Capecitabine monotherapy: review of studies in first-line HER-2-negative metastatic breast cancer.

The goals of treatment for metastatic breast cancer (MBC) are to prolong overall survival (OS) while maximizing quality of life, palliating symptoms, and delaying tumor progression. For many years, anthracyclines and taxanes have been the mainstay of treatment for MBC, but these agents are now commonly administered earlier in the course of the disease. A recent meta-analysis revealed adverse effects on OS and overall response rates in patients with MBC receiving first-line anthracycline-based chemotherapy following relapse on adjuvant chemotherapy. Noncrossresistant cytotoxic agents and combinations that combine high clinical activity and acceptable tolerability while being convenient for patients are therefore needed for the first-line treatment of MBC patients. Capecitabine has substantial antitumor activity in the first-line treatment of patients with MBC in prospective, randomized, phase II/III clinical trials as monotherapy and in combination with biologic and novel agents. First-line capecitabine monotherapy has a favorable safety profile, lacking myelosuppression and alopecia, and does not compromise the administration of further lines of chemotherapy. Capecitabine is suitable for long-term administration without the cumulative toxicity that can limit the prolonged use of other chemotherapy agents. Here, we review the available data on capecitabine as a single agent for first-line treatment of patients with human epidermal growth factor receptor 2-negative MBC.

Identification of early molecular markers for breast cancer.

BACKGROUND: The ductal carcinoma in situ (DCIS) of the mammary gland represents an early, pre-invasive stage in the development of invasive breast carcinoma. Since DCIS is a curable disease, it would be highly desirable to identify molecular markers that allow early detection. Mice transgenic for the WAP-SV40 early genome region were used as a model for DCIS development. Gene expression profiling was carried out on DCIS-bearing mice and control animals. Additionally, a set of human DCIS and invasive mammary tumors were analyzed in a similar fashion. Enhanced expression of these marker genes in human and murine samples was validated by quantitative RT-PCR. Besides, marker gene expression was also validated by immunohistochemistry of human samples. Furthermore in silico analyses using an online microarray database were performed. RESULTS: In DCIS-mice seven genes were identified that were significantly up-regulated in DCIS: DEPDC1, NUSAP1, EXO1, RRM2, FOXM1, MUC1 and SPP1. A similar up-regulation of homologues of the murine genes was observed in human DCIS samples. Enhanced expression of these genes in DCIS and IDC (invasive ductal carcinoma) was validated by quantitative RT-PCR and immunohistochemistry. CONCLUSIONS: By comparing murine markers for the ductal carcinoma in situ (DCIS) of the mammary gland with genes up-regulated in human DCIS-samples we were able to identify a set of genes which might allow early detection of DCIS and invasive carcinomas in the future. The similarities between gene expression in DCIS and invasive carcinomas in our data suggest that the early detection and treatment of DCIS is of utmost relevance for the survival of patients who are at high risk of developing breast carcinomas.

Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020).

Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.

Capecitabine in the routine treatment of advanced breast cancer: results from a non-interventional observational study in 876 [corrected] patients.

BACKGROUND: This observational study evaluated patient characteristics, treatment schedule and setting, efficacy and tolerability of capecitabine in routine clinical practice in Germany. PATIENTS AND METHODS: Patients with advanced breast cancer pretreated with or ineligible for anthracycline-containing therapy were treated with capecitabine. Data were collected until disease progression or completion of 12 cycles (with long-term follow-up in progression-free patients). RESULTS: 846 of the 876 [corrected] patients enrolled between 2002 and 2007 were eligible. Capecitabine was administered as monotherapy in 64% (median starting dose 1,070 mg/m(2) bis in diem (b.i.d.)) and combination chemotherapy (typically with vinorelbine or docetaxel) in 36% (median starting dose 987 mg/m(2) b.i.d.). Capecitabine was given as first-line therapy in 35% of patients. Objective response rate was 41% and median progression-free survival was 7.5 months. Good performance status at baseline was a significant predictor of efficacy. The most common non-hematological toxicity was hand-foot syndrome (all grades: 54%; grade 3: 7%). Myelosuppression and alopecia were substantially less common with capecitabine monotherapy than with capecitabine combination regimens. CONCLUSIONS: Capecitabine, alone or in combination, is a feasible, effective treatment for breast cancer. Our findings in real-life clinical practice compare favorably with results from interventional studies, perhaps reflecting the longer treatment duration possible at more tolerable doses.

Fertility Preservation for Patients with Malignant Disease. Guideline of the DGGG, DGU and DGRM (S2k-Level, AWMF Registry No. 015/082, November 2017) - Recommendations and Statements for Girls and Women.

AIM: The aim of this official guideline published by the German Society of Gynecology and Obstetrics (DGGG) and coordinated with the German Society of Urology (DGU) and the German Society of Reproductive Medicine (DGRM) is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age. Statements and recommendations for girls and women are presented below. Statements or recommendations for boys and men are not the focus of this guideline. METHODS: This S2k guideline was developed at the suggestion of the guideline commission of the DGGG, DGU and DGRM and represents the structured consensus of representative members from various professional associations (n = 40). RECOMMENDATIONS: The guideline provides recommendations on counseling and fertility preservation for women and girls which take account of the patient's personal circumstances, the planned oncologic therapy and the individual risk profile as well as the preferred approach for selected tumor entities.

Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer.

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.

Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 1 with Recommendations for the Screening, Diagnosis and Therapy of Breast Cancer.

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.

Fears and Concerns of Patients with Uterine Fibroids - a Survey of 807 Women.

STUDY QUESTIONS: What specific fears and concerns do patients with uterine fibroids have? How are these influenced by sociodemographic factors, duration of condition and level of knowledge among these women? METHODS: Between January 2016 and January 2017 807 patients were consecutively surveyed at a university hospital speciality fibroid clinic using a two page locally developed and validated questionnaire focusing on fibroid-associated fears and concerns. RESULTS: The questionnaire was completed by 730 women (90.5%) the majority of whom reported fears/concerns mainly with regards to treatment (need to treat/side-effects/hysterectomy) and the fibroids themselves (increasing size and number). Various parameters influenced the type and severity of fears: Young patients (< 40 years) had concerns particularly with regard to pregnancy/birthing while older patients (> 40 years) were more concerned about general health and significant blood loss. Time interval since diagnosis also affected fears with different concerns between patients with shorter duration of diagnosis (< 12 months) vs. longer duration (> 12 months). Overall only slight differences could be attributed to immigrant background. Higher level of education correlated with less anxiety. Proper information about fibroids relieved fears of malignant change in particular. Doctors and the internet were the most important sources of patient information. CONCLUSIONS: Due to the benign nature of uterine fibroids and their good treatability, fibroid-associated fears are generally unfounded. Precise knowledge of patient fears and concerns should be integrated into clinical care with targeted psychological support to help patients better understand their condition.

Myoma-associated pain frequency and intensity: a retrospective evaluation of 1548 myoma patients.

OBJECTIVE: To analyze the possible relation between symptoms (especially pain) reported by myoma patients and objective features of their myomas as determined by ultrasound. Specifically: (1) What is the frequency and intensity of myoma-related pain? (2) Does the pain intensity depend on the number, size, or location of the myomas? (3) Is there any correlation between premenstrual pain, menstrual pain, and pain during sexual intercourse? STUDY DESIGN: A retrospective analysis of data from a patient questionnaire and ultrasound exams, collected from February 2009 until January 2013 at the myoma clinic of a university hospital in a large European city. The study analyzed data from 1548 myoma patients. Patients completed a 0-10 Likert scale questionnaire about their symptoms. The number, size, and location of myomas were determined from ultrasound exams. RESULTS: The three most frequent symptoms reported were hypermenorrhea, dysmenorrhea, and premenstrual pain. There was no statistically significant relationship between premenstrual pain or pain during sexual intercourse on the one hand and the number, size, or location of myomas on the other hand. For women with severe dysmenorrhea (Likert-scale scores of 8-10), submucosal myomas were significantly more frequent than all other myoma locations (p=0.01). Severe dysmenorrhea (Likert-scale scores of 8-10) was reported by a significantly (p<0.001) greater portion of the women whose largest myoma had a largest diameter of <5cm than by the women whose largest myoma had a diameter ≥5cm. The number of myomas did not have a significant influence on the dysmenorrhea intensity. The three types of pain (premenstrual, menstrual, and/or during sexual intercourse) had moderate pairwise correlations (ρ values from 0.304 to 0.542) that were all statistically highly significant (p<0.001). CONCLUSION: Myoma-associated pain is, alongside hypermenorrhea, the most frequent problem reported by the affected patients. Unlike premenstrual pain and pain during sexual intercourse, the intensity of menstrual pain is clearly dependent on the location and size of the largest myoma. Further research is needed to better understand the degree to which the pain reported by the patients is due to features of the myomas versus other possible factors.

