Vergleich verschiedener Meßinstrumente aus den Ergebnissen der Schlaganfalldatenbank der Stiftung Deutsche Schlaganfallhilfe

Ziel dieser Studie war der Vergleich und die kritische Bewertung der eingesetzten Meßinstrumente anhand der Erhebung des funktionellen und psychosozialen Outcomes nach ischämischem Schlaganfall an einer großen, krankenhausbasierten Kohorte. An insgesamt 30 teilnehmenden Zentren wurden zwischen 1998 und 1999 alle Patienten mit akutem Schlaganfall über einen Zeitraum von einem Jahr prospektiv erfaßt. Etwa 2/3 (67,2%) der 4255 in die Untersuchung eingeschlossenen Patienten mit ischämischem Schlaganfall konnten für eine zentrale Nachbefragung nach 100 Tagen erreicht werden. Die Letalität nach 100 Tagen betrug 13,9%. Etwa die Hälfte aller Patienten war zu diesem Zeitpunkt weitgehend funktionell unabhängig. 55% der überlebenden Patienten wiesen meßbare neuropsychologische Defizite auf, wobei am häufigsten Einschränkungen in den Bereichen "Problemlösen" und "Gedächtnis/Orientierung" zu verzeichnen waren. Eine klinisch relevante Depression war bei etwa 33% der Patienten festzustellen. Im Vergleich zu den anderen Endpunktparametern war hier noch eine deutliche Verbesserung im weiteren Verlauf des ersten Jahres nach dem Ereignis erkennbar. Für den Barthel-Index erweist sich der hohe Deckeneffekt (> 40%) als nachteilig vor allem für den Nachweis von Verbesserungen bei leicht-mittelgradigen Schlaganfällen. Bei allen anderen eingesetzten Skalen waren die Deckeneffekte deutlich geringer ( .80) mit der Modified Rankin Scale. Hohe Übereinstimmungen fanden sich auch bei der Ermittlung unabhängiger Prädiktoren für Barthel-Index und Modified Rankin Scale, während die SF-36 "Physical Functioning" Einschränkungen der Mobilität im Vergleich zu den beiden anderen Skalen deutlich höher gewichtet. Für zukünftige Studien ist am ehesten die Modified Rankin Scale als primärer Endpunkt zu empfehlen, für leichtere Verlaufsformen die Subskala "Physical Functioning" des SF-36 ggf. in Ergänzung mit Instrumenten, die Einschränkungen im Bereich von Kognition und Affektivität abbilden

Krebsregistrierung heute: zwischen Epidemiologie, Qualitätssicherung und Forschung

Die Rolle der Krebsregister hat in Deutschland über die Jahrzehnte einen deutlichen Wandel erfahren: Ging es zunächst vor allem um die Aufgabe, im Sinne von „Cancer Control“ die Entwicklung der Inzidenz von Krebserkrankungen im Blick zu behalten, haben sich die Register inzwischen zu Instrumenten der Evaluation von Präventions- und Früherkennungsmaßnahmen und der Beschreibung der Ergebnisqualität der Versorgung entwickelt. Inzwischen sind Krebsregister in ganz Deutschland flächendeckend tätig und zuständig für die Qualitätssicherung der onkologischen Versorgung. Neben Auswertungen auf Bevölkerungsebene werden auch einrichtungsbezogene Daten verglichen und analysiert. Gleichzeitig hat der inzwischen deutlich erweiterte Datensatz ein großes Potenzial für verschiedene Bereiche der Forschung. Ein aktueller Gesetzentwurf des Bundes will die Rahmenbedingungen für die wissenschaftliche Nutzung weiter verbessern. Der vorliegende Artikel beschreibt die wichtigsten Perspektiven und Ziele für die Krebsregistrierung in Deutschland

Widening area‑based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019

Cancer mortality has declined in recent decades, but—due to a lack of national individual-level data—it remains unclear whether this applies equally to all socioeconomic groups in Germany. Using an area-based approach, this study investigated socioeconomic inequalities in cancer mortality and their secular trends on a German nationwide scale for the first time. Official cause-of-death data from 2003 to 2019 were linked to the district-level German Index of Socioeconomic Deprivation. Age-standardised mortality rates for all cancers combined and the most common site-specific cancers were calculated according to the level of regional socioeconomic deprivation. To quantify the extent of area-based socioeconomic inequalities in cancer mortality, absolute (SII) and relative (RII) indices of inequality were estimated using multilevel Poisson models. On average, cancer mortality was 50% (women) and 80% (men) higher in Germany’s most deprived than least deprived districts (absolute difference: 84 deaths per 100,000 in women and 185 deaths per 100,000 in men). As declines in cancer mortality were larger in less deprived districts, the socioeconomic gap in cancer mortality widened over time. This trend was observed for various common cancers. Exceptions were cancers of the lung in women and of the pancreas in both sexes, for which mortality rates increased over time, especially in highly deprived districts. Our study provides first evidence on increasing socioeconomic inequalities in cancer mortality on a nationwide scale for Germany. Area-based linkage allows to examine socioeconomic inequalities in cancer mortality across Germany and identify regions with high needs for cancer prevention and control.Peer Reviewe

Descriptive analysis of 179 German reports of melanoma reported to an adverse drug reaction database as a drug-related adverse effect, and comparison with melanoma cases contained in German cancer registries

Background: Malignant melanoma (MM) is one of the most aggressive forms of skin cancer. The occurrence of MM associated with drug therapy has been described in the literature. However, there is no analysis of a substantial number of validated reports of drug-associated MM. Aim: To analyse a substantial number of validated spontaneous reports of drug-associated MM with regard to the suspected drug and the reported characteristics, and to compare these analyses with those of MM cases occurring in the general population in Germany. Methods: Spontaneous reports of MM associated with drug therapy in Germany were identified in a large adverse drug reaction database (EudraVigilance). These results were then compared with analyses of MMs in the pooled data from a population-based German cancer registry. Results: The 10 most frequently suspected drugs in the MM reports all target the immune system, with 7 of these being immunosuppressants. The median time to onset to MM diagnosis was 2.0 years. Patients with drug-associated MM were 11 years (median) younger than patients with MM in the cancer registry, and this age difference was greater for female than for male patients. Conclusions: Our results emphasize the importance of regular dermatological examinations of patients being treated with immunosuppressants. Physicians should be aware that in these patients, MM might be detected at younger ages and even within 2 years after initiating therapy.Peer Reviewe

Need for nursing care support in cancer patients: Registry-linkage study in Germany

Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care. Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients. Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants. Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed

ASO Author Reflections: How Many Centers Do We Need for High-Quality Penile Cancer Surgery in Germany? An Analysis of Total Population Data from 2006 to 2016

Peer Reviewe

Need for nursing care support in cancer patients: Registry-linkage study in Germany

Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care.Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients.Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants.Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed.

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe