Lifestyle modifications after the diagnosis of gynecological cancer.

BACKGROUND: The influence of lifestyle factors on the quality of life, incidence and tumor recurrence has been evaluated in several studies and is gaining increasing importance in cancer research. However, the extent of the influence of such lifestyle factors on the quality of life of cancer patients remains largely unclear, as does the number of patients actually pursuing these lifestyle changes. The purpose of this study was to examine the prevalence and predictors of lifestyle changes in patients with gynecological cancer. METHODS: The survey consisted of a pseudonymous questionnaire that was conducted from January to May 2014 via a telephone interview with 141 patients with a gynaecological malignancy who had undergone surgery at our Department of Gynaecology and Obstetrics. Lifestyle factors (diet, physical activity, stress level, alcohol and nicotine consumption) prior to and after the diagnosis of cancer were evaluated. RESULTS: 89% (n = 125) of the patients reported lifestyle changes after being diagnosed with cancer. There was a significant association between the implementation of lifestyle changes and age as well as the use of complementary medicine. Nutrition: 66% of the patients (n = 93) consumed more fruit and vegetables and 65% ate less meat (n = 92). Physical activity: 37% (n = 52) reported no change in their exercise routine, 36% (n = 51) described a decrease, 27% (n = 38) an increase in their physical activity. Subjective feeling of stress: 77% of the patients (n = 108) described a reduction in their perceived level of stress. Nicotine consumption: 63% (n = 12) of the 19 patients who were smokers at the time of the diagnosis quit or reduced smoking thereafter. Alcohol consumption: 47% (n = 61/129) of the patients reduced their alcohol consumption. CONCLUSIONS: Most of the patients from our study group implemented lifestyle changes after being diagnosed with cancer. Prospective randomized trials are needed in order to determine the benefit of lifestyle changes (physical activity, dietary habits and stress reduction) for cancer survivors. The potential impact of lifestyle on the quality of life and the trajectory of the disease should be discussed with all oncological patients.

Prevalence and Predictors for Nonuse of Complementary Medicine among Breast and Gynecological Cancer Patients.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among cancer patients. Data indicated that CAM use correlates with younger age, higher education levels, higher income, and less physician consultations. However, non-CAM use and predictors for non-CAM use are less clear among breast and gynecological cancer patients. OBJECTIVES: The purpose of this study was to determine the prevalence of non-CAM use and to investigate factors that might influence non-CAM use. METHODS: The survey was conducted in breast cancer patients from January to May 2013 and in gynecological cancer patients from January to May 2014 with 2 pseudoanonymous questionnaires: one for CAM users (109 questions) and one for non-CAM users (85 questions). The survey was conducted via a telephone interview with 333 patients. Eligible participants were women with breast cancer (n = 285) and gynecological cancer (n = 291) who had undergone surgery at the Department of Gynecology and Obstetrics at the Technical University Munich, Germany, in the years 2012 (breast cancer) and 2011-2013 (gynecological cancer). Descriptive statistics were generated to determine patterns of non-CAM use. Univariable analysis was used to detect patient characteristics associated with noninterest in the different CAM therapies. RESULTS: A total of 333 of 576 patients participated in the survey (58%). Fifty-eight percent (n = 192/333) were diagnosed with breast cancer and 42% (n = 141/333) with gynecological cancer. The overall prevalence of non-CAM use was 42% (n = 139/333). Eighty-one percent (n = 112/139) of the non-CAM users stated to have received no recommendation for CAM use, although 53% (n = 73/139) would have liked to receive information from their physician. As reasons for the nonuse of CAM therapies, 76% (n = 106/139) nonusers declared that they did not believe CAM use was necessary since the conventional therapy was considered sufficient, 44% (n = 61/139) reported a lack of information, 31% (n = 43/139) a fear of fraud, and 22% (n = 31/139) a fear of interactions and side effects of CAM. Sixty-eight percent (n = 95/139) of the patients stated that they would resort to CAM if the disease progressed while only 27% (n = 37/139) would still not use any CAM with progression of disease. Five percent (7/139) did not give any information regarding possible future CAM use with disease progression. Seventy-three percent (n = 102/139) would both welcome more physicians with qualifications in complementary medicine and supported an integration of CAM into our health care system. Furthermore, statistically significant correlations between patients' sociodemographic characteristics and their nonuse of complementary therapies were identified. CONCLUSIONS: Our data demonstrate a high overall interest in CAM even in non-CAM users. Health care professionals should be aware of this in order to be able to better address patients' needs. It is necessary to explore the use of CAM with cancer patients, educate them about potentially beneficial therapies even in the light of the limited available evidence, and work towards an integrated model of health care. Therefore, we implemented a counseling service as an outpatient program (ZIGG) for integrative medicine concepts and evidence-based complementary treatments to discuss integrative health approaches proactively with cancer patients in our cancer center in 2013.

Changes in pathogen spectrum and antimicrobial resistance development in the time-course of acute necrotizing pancreatitis.

BACKGROUND AND AIM: In contrast to the first peak of multi-organ failure in acute pancreatitis, the second peak is mostly triggered by septic complications. Our aim was to analyze the spectrum of pathogens and antimicrobial resistance development in relation to the time-course of the disease and its clinical outcome. METHODS: One hundred twenty-two patients with acute necrotizing pancreatitis undergoing pancreas puncture at two tertiary academic medical centers in Germany were retrospectively analyzed. RESULTS: At species level, there was a change in spectrum from Enterococcus faecalis (∆d150 - d1 = 14.6% - 16.7% = -2.1%) to Enterococcus faecium (∆d150 - d1 = 93.1% - 16.3% = 76.8%) (P < 0.001) and from Candida albicans (∆d150 - d1 = 39.7% - 23.6% = 16.1%) to non-albicans Candida spp. (∆d150 - d1 = 43.5% - 6.4% = 37.1%) (P = 0.005). Time-to-event analysis of acquired antimicrobial resistance showed that the overall number of patients with Enterobacteriaceae presented an antimicrobial susceptibility decrease by 59.7% (∆d1 - d100 = 87.0% - 27.3% = 59.7%). The cumulative incidence of multi-resistant bacteria increased with length of hospital stay (∆d150 - d1 = 49.1% - 3.1% = 46.0%) (P = 0.004). Multivariable logistic regression analysis in relation to the pathogen spectrum and antimicrobial resistance development showed a significantly higher mortality for non-albicans Candida spp. (P = 0.039, odds ratio [OR] = 3.32 [95% confidence interval [CI]: 1.07-10.35]), E. faecium (P = 0.009, OR = 3.73 [95% CI: 1.38-10.05]), and multi-resistant bacteria (P = 0.007, OR = 5.08 [95% CI: 1.55-16.66]). CONCLUSIONS: Antimicrobial treatment of infected pancreatic necrosis becomes more challenging over time, owing to a change in spectrum favoring difficult-to-treat pathogens and an increase in multi-resistant bacteria associated with worse clinical outcomes (World Health Organization trial registration number: DRKS00014785).

Evaluating the Demand for Integrative Medicine Practices in Breast and Gynecological Cancer Patients.

INTRODUCTION: Integrative medicine is becoming increasingly relevant to modern oncology. The present study aims to assess the demand for integrative therapeutic approaches including complementary and alternative medicine (CAM), body and mind practices, nutritional counseling, and psychological assistance among breast and gynecological cancer patients. METHODS: From April to July 2017, a pseudo-anonymous questionnaire was distributed to cancer patients at the Department of Gynecology and Obstetrics, Technical University of Munich. Patterns of CAM use and demand for integrative health approaches were investigated by generating descriptive statistics. RESULTS: 182 (90%) of 203 patients participated in the survey. 59% indicated the use of CAM practices in general, and 41% specifically in relation to their oncological disease. Most frequently used modalities were herbal supplements (32%), homeopathy (29%), vitamins (28%), and selenium (21%). Integrative health approaches that patients would have desired alongside conventional oncological treatment were CAM (54%), relaxation therapies (44%), and dietary counseling (43%). CONCLUSION: There is a considerable demand for integrative medicine among breast and gynecological cancer patients. Our results underline the need for the implementation of evidence-based integrative treatments in cancer care in order to meet the standards of modern oncology.

Demand for integrative medicine among women in pregnancy and childbed: a German survey on patients' needs.

BACKGROUND: Although integrative medicine is gaining increasing attention and is claiming more and more its place in modern health care, it still plays a marginal role in conventional maternity care. The present study aims to examine the patterns of Complementary and Alternative Medicine (CAM) use and the demand for integrative therapies, including CAM, relaxation therapies, nutritional counseling, and psychological assistance, among women in pregnancy and childbed. METHODS: The survey was conducted from April 2017 to July 2017 by means of a pseudo-anonymous 38-item questionnaire at the Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich. Eligible participants were women hospitalized due to pregnancy related complications and women in childbed. Descriptive statistics were generated to determine patterns of CAM use and demand for integrative therapeutic approaches. Univariate analysis was used to detect associations between patients' characteristics and their interest in the different integrative therapies. Furthermore, binary logistic regression was used to estimate the odds ratio of demand for CAM. RESULTS: A total of 394 out of 503 patients participated in the survey (78%). 60% declared using CAM in general, 45% specifically in relation to their pregnancy or childbed. Most commonly used modalities were vitamins (31% of all patients), yoga (24%), and herbal supplements (23%). Most popular sources of recommendation of CAM use were midwives and gynecologists. Integrative therapy options patients would have wanted alongside conventional maternity care were CAM (64%), relaxation therapies (44%), dietary counseling (28%), and psychological counseling (15%). Furthermore, associations between patients' sociodemographic characteristics and their demand for integrative therapies were identified. CONCLUSIONS: The results of this study demonstrate that there is a considerable demand for integrative medicine and widespread use of CAM among women during pregnancy and childbed in Germany. Maternity health care providers should be aware of these findings in order to be able to better address patients' needs and wishes. Our study findings should be interpreted with regard to patients in an hospital setting.