The St. Gallen surrogate classification for breast cancer subtypes successfully predicts tumor presenting features, nodal involvement, recurrence patterns and disease free survival.

AIMS: To evaluate how the St. Gallen intrinsic subtype classification for breast cancer surrogates predicts disease features, recurrence patterns and disease free survival. MATERIALS AND METHODS: Subtypes were classified by immunohistochemical staining according to St. Gallen subtypes classification in a 5-tyre system: luminal A, luminal B HER2-neu negative, luminal B HER2-neu positive, HER2-neu non luminal or basal-like. Data were obtained from the records of patients with invasive breast cancer treated at our institution. Recurrence data and site of first recurrence were recorded. The chi(2) test, analysis of variance, and multivariate logistic regression analysis were used to determine associations between surrogates and clinicopathologic variables. RESULTS: A total of 2.984 tumors were classifiable into surrogate subtypes. Significant differences in age, tumor size, nodal involvement, nuclear grade, multicentric/multifocal disease (MF/MC), lymphovascular invasion, and extensive intraductal component (EIC) were observed among surrogates (p < 0.0001). After adjusting for confounding factors surrogates remained predictive of nodal involvement (luminal B HER2-neu pos. OR = 1.49 p = 0.009, non-luminal HER2-neu pos. OR = 1.61 p = 0.015 and basal-like OR = 0.60, p = 0.002) while HER2-neu positivity remained predictive of EIC (OR = 3.10, p < 0.0001) and MF/MC (OR = 1.45, p = 0.02). Recurrence rates differed among the surrogates and were time-dependent (p = 0.001) and site-specific (p < 0.0001). CONCLUSION: The St. Gallen 5-tyre surrogate classification for breast cancer subtypes accurately predicts breast cancer presenting features (with emphasis on prediction of nodal involvement), recurrence patterns and disease free survival.

Emotional impact and acceptability of medical abortion with mifepristone: a German experience.

In Germany, four years of experience with mifepristone as an alternative procedure to surgical abortion have revealed a still reluctant use of the new method. In the public discussion, the more participatory role of the women in the abortion procedure is often feared to have negative consequences for the emotional processing of the event. This study compares the women's criteria for selecting a method and the psychological responses before and four weeks after medical or surgical abortion. Two hundred and nineteen women answered questions regarding demographic data, motivation, medical details and social support. Additionally, the women completed the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). There were no differences regarding sociodemographic and reproductive characteristics among both groups. Comparing data before and a month after the abortion, our study showed a significant decline of both anxiety and depression for both abortion methods. The medical group had significantly lower entrance levels of anxiety than the surgical group. The medical regimen caused significantly more sequelae such as prolonged bleeding, pain and other side effects. However, this did not have a negative influence on the coping process. A vast majority of women in both groups evaluated choosing between different abortion methods as being highly important to them. Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.

ISPOG European Consensus Statement - chronic pelvic pain in women (short version).

To date there is no international guideline on chronic pelvic pain available that focuses on medical, psychosomatic and psychological diagnostics and treatment of this complicated disease pattern. In this paper, a European working group, which was established in October 2010, aims to bridge this gap. The working group decided to use the current German guideline as source text and to transform it into a European consensus statement by deleting parts that apply only to the conditions of the German health system. The literature search included papers published up to and including December 2010, using Medline search and by adding some new search terms. This manuscript reports the essential facts of the above-mentioned consensus statement. Within this article we use the term "psychosomatic" as the integrated concept of medical and psychosocial aspects of a disease.

The desire for children and fertility issues among young German cancer survivors.

