wobei Patienten in jüngerem Alter und solche mit Plattenepithelkarzinomen deutlich höhere Überlebenschancen aufweisen

Distress mediates the relationship between cognitive appraisal of medical care and benefit finding/posttraumatic growth in long-term cancer survivors

BACKGROUND: The objective of this study was to ascertain long-term cancer survivors' (LTCS') appraisal of medical care and how these perceptions may influence their health and well-being, including benefit finding (BF) and posttraumatic growth (PTG). METHODS: In total, 6952 LTCS from a multiregional population-based study in Germany completed the Benefit Finding Scale, the Posttraumatic Growth Inventory, the Questionnaire on Stress in Cancer, and self-designed questions on cognitive appraisal of medical care. The authors explored the mediating role of distress between medical care appraisal and BF and PTG and the possible moderation of time since diagnosis in this relationship. RESULTS: LTCS' medical care appraisals (“no unresolved/untreated symptoms,” “satisfaction with cancer care,” and “satisfaction with care for other diseases”) were positively associated with BF. PTG was positively associated with “no unresolved/untreated symptoms” and negatively associated with “satisfaction with care for other diseases.” Cancer distress partially mediated the associations between appraisals of medical care and BF, between “no unresolved/untreated symptoms” and PTG and between “satisfaction with care for other diseases” and PTG; whereas it totally mediated the association between “satisfaction with cancer care” and PTG. Time was a significant moderator in the model; the negative indirect effect of cognitive appraisal on BF and PTG through cancer distress weakened with longer time since diagnosis. CONCLUSIONS: Cancer survivors' medical care appraisal is associated with their perceptions of BF and PTG through distress. Therefore, distress screening could be part of the regular workup to identify distressed cancer survivors who are not satisfied with medical care; these survivors may benefit from interventions to reduce distress and increase BF and PTG

Age‐specific prevalence and determinants of depression in long‐term breast cancer survivors compared to female population controls

BACKGROUND: Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. METHODS: About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. RESULTS: Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups &lt;80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. CONCLUSIONS: Long‐term BC survivors &lt;80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care

Specifics of young gastric cancer patients: a population-based analysis of 46,110 patients with gastric cancer from the German Clinical Cancer Registry Group

Introduction: 2–8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000–2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival

Age‐specific prevalence and determinants of depression in long‐term breast cancer survivors compared to female population controls

BACKGROUND: Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. METHODS: About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. RESULTS: Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups &lt;80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. CONCLUSIONS: Long‐term BC survivors &lt;80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care

Health-related quality of life in long-term survivors with localised prostate cancer by therapy-Results from a population-based study

OBJECTIVE Several therapies for localised prostate cancer (PC) are available; all yield similar survival rates. However, each therapy has significant side effects that can influence patients' health-related quality of life (HRQoL) in the long run. METHODS The study sample included 911 survivors with localised PC, 5-15 years post-diagnosis who were identified from the population-based CAESAR + study in Germany. HRQoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. The association between type of therapy and HRQoL was assessed with multivariable linear regression and global F-test adjusting for age, time since diagnosis and comorbidities. RESULTS Overall, survivors treated with radical prostatectomy (RP) or radiotherapy (RT) alone reported the best HRQoL and the lowest symptom burden. Conversely, survivors treated with androgen deprivation therapy (ADT) (& RP/RT) or RP & RT (in combination) reported the worst HRQoL and the highest symptom burden. Significant differences among treatment groups in HRQoL were found for global health status (p = 0.041), social functioning (p = 0.007), urinary symptoms (p = 0.035), bowel symptoms (p = 0.017) and hormonal treatment-related symptoms (p < 0.001) among other symptoms. CONCLUSIONS Long-term localised PC survivors formerly treated with a combination of RP and RT or with ADT report poorer HRQoL and more symptoms than patients treated with either RP or RT alone