[What does the general and abdominal surgeon need to know about oncologically oriented radiotherapy?] / Was muss der Allgemein- und Viszeralchirurg von der onkologisch ausgerichteten Strahlentherapie wissen?

BACKGROUND: Radiotherapy is an integral component of most modern multimodal tumor treatment concepts, both in palliative and curative situations and intentions. This also applies to many tumor entities relevant in general as well as abdominal surgery. This can give rise to new challenges in the context of the daily clinical routine and interdisciplinary tumor conferences. AIM: Practice relevant overview, based on selective references from the current scientific literature in medicine and own experiences obtained in daily work, for the oncological surgeon on radiotherapy-associated options for visceral tumor lesions. A particular focus is on rectal cancer, esophageal cancer, anal cancer and liver metastases. METHOD: A narrative review is given. RESULTS (SELECTED CORNER POINTS): In total neoadjuvant therapy it is possible to avoid resection in rectal cancer if a good response is achieved and close monitoring can be provided. In esophageal cancer neoadjuvant chemoradiotherapy followed by resection can be considered the therapeutic regimen of choice for all suitable patients. If surgery is not an option, definitive chemoradiotherapy is an appropriate and favorable alternative, especially with respect to squamous cell carcinoma. Even taking the latest data on the topic into account, definitive chemoradiotherapy remains undisputedly recommended for anal cancer. Liver tumors can be locally ablated by stereotactic radiotherapy. CONCLUSION: Close cooperation between disciplines in the context of tumor therapy remains essential for the best possible treatment and outcome of patients.

An implementation study of electronic assessment of patient-reported outcomes in inpatient radiation oncology.

PURPOSE: Despite evidence for clinical benefits, recommendations in guidelines, and options for electronic data collection, routine assessment of patient-reported outcomes (PROs) is mostly not implemented in clinical practice. This study aimed to plan, conduct and evaluate the implementation of electronic PRO (e-PRO) assessment in the clinical routine of an inpatient radiation oncology clinic. METHODS: The guideline- and evidence-based, stepwise approach of this single-center implementation study comprised preparatory analyses of current practice, selection of assessment instruments and times, development of staff training, and evidence-based recommendations regarding the use of the e-PRO assessment, as well as on-site support of the implementation. Process evaluation focused on potential clinical benefit (number of documented symptoms and supportive measures), feasibility and acceptance (patient contacts resulting in completion/non-completion of the e-PRO assessment, reasons for non-completion, preconditions, facilitators and barriers of implementation), and required resources (duration of patient contacts to explain/support the completion). RESULTS: Selection of instruments and assessment times resulted in initial assessment at admission (EORTC QLQ-C30, QSR 10), daily symptom monitoring (EORTC single items), and assessment at discharge (EORTC QLQ-C30). Recommendations for PRO-based clinical action and self-management advice for patients concerning nine core symptoms were developed. Staff training comprised group and face-to-face meetings and an additional e-learning course was developed. Analyses of clinical records showed that e-PRO assessment identified more symptoms followed by a higher number of supportive measures compared to records of patients without e-PRO assessment. Analysis of n = 1597 patient contacts resulted in n = 1355 (84.9%) completed e-PROs (initial assessment: n = 355, monitoring: n = 967, final assessment: n = 44) and n = 242 (15.2%) non-completions. Instructions or support to complete e-PROs took on average 5.5 ± 5.3 min per patient contact. The most challenging issue was the integration of the results in clinical practice. CONCLUSION: E-PRO assessment in oncologic inpatient settings is acceptable for patients and can support symptom identification and the initiation of supportive measures. The challenge of making the "data actionable" within the clinical workflow and motivating clinical staff to use the results became evident.