PURPOSE: For young cancer patients, family planning is not always completed at the time of cancer diagnosis. This study investigated young cancer patients' desire to have children, its intensity, and their discussion with oncologists and fertility specialists about fertility. Furthermore, gender differences, differences between childless patients and patients with children, and correlations with psychological distress were analyzed. METHODS: A total of 149 cancer patients (range, 18-45 years of age) answered a self-developed questionnaire. Psychological distress was measured with the Patient Health Questionnaire. RESULTS: Seventy-four percent of patients had a desire to have children at the time of diagnosis. Whereas the intensity of the desire for children increased pre- to post-treatment in childless patients, it decreased in patients who already had children. A total of 55 patients who wanted a child (50%) needed supportive care concerning this issue; 60% of the total sample had discussed fertility aspects with their oncologists and 20% with fertility specialists. Patients reported higher levels of satisfaction with their discussions with fertility specialists than with their discussions with oncologists. Men (56%) underwent fertility preservation more often than did women (31%). Female sex was the only variable predicting psychological distress, whereas parenthood, fertility preservation, and desire for children had no significant impact. CONCLUSIONS: The desire to have children and the fertility issues involved are important for young cancer patients. Reasons for not discussing fertility aspects with oncologists and the cause of low referral rates to fertility specialists should be explored in future studies. The implementation of structured psychosocial supportive care might address the needs of highly fertility-distressed patients.

Do immigration and acculturation have an impact on hyperemesis gravidarum? Results of a study in Berlin/Germany.

QUESTION: How large is the number of immigrant women being treated for hyperemesis gravidarum (HG) among the in-patients in a University hospital in Germany? Does migration have an impact on the psychosocial state of HG patients? Does acculturation have an impact on psychosocial distress in HG patients? METHODS: The following methods were used: retrospective evaluation of all in-patients with HG from 1/1997 to 11/2009, inquiry of a consecutively surveyed group (from 2007 to 2009) of HG in-patients with a questionnaire set: socio-demographic data, questionnaire on psychic distress (SCL-90-R) questionnaire on migration/acculturation, and comparison of German patients and patients with immigration backgrounds as well as among immigrant groups. RESULTS: During the 13-year study period, there were 4.5 times more immigrants treated for HG than native German patients. Compared to the age standardized resident population, the number of women with immigration backgrounds is over-proportionally high. The HG patients scored high in the SCL-90-R scale "somatization" without showing a higher level of psychic distress than the native patients. CONCLUSIONS: Experience of migration is an etiological cofactor for HG. The grade of acculturation does not have a significant influence on the psychic well-being of HG patients.

Attitudes toward mode of hysterectomy: a survey-based study among German gynecologists.

OBJECTIVE: To determine the attitudes of Germany's gynecologists to mode of hysterectomy (HE) for benign indications. STUDY DESIGN: In this cross-sectional study a postal questionnaire was sent to all members of the North-Eastern German Society of Gynecological Oncology (NOGGO) and the German Society of Psychosomatic Obstetrics and Gynecology (DGPFG). Questions examined attitudes to mode of HE based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of HE for benign conditions should be. Analyses were performed with multiple logistic regression, chi-square tests and univariate nonparametric ANOVA. The main outcome measure was the analysis of current attitudes toward three well-defined settings regarding HE amongst German gynecologists. RESULTS: The response rate was 27%, giving a sample size of 354, and 36% (n=128) of the gynecologists performed HE as part of their daily work. In this subgroup the following results were statistically significant. (1) Female gynecologists chose total vaginal hysterectomy (TVH) more often than male gynecologists. (2) With increasing professional experience of the female gynecologists the choice of TVH grew. (3) Gynecologists in private practice preferred laparoscopic-assisted vaginal hysterectomy (LAVH) compared to gynecologists in hospital. Personal choice of mode of HE varied significantly depending on the gender and place of work. CONCLUSIONS: The preferred mode of HE varied significantly depending on gynecologist's gender, type of clinical setting and professional experience.

A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks.

PURPOSE: This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women. METHODS: All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later. RESULTS: More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery. CONCLUSIONS: Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother-child interactions.

Experiences with a specific screening instrument to identify psychosocial support needs in breast cancer patients.

