The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors.

AIMS: Clinical experience with neuroendocrine tumors (NETs) is difficult to acquire because they are rare and heterogeneous. The impact of guidelines on the care for NETs is not known. The German NET Registry compiled information for Germany pertaining to three questions: who provides care for NET patients; does the care comply with proposed guidelines, and are the results comparable to those described in the literature? PATIENTS AND METHODS: Between 2004 and 2007 data on 1,263 patients from 21 centers were compiled in a dedicated database. RESULTS: Tumor location, age and sex compared well with published data. Most patients were cared for in centers with more than 100 (47.9%) or between 20 and 99 patients (46.1%). Imaging (magnetic resonance tomography, computer tomography, ultrasound) was available for 79% of the patients, specific laboratory tests for 67%, somatostatin receptor scintigraphy for 56%, and pathology findings for 79%. High-quality pathology reports were rare (2%). Sufficient documentation was mostly found in large centers. Surgery was the first-line therapy in 70.9%, while medical therapy was the second-line therapy in 45.7% of the patients. Median follow-up was 2.8 (0.4-6.4) and median overall survival was 2.5 (0.34-6.3) years. CONCLUSIONS: Most patients were referred to large specialized centers. Those centers adhered best to published guidelines for NETs. However, there are still significant deficiencies in the documentation of diagnostic results, mainly with regard to pathology reports. Therapeutic strategies were comparable between centers. The data provide a basis for future studies assessing improvements in documentation, diagnosis and treatment of NET.

[Evaluation of the effectiveness of psychosomatic in-patient treatment on the basis of subjective and objective criteria]. / Evaluation stationärer psychosomatischer Behandlung anhand subjektiver und objektiver Kriterien.

OBJECTIVES: The effectiveness of psychosomatic in-patient treatment was evaluated using patients' subjective health ratings and objective data provided by health insurance companies. Associations between subjective and objective criteria were investigated. METHODS: 318 patients participated in the study. They completed questionnaires on physical complaints, moods and everyday functioning upon hospital admission, at discharge and at one-year follow-up. Insurance companies provided data for 140 of these patients (44 %). Sick leave and the utilization of in-patient treatment were assessed for a period of two years before and two years after psychosomatic treatment. RESULTS: As expected, subjective health status improved. The utilization of in-patient treatment decreased in both years after treatment compared to the year before. Sick leave increased in the first year after treatment but decreased significantly below the base level in the second year after treatment. Self-efficacy expectations and being employed were found to be predictors for long-term reduction in the length of in-patient treatment. Subjective and objective criteria were only slightly correlated. CONCLUSIONS: Sick leave and utilization of in-patient treatment were found to increase considerably in the year before psychosomatic treatment. Therefore, pre-post differences over the entire period were only marginal. The change in subjective criteria was more immediate, while changes in some objective parameters were delayed. Both subjective and objective criteria should be included in outcome studies.