Cancer patients' perceptions regarding their symptoms and functioning are important as they can differ from a professional assessment. Patients' perceptions and self-assessment can be collected via electronic devices. Thus, the clinical staff can see a graphic overview of individual disease-related burden. Despite studies indicating the benefit of this assessment for care and symptom management, it is not integrated into routine care so far. The aim of our study was, to plan, conduct and evaluate the implementation of electronic patient-reported assessment in a radio-oncology inpatient clinic under "real-life" clinical conditions instead of study conditions. Patients could complete an electronic assessment at the beginning/end and during their treatment. Results indicate that electronic self-assessment can identify more symptoms than the assessment of physicians and nurses. Patients completing a self-assessment are more likely to receive supportive measures. The majority of 80­90% of patients were willing to complete a self-assessment. On average 5­6 min were needed to explain or support the completion. While the intervention was feasible and acceptable for patients, motivating clinical staff using its results was most challenging. The importance of technical support became evident.

Dipeptidyl peptidase 4 serum activity and concentration are increased in women with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a complex disease, the aetiology of which is not well understood. Alterations in potential candidate genes involved in the biosynthesis and metabolism of androgens, folliculogenesis and insulin and glucose metabolism have been suggested as possible aetiologies. Dipeptidyl peptidase-4 (DPP4) plays a key role in glucose homoeostasis and, thus, in the regulation of insulin secretion. The aim of our study was to analyse the DPP4 activity and concentrations in the serum of PCOS and non-PCOS patients and, additionally, study the activation of the DPP4 promoter by androgens in vitro. DESIGN, PATIENTS AND MEASUREMENTS: Serum samples were obtained from 288 female patients treated at the Center for Reproductive Medicine and Andrology (154 non-PCOS and 134 patients with PCOS). DPP4 activity was measured by the conversion of the DPP4 substrate Gly-Pro p-nitroanilide hydrochloride and DPP4 concentration with a commercial ELISA. Luciferase reporter assays, qPCR and Western Blot analyses were performed for the in vitro evaluation of the activation of the DPP4 promoter by androgens. RESULTS: DPP4 serum activity was increased in women with PCOS, regardless of which Rotterdam criteria led to the PCOS diagnosis. Furthermore, DPP4 serum levels were strongly correlated with the anti-Müllerian hormone (AMH) serum level. In vitro, the DPP4 promoter was stimulated by androgens in luciferase reporter assays, and DPP4 mRNA expression was increased in KGN granulosa carcinoma cells after androgen treatment. CONCLUSIONS: The results suggested that a deregulation of DPP4 serum levels could be an additional characteristic of the metabolic imbalances associated with PCOS.

Trans sectoral care of geriatric cancer patients based on comprehensive geriatric assessment and patient-reported quality of life - Results of a multicenter study to develop and pilot test a patient-centered interdisciplinary care concept for geriatric oncology patients (PIVOG).

OBJECTIVES: For older patients with cancer the maintenance of independence, functionality and health-related quality of life (HRQOL) is of great importance. Aiming to maintain HRQOL of older patients with cancer we developed an interdisciplinary care program based on comprehensive geriatric assessment (CGA) and patient-reported HRQOL comprising tailored supportive measures and telephone-based counseling during 6month aftercare. MATERIALS AND METHODS: Pilot-testing of the intervention took place in three centers at the University Hospital Halle to examine feasibility, acceptance and potential benefit. Patients≥70years with confirmed diagnosis of cancer, at least one comorbidity and/or one functional impairment, receiving curative or palliative care were eligible. Primary endpoint was global HRQOL (EORTC QLQ C30). RESULTS: Mean age of the participants (n=100) was 76.3years (SD 4.8), 47% were female. On average they had 5 comorbidities (SD 2.8, min. 0, max. 15) and took 8 prescribed medications (SD 3.6, min. 0, max. 15). According to predefined treatment pathways, supportive care was triggered by summarized individual assessments that were presented to the treating physicians. Descriptive analyses showed that global HRQOL measured at the 6-month follow-up (n=57) had declined (≥10 points) for n=16 (28%) and improved or remained unchanged for n=41 (72%) patients, although some functional scales (e.g. mobility, role function) and some symptoms (e.g. fatigue, pain) had worsened. The nurse-led telephone-based aftercare was well accepted. CONCLUSION: The results show feasibility and potential benefit of the combination of CGA and HRQOL to complement standard assessments. Patient-reported symptoms and functioning indicate the need for intensified supportive therapy during aftercare.