OBJECTIVE: In order to determine the need for professional psychosocial support in breast cancer patients, we used the physician-administered Basic Documentation for Psycho-Oncology (PO-Bado), which is an expert rating scale containing 12 items belonging to somatic and psychological problems. Furthermore, we investigated sociodemographic and medical predictors of somatic and psychological distress and need for psychosocial support. STUDY DESIGN: From 2/2005 to 09/2007, n=333 consecutive patients with breast cancer were included in the study. The majority of the patients suffered from early-stage breast cancer. The mean age of the participants was 59.9 years (SD=12.6, range 24-92). Two physicians rated patients' psychosocial distress and evaluated their need for psychosocial support according to the PO-Bado guidelines. RESULTS: Exhaustion/tiredness was the item rated highest in the physical distress dimension. In the psychological distress dimension, the items anxiety/worries/tension and grief/despondency/depression obtained the highest mean. Younger age and a history of psychiatric/psychotherapeutic treatment in the past were associated with higher current distress. Women who planned to undergo mastectomy were rated as showing more somatic distress than women for whom breast conserving therapy was planned, but the two groups did not differ with regard to psychological distress. Objective cancer-related variables (tumour size and grading) were not associated with distress. Need for professional psychosocial support was seen in 23% of the patients. Previous psychiatric/psychotherapeutic treatment was the only variable associated with current need for psychosocial support. Forty-six percent of the patients with need for psychosocial support accepted the counselling offered. CONCLUSIONS: The structured assessment of breast cancer patients' psychosocial distress with the interviewer-administered PO-Bado assists the physician to arrive at a detailed expert evaluation. This might help to improve the psychosocial care of breast cancer patients.

Neuroendocrine circuitry and endometriosis: progesterone derivative dampens corticotropin-releasing hormone-induced inflammation by peritoneal cells in vitro.

Clinical symptoms of endometriosis, such as pain and infertility, can be described as persistent stressors. Such continuous exposure to stress may severely affect the equilibrium and bidirectional communication of the endocrine and immune system, hereby further aggravating the progression of endometriosis. In the present study, we aimed to tease apart mediators that are involved in the stress response as well as in the progression of endometriosis. Women undergoing diagnostic laparoscopy due to infertility were recruited (n = 69). Within this cohort, early stage of endometriosis were diagnosed in n = 30 and advanced stage of endometriosis in n = 8. Levels of progesterone in serum were determined. Frequency of progesterone receptor (PR) expression on CD56(+) and CD8(+) peritoneal lymphocytes was analysed by flow cytometry. The production of tumour necrosis factor (TNF) and interleukin (IL)-10 by peritoneal leukocytes upon stimulation with the potent stress mediator corticotropin-releasing hormone (CRH) and the progesterone derivative dydrogesterone, or both, were evaluated. Furthermore, the production of progesterone-induced blocking factor (PIBF) by peritoneal leukocytes and the expression of PR in endometriotic tissue were investigated. Levels of progesterone in serum were decreased in women with endometriosis and inversely correlated to pain scores. Furthermore, an increased frequency of CD56(+)PR(+) and CD8(+)PR(+) peritoneal lymphocytes was present in advanced endometriosis. The TNF/IL-10 ratio, reflecting cytokine secretion by peritoneal cells, was higher in cells derived from endometriosis patients and could be further heightened by CRH stimulation, whereas stimulation with dydrogesterone abrogated the CRH-mediated inflammation. Finally, the expression of PIBF by peritoneal leukocytes was increased in endometriosis. Low levels of progesterone in the follicular phase could be responsible for the progression of endometriosis and related pain. Peripheral CRH, increasing upon high psychological stress, might contribute to the peritoneal inflammation present in endometriosis. The therapeutic application of progesterone derivatives, CRH blocking agents as well as improvement of stress coping may disrupt the vicious circle between the chronic peritoneal inflammation and high perception of psychological stress in endometriosis.

Immune status, psychosocial distress and reduced quality of life in infertile patients with endometriosis.

PROBLEM: The aim of the study was to identify if (i) psychosocial factors differ in endometriosis; (ii) related psychosocial aspects alter immune markers of depression/sickness behaviour; and (iii) serum immune marker may be indicative for endometriosis. METHOD OF STUDY: We enrolled 103 women in a case-control study. Psychosocial data were obtained, serum levels of interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, interferon (IFN)-gamma, TNF-alpha, IFN-alpha and soluble intercellular adhesion molecule-1 (sICAM-1) were analysed. RESULTS: Among 69 eligible patients, endometriosis was diagnosed in 38 women. Patients with endometriosis reported reduced quality of life, increased stress perception/depressive symptoms; the Th1/Th2 ratio was in favour of Th1, accompanied by the increased levels of IFN-alpha. sICAM-1 levels were unaffected. No correlation could be confirmed between psychosocial and immune markers. CONCLUSION: Women with endometriosis may benefit from strategies contributing to reduction of stress and development of coping mechanisms, thus helping to break the vicious circle of inflammation, sickness behaviour and depression.