Dermatologic events from EGFR inhibitors: the issue of the missing patient voice.

PURPOSE: As epidermal growth factor receptor (EGFR) inhibitors are associated with a variety of dermatologic adverse events (dAEs), the purpose of this study was to develop an overview of current knowledge of dAEs associated with EGFR inhibitors and to identify knowledge gaps regarding incidence, treatment, impact on quality of life (QOL), and patient acceptance. METHOD: A structured literature search was conducted using MEDLINE/PubMed (January 1983 to January 2014). In total, 71 publications published from 2004 to 2014 were identified for consideration in the final evidence review. RESULTS: The majority of published articles concentrate on the incidence of skin reactions, duration, treatment, and prevention strategies. Different grading systems based on the symptoms of skin rash or on health-related QOL (HRQOL) are used. An additional topic is the possible correlation between acneiform rash and efficacy of EGFR inhibitors. Knowledge gaps identified in the literature were how dAEs impact QOL compared with other AEs from a patient's perspective, patients' acceptance of dAEs (willingness to tolerate), and the impact of physician-patient communication on treatment decisions. CONCLUSIONS: Research is needed on the impact of dAEs on patients' acceptance of cancer treatments. Systematic studies are missing that compare the impact of dAEs with other toxicities on therapy decisions from both physician's and patient's view, and that investigate the balance between efficacy and avoidance of acneiform rash in treatment decisions. Such studies could provide deeper insights into the acceptance of the risk of untoward dermatologic events by both physicians and patients when treating advanced cancers.

Water flows of MSW landfills and implications for long-term emissions.

A test landfill served for experiments to describe the water and material household of municipal solid waste (MSW) landfills. Special emphasis was given to the determination of the influence of the water flow on the substance balance. Therefore, a water balance was measured and the discharge was modeled by means of a mathematical model. A model, which separates the landfill into an area of preferential flow and an area of matrix flow fits best water flow data measured from 1987 to 1989 in the Breitenau landfill of 95,000 t MSW. This test landfill consists of three compartments C1, C2 and C3 with different covering systems. Leachate amount was highest in C1 with a permeable cover of silt and gravel. The lowest amount of leachate was found in C3 with a less permeable cover of gravel, humus, and plants. The values for C2 lie in between. An input-output balance for the substances C, N, S, P, Cl, Na, Ca, Fe, Zn, Pb, Cd and Cu was prepared. Contrary to the expectations the output of some substances was higher for C2 than for C1 with more leachate. Possibly a higher flow rate leads to preferential water flows that contact only small parts of the landfill body while most part of the landfill stays more or less dry. The substance balance reveals that most of the substances still remain in the landfill after 15 years of leaching. Hence, focusing on leachate concentrations only results in underestimating the after-care period of MSW landfills. Leachate concentrations reflect just a small part of a landfill. Understanding water flows and measuring substance balances improve considerably the assessment of the long-term emission potentials of landfills.