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Phase I dose escalation study with the Lewis Y carbohydrate specific humanized antibody IGN311
(2011)
Hintergrund: An zwei Standorten wurden die palliativen Versorgungsstrukturen, sektorenübergreifenden Übergänge und Verlaufswege von Patienten mit einem palliativen Versorgungsbedarf untersucht. Der systematische Vergleich von Gemeinsamkeiten und Unterschieden anhand der exemplarischen Fokussierung auf den Themenkomplex „Schmerz“ soll Auskunft darüber geben, inwiefern diese mit standortspezifischen Palliativversorgungskonzepten (integriert und kooperativ)
zusammenhängen.
Methodik: Die Studie verfolgt ein Mixed-methods-Design. Neben einer Dokumentenanalyse von anonymisierten Patientenakten (n= 774) wurden Experteninterviews (n= 20), Interviews mit Patienten und Angehörigen (n= 60) sowie Fokusgruppen (n= 12) durchgeführt.
Ergebnisse: Die systematische vergleichende Analyse liefert Hinweise auf konzeptunabhängige Gemeinsamkeiten (z. B. soziodemografische Verteilungen, erschwerte medikamentöse Schmerzbehandlung aufgrund rechtlicher Rahmenbedingungen) wie auch konzeptabhängige Unterschiede (z. B. Verlaufswege, erleichterte kontinuierliche Symptomkontrolle durch integrierte Versorgungsstrukturen) im Rahmen integrierter oder kooperativer Palliativversorgung.
Diskussion: Gemeinsamkeiten und Unterschiede hinsichtlich der hier fokussierten Schmerzthematik bzw. der im Raum stehenden Symptomlast und ihre organisatorische Bearbeitung werden als Effekte der jeweiligen Organisationsstruktur (= konzeptabgängig) sowie konzeptunabhängiger äußerer Einflussfaktoren greifbar.
Background and study aims Bowel obstruction is a common complication in advanced cancer patients. Patients are restricted in quality of life (QOL) due to nausea, vomiting, or abdominal pain. Prospective data on the feasibility and benefit of decompressive percutaneous endoscopic gastrostomy (dPEG) are scarce.
Patients and methods Patients suffering from symptomatic bowel obstruction due to advanced cancer were included prospectively in a single-center study when other treatments to eliminate the obstruction were impossible. Patients were given a questionnaire the day before dPEG (d-1) and, if the procedure was successful, the day after (d+1) and 14 days after the procedure (d14). Furthermore, lifetime after dPEG was assessed.
Results 53 patients were included. dPEG was technically feasible in 34 of 53 (64.2%). Significant improvement could be shown for nausea and vomiting when comparing d-1 to d+1 (nausea (P = 0.002), vomiting (P < 0.001)) and when comparing d-1 to d14 (P = 0.021 and P = 0.003, respectively). Comparing d+1 to d14, there was no further improvement. QOL improved significantly from 8.1 (mean) on d-1 to 5.9 (mean) on d+1 (P < 0.001). Median survival after successful dPEG was 27 days (range 2–353).
Conclusions dPEG is an effective method for quickly relieve symptoms of malignant bowel obstruction in advanced cancer patients. However, the technical success rate is limited and needs to be improved. Prospective studies comparing endoscopic and computed tomography-guided procedures are needed to avoid unsuccessful procedures in patients with advanced cancer and limited life expectancy.
Aim of the study: The "WAVES" study (Widening Aims and giving patients a Voice for Expanded Structures in breast cancer care developed jointly by patients and physicians) aims to illuminate current breast cancer care structures with special focus on physician-patient-communication.
Methods: The study is conducted within and funded by the BZKF (Bavarian Center for Cancer Research). Here, we present the results of the first preplanned analysis of the survey designed together with patients and patient advocates with the aim of adequately reflecting patients concerns. It is based on the evaluation of the first 1.000 patients who participated between 05/2022 and 08/2023, focusing on the duration of the first diagnosis consultation.
Results: The participants were between 23 and 89 years old (mean: 59.18 years). There was a significant association between longer initial consultation duration and higher patient satisfaction (p < 0.001). When the first consultation lasted 30 minutes or more, patients stated more frequently that they felt better informed (p < 0.001) and had fully or substantially understood the content (p < 0.001).
Conclusion: These results demonstrate a significantly higher satisfaction and better preparation of patients with initial breast cancer diagnosis if physicians’ communication lasted 30 minutes or more. Therefore the WAVES study clearly demonstrates the need for improved communication structures in terms of an appropriate time frame for breast cancer patients, which is not reflected in the current reimbursement structures.
